Module 7 - Personality Disorders

Management Approaches to people with intellectual disability and

personality disorder

Personality disorders are one of the hardest groups of psychiatric disorders to treat because usually the personality traits are so deeply ingrained, disruptive and in many cases may not be recognised as a problem by the person. The person has to be highly motivated for treatment to be successful. For this reason, any management plan should not be expect that the personality disorder will be cured by treatment. Rather, a longitudinal approach should be taken which includes life-long learning and appropriate support to manage the difficulties, which includes education for both the person and their carers. People working with people with personality disorder should be aware that they and others may experience intense emotional reactions and there may be fierce disagreement about how to care for the person (this is referred to as ‘splitting’ in psychodynamic theory). It is often important to have time to discuss these and to reach an agreement to ensure that a coherent approach is employed. Abnormal interpersonal functioning is a core feature of personality disorder so it is to be expected that the relationship will be difficult. Angry outbursts and dependent or manipulative behaviour should be managed with firm limit setting. People with intellectual disability and personality disorder often need additional support to manage their personality disorder. This is particularly true for the implementation of psychological strategies where carers can remind and coax the person into trying to employ these at the appropriate times. Psychological therapies that are used include psychodynamic psychotherapy, cognitive behavioural therapy, dialectical behavioural therapy and supportive therapy.  The evidence for their effectiveness in this population is sparse and there are few clinicians experienced in the provision of any of these therapies in people with intellectual disabilities. Social, environmental and behavioural strategies are also important in improving quality of life, skills, coping mechanisms and in providing alternative positive opportunities. Medication is frequently prescribed but in reality has a limited role in the treatment of concurrent mental illnesses.
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