MHM Magazine

24 | MENTAL HEALTH MATTERS | Issue 1 | 2022 MHM the risk of developing or triggering personality disorders, including: • Family history of personality disorders or other mental illness • Abusive, unstable or chaotic family life during childhood • Being diagnosed with childhood conduct disorder • Variations in brain chemistry and structure RECOGNISING THE SIGNS Understanding whether you may be dealing with someone with a personality disorder can be complex and the following questions can help you think more deeply about this: • Does your patient have rapid mood changes that are reactive to external circumstances? Small negative events can make patients with PD feel suddenly bad. Equally small positive events can make them feel on top of the world. • How long do the moods last and can you trace the change to interpersonal events? The mood states are generally short-lived and responsive to others. • How long have the problems lasted? If they have persisted over more than two years, they may be part of the way in which the individual functions and part of their personality, rather than a depressive and anxiety disorder. • Does the problem occur in a wide variety of contexts? For example, at home, work or with their peer group? If so, this is indicative of PD. • Do they manage emotions, particularly anger and irritability and interpersonal sensitivity, with self-harm or the persistent use of drugs? MANAGEMENT ISSUES There can be a number of factors to consider when thinking about the management of people with personality disorders. Referral for further psychiatric and psychological support will be paramount to the treatment of this patient. They may make inappropriate demands and even be threatening at times. These behaviours must be discussed openly with them with strong emphasis on agreed boundaries about what you can and can’t offer. Working with them to develop a crisis plan and who to contact when they feel distressed or suicidal can be helpful in empowering them to follow through with their treatment. There are various psychological treatments that are effective in supporting people with personality disorders such as metallisation based techniques or dialectical behaviour therapy. While medication can play a role, usually in treating the comorbidities that accompany the disorder, therapy is vital in the treatment of the personality disorder itself. References available upon request visit our website www.ihpublishing.co.za