Personality disorder: no longer a diagnosis of exclusion

Snowden, Peter; Kane, Eddie

doi:10.1192/pb.27.11.401

Cited by 44 publications

(17 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PD is no longer a diagnosis of exclusion [12], but research into comorbidity with PD remains immature. Addictive behaviors, including the broad gamut of alcohol use problems (hereafter labeled as alcoholism), have the advantage of a longer psychological lineage than is the case for PD, more highly developed specialist clinical services, and historically better research funding.…”

mentioning

confidence: 99%

Personality Disorder and Alcohol Use Disorder: An Overview

Newton‐Howes

Foulds

2018

Psychopathology

View full text Add to dashboard Cite

Background: Clinically, personality disorder (PD) commonly coexists with alcohol use disorder (AUD), although within mainstream mental health services both of these mental disorders are routinely overlooked. Despite a rich literature examining the interactions between AUD and personality functioning, personality traits, and PD, there remains conflicting evidence as to the degree of association and impact of one on the other. Methods: A narrative review and a synthesis of the literature were done. Results: The lifetime prevalence of AUD approaches 50% in some PD populations. The rates of PD in AUD populations are less clear but likely similar. Personality influences outcomes in AUD regardless of whether a categorical personality diagnosis or dimensional trait domain approach is taken. There are, however, no good data to inform clinicians on the impact of AUD on the outcomes of PD. Understanding the extent of this impact is complicated by the multiple tools used for diagnosis (of both PD and AUD) and the statistical methods used. Overall, caution is required in interpreting the data due to the quality of the current literature; however, comorbidity between the two disorders is likely significant and the impact of PD on AUD outcomes is sufficient to require consideration. Conclusions: From a research perspective, better agreement on both diagnoses and outcomes is urgently needed to improve the overall quality of the evidence. Clinically, despite the limitations in the literature, it is unacceptable for PD services to ignore AUD and for AUD services not to screen for PD. Both are likely to have an impact on health and functioning and should be considered in routine reviews. A better conceptualization of the putative mechanisms of this interaction, as well as an understanding of the neurobiology and reasons for the impact on treatment outcomes, will help to move the field forward.

show abstract

mentioning

confidence: 99%

Personality Disorder and Alcohol Use Disorder: An Overview

Newton‐Howes

Foulds

2018

Psychopathology

View full text Add to dashboard Cite

show abstract

“…It remains to be seen to what extent the NIMHE guidance will or can be taken up by primary care and other trusts, in the absence of secure funding streams. Some are optimistic that money earmarked for personality disorder will remain in the field of mental health (Snowden & Kane, 2003). There is clearly a long way to go.…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines for practice are likely to emerge with the development of new secondary-level services. They might apply, for example, to breaking the news to patients about their diagnosis, since there is evidence that this disclosure is avoided in a proportion (Snowden & Kane, 2003). Within these settings, assessments might also be standardised and treatments manualised to enable the generalisability of treatment methods.…”

Section: Evidence-based Treatment Guidelinesmentioning

confidence: 99%

Specialist personality disorder services in England: a case for managed clinical networks?

Norton¹,

Lousada

Healy

2005

Psychiatr. bull.

View full text Add to dashboard Cite

Following the publication by the National Institute for Mental Health in England (NIMHE) of Personality Disorder: No Longer A Diagnosis of Exclusion (National Institute for Mental Health in England, 2003), it is perhaps surprising that so soon after there have been threats to the survival of some of the small number of existing specialist personality disorder services to which it refers. Indeed, one of the few in-patient units specialising in such disorders (Webb House in Crewe) closed in July 2004. Such closures or threats argue for closer collaboration in planning between the relevant secondary and tertiary services and also between the Department of Health, the NIMHE and local National Health Service commissioners. Not safeguarding existing tertiary specialist services, at a time of increasing awareness of the needs of patients with personality disorders, may be short-sighted.

show abstract

“…In parallel with the development of the recovery framework, the last two decades have seen a growth in recognition of the importance of personality in psychiatric practice. This has ranged from analysis that argues for the centrality of personality pathology in the development of all psychopathology (Clark, ) to the creation and attendance to personality disorder as a distinct category of diagnosis (Snowden & Kane, ). Much is known about the relationship between personality and psychopathology; however, less is known about the relationship of personality to health as a state of physical, mental and social well‐being (Cloninger & Zohar, ).…”

Section: Recognizing the Importance Of Personality In Psychiatric Pramentioning

confidence: 99%