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Personality disorders: Increasing awareness and raising hope

Personality disorders have been called the most misunderstood mental health condition. They have a legacy of confusion and controversy around diagnosis, language, what it means and how it impacts individuals, and even what they should be called.

Yet it is estimated that worldwide, around 8% of the general population report having complex emotional needs These figures rise to around 25% of people accessing primary care services and 50% accessing community mental health services will experience symptoms or behaviours related to the formally diagnosed.

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  1. About the campaign
  2. The importance of diagnosis
  3. Understanding personality disorders
  4. Further reading
  5. Resources

About the campaign

Now a team of people who have mental health and social difficulties commonly associated with the diagnosis of ‘personality disorder’, supported by Healthy London Partnership, launched on Wednesday 25th May 2022, to raise awareness of a condition which affects an estimated 10-13% of the population, but which can result in rejection and stigma, rather than support.

The campaign centres on a series of podcasts, devised, produced and led by those with lived experience, to increase awareness and understanding of the conditions, and raise hope regarding support and treatment options.

The importance of diagnosing personality disorders

Personality disorders can be difficult to diagnose, and in the past, there has been controversy as to how far treatment can help. Research and the voice of those who have accessed help have made it clear that mental health services can and should help people with personality disorders

Diagnosis can help make sense of the condition – both for the person and for their family and friends. But for others, it may result in feeling marginalised by health care services, family and community.

There is too often a lack of understanding of the various personality disorders, even among health professionals. There is a need for more training, better access to information and, for some, a mindset change when it comes to addressing the conditions.

The NHS Long Term Plan for Mental Health makes a renewed commitment to improve and widen access to care for children and adults needing mental health support. Crucially, this includes ensuring change is co-produced, from design to delivery – with people with lived experience.

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Understanding personality disorders

  1. What is a personality disorder?
  2. How many people are affected by personality disorders?
  3. What causes personality disorders?
  4. How are personality disorders diagnosed?
  5. How are personality disorders treated?
  6. Where can you get help for personality disorders?
  7. What is the NHS doing?

1. What is a personality disorder?

The Royal College of Psychiatrists defines a personality disorder as “an enduring condition which interferes with the sufferer’s sense of wellbeing and ability to function in full in ordinary social settings.”

There is disagreement about the term ‘personality disorders’, with some people finding it confusing or stigmatising. It can feel like being told that your personality is ‘wrong’. Some clinicians and people with lived experience prefer the term complex emotional needs or CEN.

Personality disorders are in fact a range of 10 different mental health conditions. However, some peopled find these classifications unhelpful, as most people with a personality disorder do not fit neatly into one category. According to the mental health charity Mind: “Some people believe the focus should instead be on what each person needs in order to deal with their problems and discover new ways of living, not what category they are in.”

Life can be difficult for people with a personality disorder as they can also develop other mental health problems such as depression and anxiety.

2. How many people are affected by personality disorders?

Estimates vary, but in the NHS’s latest Adult Psychiatric Morbidity Survey of England (2014) 13.7% of people aged 16 and over screened positive for a personality disorder, with similar rates in men and women.

3. What causes personality disorders?

It is not known exactly what causes them, but it is thought to be a combination of genetic factors and life events.

4. How are personality disorders diagnosed?

Personality disorders can be difficult to diagnose. To receive a diagnosis of personality disorder, somebody must meet some or all of a set of diagnostic criteria.

Diagnosis can help make sense of the condition – both for the person with the personality disorder, and for their family and friends. But for others, it may result in feeling marginalised by health care services, family, and their community.

5. How are personality disorders treated?

In the past there has been controversy as to how far treatment can help., Recent research however has made it clear that mental health services can and should help people with personality disorders. Many people with a personality disorder do recover over time. Psychological or medical treatment is often helpful, but support is sometimes all that is needed.

There’s no single approach that suits everyone and treatment should be tailored to the individual.

6. Where can you get help for personality disorders?

If you are concerned that you might have a personality disorder, there are a range of resources available online which will help you further understand the signs and symptoms of personality disorders. This piece from the Royal College of Psychiatrists is a good place to start but we’ve also compiled a short list of other useful resources at the bottom of the page.

