Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-22T07:49:38.646Z Has data issue: false hasContentIssue false
  • English
  • Français

Severe Personality Disorder

Treatment Issues and Selection for In-Patient Psychotherapy

Published online by Cambridge University Press:  02 January 2018

Kingsley Norton  and
R. D. Hinshelwood
Kingsley Norton*
Affiliation:
Henderson Hospital, Surrey
R. D. Hinshelwood
Affiliation:
The Riverside Mental Health Cassel Service, 1 Ham Common, Richmond, Surrey TW10 7JF
*
Dr K. Norton, Henderson Hospital, 2 Homeland Drive, Brighton Road, Sutton, Surrey SM2 5LT
Get access Rights & Permissions [Opens in a new window]

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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 168 , Issue 6 , June 1996 , pp. 723 - 731
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Casey, P. (1988) The epidemiology of personality disorder. In Personality Disorder: Diagnosis, Management and Care (ed. Tyrer, P.), pp. 74–81. London: Wright.Google Scholar
Department of Health (1992) The Health of the Nation: A Strategy for Health in England. London: HMSO (Cm 1985).Google Scholar
Dolan, B., Evans, C. & Norton, K. R. W. (1995) Multiple Axis-II diagnosis of personality disorder. British Journal of Psychiatry, 166, 107–112.Google Scholar
Greben, S. (1983) The multi-dimensional inpatient treatment of severe character disorders. Canadian Journal of Psychiatry, 28, 97–101.Google Scholar
Greene, L. R. & Johnson, D. R. (1987) Leadership and structuring of the large group. International Journal of Therapeutic Communities, 8, 99–108.Google Scholar
Healey, K. & Kennedy, R. (1993) Which families benefit from inpatient psychotherapeutic work at the Cassel Hospital? British Journal of Psychotherapy, 9, 394–404.CrossRefGoogle Scholar
Hinshelwood, R. (1988) Psychotherapy in an inpatient setting. Current Opinion in Psychiatry, 1, 304–308.CrossRefGoogle Scholar
James, O. (1986) The role of the nurse–therapist relationship in the therapeutic community. International Review of Psycho-Analysis, 11, 151–159.Google Scholar
Jones, M. (1952) Social Psychiatry. London: Tavistock.Google Scholar
Kernberg, O. F. (1984) Severe Personality Disorders: Psychotherapeutic Strategies. London: Yale University Press.Google Scholar
Knight, R. (1953) Management and psychotherapy of the borderline schizophrenic patient. Bulletin of the Menninger Clinic, 17, 139–150.Google ScholarPubMed
Main, T. (1957) The Ailment British Journal of Medical Psychology, 30, 129–145. Reprinted Main, T. (1989) The Ailment and other Psycho-Analytic Essays. London: Free Association Books.CrossRefGoogle ScholarPubMed
Main, T. (1983) The concept of the therapeutic community: its variations and vicissitudes. In The Evolution of Group Analysis (ed. Pines, M.). London: Routledge & Kegan Paul Reprinted: Main, T. (1989) The Ailment and other Psycho-Analytic Essays. London: Free Association Books.Google Scholar
Masterson, J. F. (1972) Treatment of the Borderline Adolescent: A Development Approach. New York: Wiley.Google Scholar
Miller, L. J. (1989) Inpatient management of borderline personality disorder, a review and update. Journal of Personality Disorders, 3, 122–134.Google Scholar
Norton, K. R. W. (1992a) Health of the Nation: The impact of personality disorder on ‘key areas’. Postgraduate Medical Journal, 68, 350–354.Google Scholar
Norton, K. R. W. (1992b) A culture of enquiry: its preservation or loss. International Journal of Therapeutic Communities, 13, 3–26.Google Scholar
Norton, K. R. W. & Smith, S. (1994) Problems with Patients: Managing Complicated Clinical Transactions. Cambridge: Cambridge University Press.Google Scholar
Norton, K. R. W. & Dolan, B. (1995a) Acting out and the institutional response. Journal of Forensic Psychiatry, 6, 317–332.Google Scholar
Norton, K. R. W. & Dolan, B. (1995b) Assessing change in personality disorder. Current Opinion in Psychiatry, 8, 371–375.CrossRefGoogle Scholar
Pines, M. (1978) Group analytic psychotherapy with borderline personality disorder. Group Analysis, 11, 115–126.Google Scholar
Powell, G., Caan, W. & Crowe, M. (1994) What events precede violent incidents in psychiatric hospitals? British Journal of Psychiatry, 165, 107–112.Google Scholar
Schwartz, D., Flinn, D. & Slawson, P. (1974) Treatment of the suicidal character. American Journal of Psychotherapy, 28, 194–207.Google Scholar
Stanton, A. H. & Schwartz, M. S. (1954) The Mental Hospital. New York: Basic Books.Google Scholar
Stein, G. (1992) Drug treatment of the personality disorders. British Journal of Psychiatry, 161, 167–184.Google Scholar
Stone, M. H. (1993) Long-term outcome in personality disorder. British Journal of Psychiatry, 162, 299–313.CrossRefGoogle Scholar
Tischler, L. (1986) Nurse/therapist supervision. In The Family as In-Patient (ed. Kennedy, R.), pp. 95–107. London: Free Association Books.Google Scholar
Tyrer, P. (1988) Personality Disorder, Diagnosis, Management and Care. London: Wright.Google Scholar
Whiteley, S. (1970) The response of psychopaths to a therapeutic community. British Journal of Psychiatry, 166, 517–529.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.