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Representations of 'personality disorder'
Kirsten Stalker, University of Stirling
Personality disorder is a contested concept. This paper will present some findings from a 12 month study, carried out in Glasgow by a team from Stirling University, which explored the views of service users and providers about personality disorder. We will begin by briefly outlining different approaches to the understanding of personality disorder - from psychiatric, behavioural and 'trauma' perspectives, as well as the emerging model of social model of madness and distress. The aims and methods of the study will be outlined. In-depth interviews were carried out with 10 people with a label of personality disorder, and 12 service providers. Participants were later invited to take part in a respondent validation meeting.
The study identified a range of perspectives among mental health service providers about the nature of 'personality disorder' and the usefulness of the diagnosis. There was however, agreement that using the term in a catch-all, pejorative sense was not acceptable. Most service users had been given limited information about their diagnosis, indeed some had only discovered it by accident, and few liked it. A majority of users and providers believed that adverse childhood events, usually abuse, were the major cause of people's difficulties. People with personality disorder diagnoses were generally seen as experiencing distress rather than illness, leading to problems coping with everyday life. The study also highlighted the impact of social and material conditions - users reported feelings of stigma, social isolation and discrimination, and most faced poverty, unemployment, homelessness or domestic violence. Although personality disorder is said to be a static and untreatable condition, some users had 'good and bad days' and all had developed a range of non-medicalised coping strategies, some of which, they acknowledged, were more helpful than others. Finally, the implications for a social model of madness and distress will be highlighted.
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