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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
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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 

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