DEPARTMENT OF PSYCHOLOGY

COURSEWORK ESSAY COVER SHEET

YEAR 2 - TERM 2 2007 2008
PS2050 PERSONALITY AND INDIVIDUAL DIFFERENCES
Course Coordinator: Professor Michael Eysenck
A 2,000 word essay with a 5% excess leeway (2,100 words maximum), excluding references, is required
on:
Describe the difficulties in treating personality disorder.
(25% of examination)
DEADLINE FOR SUBMISSION:
NO LATER THAN 5PM MONDAY 4th FEBRUARY 2008
REQUIREMENTS

* Please submit electronically via the departmental web based submission link
* To assist with blind-marking please put your STUDENT NO. on the front page of your essay.
* Please use a word processor, double-spacing with a minimum font size of 12 point.
* Please retain an electronic copy of this essay because plagiarism checks may be made.
Deadlines for submission must be strictly adhered to. Penalties for late submission:
1.
For work submitted up to 24 hours late, the mark will be reduced by ten percentage marks, subject
to a minimum
mark of a minimum Pass.
2.
For work submitted more than 24 hours late, the maximum mark will be zero.
Any student not achieving at least a pass mark for the coursework will not pass the course overall.
Extensions will only be granted in exceptional circumstances, i.e. serious illness, bereavement, family crisis or
involvement in a road accident. Requests must be made to the Course Coordinator, in writing, accompanied by a
medical certificate or other supporting evidence, at least five working days before the deadline, using the Request
for Coursework Extension form obtainable from Angela Day, Departmental Administrator, Wolfson 217.
Retrospective extensions will not be granted.

Hemis Number 100 53 22 38. Word Count 1901.

Plagiarism Declaration
Plagiarism consists of a person presenting another persons ideas, findings or work as their own by copying or
reproducing the work without due acknowledgement of the source. The University regards plagiarism as a very
serious offence. At the very least, it is a misuse of academic conventions or the result of poor referencing practice.
Where it is deliberate and systematic, plagiarism is cheating.
By completing this declaration, you are confirming in written form that the work you are submitting is original and
does not contain any plagiarised material.
When plagiarism is suspected in any work, it will be scrutinized further in line with college policy. Furthermore, to
assist with plagiarism detection the Department is implementing random checks of all coursework. We will request
electronic copies of essays (in either e-mail attachment or disk form) from 10% of all coursework submissions,
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you must do this within 7 days of receiving the request.

I confirm that this assignment is my own work and that the work of other persons has
been fully acknowledged.

V YES
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A COMPLETED COPY OF THIS SHEET MUST BE SUBMITTED WITH YOUR ESSAY.

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What are the Difficulties in treating personality disorders?

Personality Disorder is a class of mental disorders characterized by rigid and longstanding patterns of behaviour and inner experience which deviate from the
expectations of ones culture and cause serious personal and social difficulties as well
as general impairment of functioning. They are defined by the APA (American
Psychiatric Association) as "an enduring pattern of inner experience and behavior
that deviates markedly from the expectations of the culture of the individual who
exhibits it, is pervasive and inflexible, has an onset in adolescence or early
adulthood, is stable over time and leads to distress or impairment". The DSM- IV
lists ten personality disorders, grouped into three clusters. Cluster A contains the odd
or eccentric disorders which are paranoid personality disorder, schizoid personality
disorder and schizotypical personality disorder. Cluster B contains the dramatic,
emotional or erratic disorders which include antisocial personality disorder, borderline
personality disorder, histrionic personality disorder and narcissistic personality
disorder and lastly Cluster C contains the anxious or fearful disorders which are
avoidant personality disorder, dependent personality disorder and obsessivecompulsive personality disorder. Personality disorders are considered almost
untreatable due to problems in both diagnosing and treating patients who suffer from
them and these difficulties will be analyzed in the following essay.

