ABSTRACT

The concepts of personality and personality disorder are open to criticism. Nevertheless, both clinicians and researchers need some term to denote those more consistent features of a person's psychology that seem to be characteristic of them over time and that would be predicted to change only rather slowly if at all. The concept of disorder is used when these characteristics are notably maladaptive for the individual. However, the downside may be that having received a diagnosis of personality disorder, a person may tend to be viewed with lowered expectations of change and general pessimism with regard to outcome. The diagnosis may be misused as a term of abuse and as an excuse for neglect or therapeutic failure. Perhaps there is now a little more optimism than before, and a recent National Health Service document has emphasised the potential for change and for successful management and treatment of people with a diagnosis of personality disorder (National Institute for Mental Health in England, 2003). The diagnosis may remain useful as a description but should not be overemphasised as a prediction and certainly not as a reason for therapeutic nihilism.