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Correspondence to O Kanter Bax [email protected]
What you need to know
Personality disorders are a set of complex emotional difficulties. They are common, often unrecognised, and are associated with mental and physical health comorbidities and reduced life expectancy
Personality disorders are perceived as stigmatising diagnoses. Alternative terms have been proposed. New classification systems help in moving away from rigid use of categorical diagnoses
Assessment and management in primary care require a non-judgmental approach that builds trust through attentiveness, validation, openness, and consistency
Holistic care for people with personality disorders can be improved with reflective practice structures, staff training, collaboration, and team working
Sources and selection criteria
We searched Pubmed, Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, AMED, British Nursing Index, HMIC, and Health Business Elite using the term “personality disorder”. Findings from randomised controlled trials (RCTs), systematic reviews, and meta-analyses were ranked as high in quality (see table 1) and we also used our own reference archives, books, and expert contacts to supplement the structured search.
Personality disorders describe a set of long standing complex emotional difficulties, which are common, highly stigmatised, and potentially disabling. They are frequently under-recognised and may run a long course when people lack access to appropriate treatment. Recent developments in evidence, guidelines, and policy have placed an emphasis on public awareness, de-stigmatisation, training professionals in generalist settings, improving access to specialist care, and improving physical health outcomes.12 This article provides an overview of the latest information on the assessment and management of personality disorders in primary care, with an emphasis on borderline personality disorder (also referred to as emotionally unstable personality disorder).
What are personality disorders?
Personality disorders are pervasive and enduring, affecting the emotional, cognitive, and behavioural functioning of a person, expressed in relation to their self (eg, identity, self-evaluation, affect regulation, direction) and others (eg, intimacy, boundaries, sense of security in relationships). People with personality disorders may face difficulties with social functioning at work, with family, and with social life and leisure, and such difficulties may represent a significant deviation from what is expected for the individual’s developmental stage and culture.3 No consensus exists on a single definition, research in the field is growing rapidly, and controversy surrounds the validity of existing conceptual frameworks.4