In order for any treatment to be successful the correct diagnosis needs to be made
before any action is taken and the current methods for diagnosing personality
disorders are often unreliable. Psychometric testing methods which are used for

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diagnosing personality disorders need to be sufficiently reliable and valid. Perry, J. C.
(1992) conducted a study testing the reliability and validity of structured interviews
and self-report questionnaires methods for the diagnosis of mental disorders. After
comparing the results of nine studies he concluded that these methods have high
internal and test-retest reliability but come up with diagnosis that are not scientifically
comparable across methods. Additionally, the yes/no format of most of those tests
may cause more problems in validity. Another factor that contributes to the
difficulties of diagnosing PD is co-morbidity, which refers to the presence of more
than one disorder at the same time. Amongst patients with personality disorders there
appears to be a very high percentage of co-morbidity with 85 % of PD patients having
at least two which also makes diagnosis a lot more difficult and complicated.
Moreover, the DSMs standard set of criteria for diagnosing mental disorders fails to
account for social or historical factors which usually play an important rule in ones
personality. Culture influences the appearance of personality traits within a society
and when dealing with personality disorders as defined by the APA historical and
social influences need to be taken into account in order for the correct diagnosis to be
made. Lastly, the lack of evidence considering the causes of personality traits, and
therefore disorders contributes to the difficulties of diagnosing and treating
personality disorders.

Apart from the issues that occur when trying to diagnose personality disorders treating
patients who suffer from them is often very challenging as it is believed that
personality disorders are almost untreatable. Initially, one of the main reasons for the
low success rates in treating personality disorders is that samples for patients who
suffer from them are very biased. People with personality disorders rarely seek help

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because they believe that their behaviour is normal and in some cases their extreme
personality traits such as being emotionally detached and having little remorse for
their misdeeds works in their favor in the corporate world. On the other hand, 85% of
criminals meet the criteria for antisocial and other personality disorders and most
studies on PD use prisons to select their samples. Subsequently, success rates in PD
treatments are very low as treatment to patients who are in prison is very difficult and
does not produce successful results mostly because of the prison environment that
does not allow a normal life. However, a study conducted by Nee., C & Farman., S
(2007) in three female prisons showed promising results for the treatment of
borderline personality disorder for people who are institutionalized with the use of
Dialectical Behaviour Therapy. Furthermore, even for patients who are not in prison,
treatments is not easy as in most cases they have difficulties maintaining a
relationship with their therapists. For example, patients with borderline personality
disorder who have a very unstable sense of self and appear to be very unstable in their
interpersonal relationships often skip sessions or even stop therapy altogether even
when treatments appears to be going fine. Furthermore, many patients with
personality disorders do not feel the need to change such as patients with narcissistic
personality disorder who have a very high perception of themselves and often neglect
rules as they believe they dont apply to them. Groves, J.E. (1978), published an
article called Taking care of the hateful patient in which he explained that patients
with personality disorders often evoke in their therapists dislike or even hatred. He
reported four types of such undesirable patients: the dependent clingers, the
entitled demanders, which are usually patients with narcissistic or borderline
personality disorder, the manipulative help rejectors, usually patients with
borderline or paranoid personality disorder and lastly the self-destructive deniers

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which are usually individuals with schizoid, schizotypical, borderline or histrionic
personality disorder.

Groves distinguishes patients with narcissistic personality

disorders as the worse as they very often insist that they are equal with the therapist in
knowledge and experience and generally believe that the therapist has nothing to offer
them. Therapists, psychologists, social workers and psychiatrists often report negative
feelings towards all four types of patients and while they usually try to ignore feelings
of dislike the repression of those feelings prevent effective treatments and patient
management which is another reason why personality disorders are so difficult to
treat.

There are a number of different treatments available for patients who suffer from
personality disorders. As with most mental disorders, medication is often prescribed
in order to treat the symptoms of the disorder such as anxiety, anger and depression.
Tyrer, P., & Bateman,. W., (2004) conducted an experiment in order to asses the
effectiveness of some per scripted drugs in the management of borderline personality
disorder and concluded that there is more evidence on the benefits of antidepressants
than anti-psychotic drugs and mood stabilizers although there is not a sufficient
enough distinction between the different personality disorders to recommend that any
one disorder should be treated by any one drug. Psychodynamic techniques are also
often used in PD treatment as medication alone does not treat the disorder. Their aim
is to help patients alter their view of childhood problems as which are believed by
psychotherapists to be the cause of disorders. The therapy helps the patients
understand the effects that their behaviour has on themselves and others as well as try
to identify the source of their maladaptive behaviour in order to alter it. Bannon, Perry
and Ianni (1995) conducted a study assessing the effectiveness of psychodynamic

