Severe personality disorders. Treatment issues and selection for in-patient psychotherapy

Br J Psychiatry. 1996 Jun;168(6):723-31. doi: 10.1192/bjp.168.6.723.

Abstract

Background: Severe personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs.

Method: Relevant literature on the subject is summarised and integrated with the authors' specialist clinical experience.

Results: Many clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral.

Conclusions: General psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.

Publication types

  • Review

MeSH terms

  • Combined Modality Therapy
  • Dangerous Behavior
  • Diagnosis, Differential
  • Humans
  • Patient Admission*
  • Personality Assessment
  • Personality Disorders / diagnosis
  • Personality Disorders / psychology
  • Personality Disorders / therapy*
  • Physician-Patient Relations
  • Psychiatric Department, Hospital
  • Psychotherapy*
  • Psychotropic Drugs / therapeutic use
  • Specialization
  • Treatment Outcome

Substances

  • Psychotropic Drugs