Panel on controversies in the diagnosis and treatment of personality disorders

Abstract

Background: Personality disorders have a long history of controversy in diagnosis and treatment. Reformulating the understanding of the disorder and how therefore to provide treatment are areas of active debate in the field. Objectives: This panel will review and discuss a range of key controversies, including diagnosing and treating young people, what to do with challenging diagnoses such as narcissistic personality disorder, and the role of trauma. There will be discussion on developments in State-based models of care, and the engagement by Mental Health Commissioners to advocate for the needs of people with personality disorder to ensure services have a recovery focus and that peers with lived experience play a role. Methods: There is no consensus about how to understand the disordered personality, with views ranging from 'big 5 factor' statistical models of personality traits, to theories informed by developmental trauma, and existential phenomenology. Findings: Personality disorders have recently been reformulated in ICD-11 as a single disorder of self and relationship, with markers for severity and trait markers of negative affectivity, detachment, dissociality, disinhibition, anankastia, and the borderline pattern. ICD-11 have also introduced the diagnosis of complex PTSD which includes disturbances of self-organization symptoms defined as emotional dysregulation, interpersonal difficulties, and negative self-concept furthering the overlap with personality disorders. Conclusions: Key recent research findings and developments in practice at individual, State, Commonwealth, and international levels will be reviewed and debated as they relate to the future shape of psychiatric treatment for personality disorder.L6351889132021-06-10 <br />