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treatments for patients with borderline and other personality disorders and concluded
that 11.6% of the individuals offered psychodynamic treatment recover each year.
They also came up with a model estimating the recovery rate for each session and
found that individuals with PDs recovered at a rate of 0.191% per session. It is safe
to conclude that even though psychotherapy does not by any means guarantee
recovery for personality disorders, it facilitates the remission symptoms [and] not
only speeds up the natural healing process but also often provides additional coping
strategies and methods for dealing with future problems. Lambert, (1994).
Alternative therapies for treating personality disorders are also available based on
behavioural and cognitive approaches such as Dialectical Behaviour Treatment used
for patients with borderline personality disorder. Cognitive behavioural treatment
methods concentrate on the situation rather than the traits of the individual or his/her
childhood and the aim of the therapy is to alter the patients schemas by using various
methods such as systematic desensitization or by training their social skills. Patients
examine, with the guidance of their therapists, their usual pattern of thought and
attitude in order to identify and challenge the ideas and beliefs that cause them
problems. A study by Linehan et al. (1993) demonstrated the effectiveness of a form
of cognitive treatment called Dialectical Behaviour Therapy in treating borderline
personality disorder. This treatment offers both individual and groups therapy in order
to have maximum results and uses specific methods in order to create a stable
relationship between the therapist and the patient and avoid reinforcing self harm.
Leichsenring, F., & Leibing, E.,(2003) conducted a meta analysis of studies of
psychodynamic and cognitive behaviour therapy to address the effectiveness of the
two treatment methods and concluded that there is evidence that supports that both
psychodynamic and cognitive behavioral treatments can be effective treatments for

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personality disorder although their analysis was based on a limited amount of studies.
On the other hand, Tyrer et al, (2001) conducted a study assessing the effectiveness of
cognitive behaviour therapy in people with recurrent episodes of deliberate self harm
42% of which had personality disorders and the results were in general negative in
terms of efficacy compared with other treatments.

Overall, it is obvious that there are a lot of complications in treating personality

disorders. To begin with, there are a lot of problems in diagnosing personality
disorders since the lack of validity of psychometric tests, the fact that social and
historical factors are not taken into consideration when diagnosing, the lack of
evidence for the causes of PD and co-morbidity make diagnosing personality
disorders very complicated. Treating personality disorders is also very challenging
since PD patients are reluctant to change, have difficulty maintaining a relationship
with their therapists and are often disliked by their own therapists. Various studies
have demonstrated the effectiveness of different types of treatments for personality
disorders based on both psychodynamic and behavioural cognitive approaches and out
of all, Dialectical Behaviour Therapy has been proven to be the most effective for
borderline personality disorder. However, the success rates for treating personality
disorders remains very low and for most personality disorders the existing types of
treatments do not produce consistently good results. In my opinion, in order to have
successful results in treating patients with personality disorders more research needs
to be conducted to determine the causes of them. Knowing the cause of personality
disorders would facilitate both the identification and the treatment of those disorders
and it would also help in prescribing the right medication for the patients who need it.

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References:

Derksen, J., Maffei, C., & Groen, H., (1999). Treatment of Personality Disorders (1 st Edition). New
York: Springer.

Groves, J. E., (1978). Taking Care of the Hateful Patient. The New England Journal of Medicine
(1978). 289 : 883-887.

Maltby, J., Day, L., & Macaskill, A. (2007). Personality, individual differences and intelligence.
Harlow: Pearson Education.
Nee, C., & Farman., S., (2007). Dialectical Behaviour Therapy as a Treatment for Borderline
Personality Disorder in Prisons: Three Illustrative Case Studies. Journal of Forensic Psychiatry &
Psychology (2007). 18 : 160-180

Paris, J., (1996). A biopsychosocial approach to etiology and treatment (1st ed.).Cambridge:
Cambridge University Press.
Perry, J., C., Banon E., & Ianni F., (1999). Effectiveness of Psychotherapy for Personality Disorders.
The American Journal of Psychiatry (1999)

Tyrer, P., (2001). Personality Disorder. The British Journal of Psychiatry (2001) 179: 81-84

Tyrer, P. & Bateman, A.W., (2004). Drug Treatment for Personality Disorders. Advances in
Psychiatric Treatment (2004) 10: 389-398