Attend to interpersonal and interagency dynamics

mansIt should by now be apparent that working with individuals with PD can often be challenging, due to having to manage heightened emotional states and un-boundaried interpersonal behaviour. These presenting problems may cause high levels of stress and anxiety in the workforce. Following this, your emotional reaction to the cases you are working with (and the emotional reactions of other professionals) may be used as a valuable resource in identifying the possible presence of personality disorder. See chapter 5 for further information on staff wellbeing.

In later chapters it will become apparent that problematic developmental experiences may lead individuals with personality disorder to develop distorted and unstable beliefs about themselves and others. They may expect relationships to be characterised by themes of dominance and submission, with associated roles of bully, victim, abuser or saviour. These themes may emerge in the relationship with professionals, often leading to challenging interpersonal behaviour. This behaviour may in turn provoke unhelpful reactions in the staff group.

  • For example, individuals with PD may hold polarised and unstable views of self and others, which may lead to them presenting differently to different professionals. This may in turn trigger different views of the individual in the staff group, thereby encouraging disagreements or ‘splits’. If not carefully monitored, these splits can lead to the staff group becoming inconsistent, unstable, punitive or detached in their management of the case, ultimately reinforcing the offender’s negative expectations of others.

Thus a practitioner’s emotional reaction to individuals with PD (and the emotional reactions of other practitioners) may be used as a valuable indicator in identifying the possible presence of PD.

Possible emotional and behavioural reactions which might indicate the presence of PD

  • Staff are falling out
  • Agencies are falling out
  • You find yourself behaving unprofessionally
  • You feel drained after seeing the individual
  • You don’t want to see the individual
  • You get over involved in the case
  • You feel threatened in the individual’s presence.

Finally…are the 3P’s present?

Having considered all the sources above, it should now be possible to consider whether the individual presents with problematic, pervasive and persistent symptoms. Where these can be identified personality disorder is suggested.