• Personality Disorders are characterized by an enduring pattern of inner experience and behaviour that is seen to deviate markedly from the expectations of the individual's culture. These patterns can be manifested in significant instability in interpersonal relationships, difficulties with self-image, unstable mood, and problems with impulsive behaviour. There can be a pattern of rapid fluctuation from periods of confidence to despair, with fear of abandonment and rejection, and for some, a strong tendency towards suicidal thinking and self-harm. Transient psychotic symptoms may also be present. Personality Disorders are associated with substantial impairment of social, psychological and occupational functioning and quality of life. People with Borderline Personality Disorder are particularly at risk of suicide.

• The extent of the emotional and behavioural problems experienced by people with personality disorder varies considerably. Some people with personality disorder are able to sustain some relationships and occupational activities. People with more severe forms experience very high levels of emotional distress and have repeated crises which can involve self-harm, impulsivity and aggression. They also have high levels of co-morbidity with other mental health conditions and are frequent users of psychiatric and acute hospital emergency services.

Referral to Community Mental Health Teams (CMHT) should be made for those whose self-harming behaviours may result in serious disability or death.

• Diagnosis of Personality Disorder can be made by close examination of a person's overall clinical history and picture. Unlike other mental health problems, Personality Disorders do not respond well to psychiatric medication and are not recommended in NICE guidance, although the guidance does suggest treatment of co-morbid psychiatric problems.

• Many people with personality disorder are able to function well in the community without contact with Mental Health Services. This is particularly likely when the person has a network of social and other support including close links with a GP. These relationships will be most beneficial when there is a good understanding of the difficulties faced by those with personality disorder.

• However, when a person with an established or a suspected diagnosis of personality disorder attends primary care in crisis, they should be offered support to identify risks and develop or enhance coping strategies. When levels of distress are expressed non-verbally in repeated and severe self-harm or suicide attempts, referral to secondary care will need to be considered. Social functioning may be significantly impaired and the person may also present with frequent suicidal ideation, relationship difficulties and marked emotional instability.

Referral Criteria

• Anyone with a diagnosis of Personality Disorder or who has traits of Personality Disorder can be referred by their Community Mental Health Team (CMHT) into the Personality Disorder Service (PDS) for assessment, consultation or treatment.

• The Personality Disorder Service (PDS) is happy to provide telephone consultation and advice to GPs who wish to discuss a particular client, especially if they are considering referral to Community Mental Health Team (CMHT). The number to ring is listed below.

Referral Information

• Written referral letters should provide an overview of the client's history and include the reasons for the referral.

Referral Instructions

The team is based at:

Riverview

Mount Gould Hospital

Mount Gould Road

Plymouth

PL4 7QD

Tel: 01752 314579

GP Information

Livewell – Personality Disorder Service (PDS)

Royal College of Psychiatrists – Personality Disorder

Dialectical Behaviour Therapy

Patient Information

• If you have a diagnosis of Personality Disorder or have been told that you may have traits of Personality Disorder and you have a care co-ordinator or psychiatrist under a Plymouth Community Mental Health Team, you should talk to them about making a referral into our service.

• You can also contact the following organisations for support or advice:

The Zone, Plymouth

• The Zone's Icebreak team provides a service committed to supporting and empowering people aged 16- 22 years who are experiencing emotional distress and who live in Plymouth, Ivybridge or Tavistock.

• The Zone is located at 14-16 Union Street, Plymouth, PL1 2SR. Telephone: 01752 206626.

Emergence

• This is a service user-led organisation supporting all people affected by personality disorder including service users, carers, family and friends and professionals

MIND

• This organization provides advice and support to empower those experiencing a mental health problem. It campaigns to improve services, raise awareness and promote understanding.

Long-term Condition Self-Management Programme

GPs and patients can refer to Improving Lives Plymouth for patient support with any long-term physical or low level mental health condition. The service helps people to better manage their condition and to achieve a better quality of life.

Evidence

National Institute for Health and Clinical Excellence (NICE) Antisocial Personality Disorder Guideline 77.

National Institute for Health and Clinical Excellence (NICE) Borderline Personality Disorder Guideline 78.

Pathway Group

This guideline has been signed off by the Psychological Therapies Strategic and Implementation Group on behalf of NHS Devon.

Publication date: August 2016
Updated: October 2018