When starting a conversation about a potential diagnosis, the first thing you should do is visit your GP.

7. What is the NHS doing to better help people with personality disorders?

The NHS is providing an increase in funding from 2022 to enable transformation of community mental health services. It will work with GPs, commissioners, local authorities and the voluntary, community and social enterprise sector, and, crucially, with service users, their families, and carers to create a new, flexible, model of community-based mental health care for people with personality disorder/complex emotional needs.

The new models will offer dedicated services, jointly created with people with lived experience of personality disorders. Services will aim to provide timely access to evidence-based psychological therapies, and provide care for co-existing needs, such as substance use. People with personality disorder/complex emotional needs have sometimes experienced punitive approaches from services. The new models of care focus on compassion and an understanding of the trauma that so many people have experienced.

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Further reading

To find out more about personality disorders – and to get help in supporting someone who is living with one – please take a look at the further reading below:

Rethink: London Borderline Personality Disorders Carers Group

A group for those who care for people living with borderline personality disorder or emotional unstable personality disorder, providing mutual support through discussions and  the opportunity to speak to our lived experience facilitator.

Rethink: Learn about personality disorders

This piece from mental health charity, Rethink, tells you what personality disorders are, what the symptoms are, and how you can get treatment. You might find it useful if you have a personality disorder yourself, or if you care for someone who does.

Centre for Mental Health: Dismissed on the basis of my diagnosis

A briefing paper by think tank, the Centre for Mental Health, running through the policy implications of the research conducted on community support for people with complex emotional needs.

Help Guide: Supporting someone with a personality disorder

A supportive piece by Help Guide, which is a great resource for anybody supporting someone who is living with a personality disorder. It provides tips and best practices to improve communication, set healthy boundaries, and stabilise your relationship.

Resources

Personality Disorder Programme Access Statement, June 2022

The Access, Delivery and Outcomes Task and Finish group preparing this statement was part of a larger Clinical reference Group originally set up by HLP in Nov 2020 to contribute to the Long-Term Plan aims to increase recognition and treatment of people with a Personality Disorder. The group includes Clinicians, Lived Experience Practitioners and Charities from the London area.

This document has been created to inform conversations between clinicians, commissioners, and leaders within organisations and systems such as Integrated Care Systems (ICS),  with the purpose of highlighting key considerations and priorities to shape improvements in access to care and support.

It has been created using the knowledge and experience of all the varied membership of the CRG to drive forward change that offers long term benefits to those who may attract or have a diagnosis of Complex Emotional Needs/ Personality Disorder.

  • the term ‘personality disorder’ is a necessary compromise that can still be stigmatising and limit the development and provision of adequate help for a broad and complex population.
  • Access this population involves an understanding of the basic emotional struggle with trust in relationships and engagement in this complex population
  • Clear, inclusive criteria for specific services and an open, flexible matrix of interventions aimed at engagement and coproduction of clients and their carers should coexist.
  • A consistent, ongoing practice of training and clinical reflection for clinicians and practitioners is necessary for rewarding integrated experience of smooth transitions in, between and out of care.

Read in full here

Carer’s information

The Carers Guidance was written by Jarka Hinksman and supported by the wider Clinical Reference Group and HLP. The guidance has a focus on Complex Emotional Needs carers however the principles outlines are relevant for all care givers.

The motivation for compiling this guidance is the experiences of carers of people living with Complex Emotional Needs (CEN) receive virtually no attention directed towards their particular characteristics, needs and requirements, despite mental health carers being increasingly recognised by healthcare services.

As such, this Guidance provides evidence-based reasons for them to be supported in their caring role so they can become confident and effective partners in care.

Read in full here

Standards for services for older adults

Colleagues in Dementia and OPMH Policy Team at NHS England & Improvement team have also produced standards for older adults. The prevalence and importance of complex emotional needs in older adults is now being increasingly recognised. The document provides recommendations on what needs to be considered when thinking about how these services will meet the needs of older adults.

In doing this, services will be addressing health inequalities, by ensuring that age-appropriate access to care and support is available to all.

Read in full here

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