Diagnosis of personality disorders in learning disability

Abstract

BackgroundThough contentious, the diagnosis of personality disorders in persons with learning disability is clinically relevant because it affects many aspects of management.AimsTo examine published literature on the diagnosis of personality disorders in learning disability.MethodSelective review with computerised (Medline, Embase and PsychInfo) and manual literature searches.ResultsThe variation in the cooccurrence of personality disorder in learning disability, with prevalence ranging from less than 1% to 91% in a community setting and 22% to 92% in hospital settings, is very great and too large to be explained by real differences.ConclusionsThe diagnosis of personality disorders in learning disability is complex and difficult, particularly in those with severe disability Developing consensus diagnostic criteria, specific for various developmental levels, is one way forward. Such criteria may need to include objective proxy measures such as behavioural observations and informant accounts.

Validation of a Brief Screening Instrument for Emotionally Unstable and Dissocial Personality Disorder Characteristics in Community Service Users with Intellectual Disabilities

“…The result of 38.7% filling the criteria of at least one personality disorder is a little lower than the findings from a selected forensic ID sample [1], which also examined the PDCC. However, it is commensurate with Alexander and Cooray [2] and the 31% to 45% found in general outpatient settings [16]. The PIMRA is not commonly used in Norway.…”

“…They also advised that "the categories of schizoid, dependent and anxious/avoidant personality disorders [be] avoided" [9]. Both DC-LD and Alexander and Cooray (2003) [2] agree that the diagnosis of paranoid personality disorder in this population is difficult because of the significant cognitive limitations seen. This leaves us with disorders in the "dramatic" cluster B (DSM-IV), which consists of Dissocial, Emotionally Unstable with subvariants Borderline and Impulsive, and Narcissistic Personality disorders.…”

“…Diagnosis of such traits in this latter population, however, is not a simple matter. Alexander and Cooray (2003) [2], citing Tyrer, Casey and Ferguson (1993) [3], note that "the diagnosis of personality disorders is fraught with methodological, clinical and ethical controversies." This, they add, also pertains to persons with intellectual disabilities (ID).…”

Assessment of personality disorder

“…There may be particular problems in assessing personality disorder in people with intel lectual disability (Alexander 2003;Mason 2007) or severe mental illness (Tyrer 1983;Moran 2003).…”

The Assessment of Treatment‐Related Issues and Risk in Sex Offenders and Abusers with Intellectual Disability

“…Alexander & Cooray (2003), in their review of the field, comment on the lack of diagnostic instruments, the difference between classificatory systems (ICD-10 and DSM-IV), confusion of definition and personality theory and the difficulties of distinguishing personality disorder from other problems integral to ID eg. communication problems, sensory disorders and developmental delay.…”