Personality disorders

Personality disorder is a topic of increasing concern not only to mental health professionals but also to those in the wider medical community, social services and criminal justice agencies. Personality disorders are common conditions that place a significant burden on the individual sufferer, their carers, and wider society. Patients with personality disorder can be complex to manage and comorbid personality disorder can impact adversely on the treatment and prognosis of other disorders. Therapeutic advances and changing expectations of healthcare commissioners now challenge the previous reluctance of doctors to engage these patients in treatment, and new Department of Health policy emphasizes that service providers must address the needs of this patient population. Despite previous pessimism regarding the treatability of personality disorder, there is a growing body of literature supporting the efficacy of various treatment approaches. New treatment programmes aimed at reducing reoffending amongst those with severe personality disorder are also currently being evaluated in forensic settings nationwide. This article reviews the aspects of epidemiology, diagnosis, clinical presentation, assessment and management, both psychotherapeutic and pharmacological, that the practical doctor may find helpful.