Rep36 Understanding Personality Disorder

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2.1 Psychological approaches to
personality disorder 
Key points:
I
Psychological perspectives on personality
disorder originate in psychodynamic,
behavioural, cognitive, and interpersonal
theories of psychopathology.
I
Although these approaches represent diverse
assumptions about personality, a common
theme is that memory systems relating to the
self and others are central to personality
disorder.
I
The development of these systems depends
on learning experiences in early relationships.
I
Biological factors also influence personality
development and may limit the extent to
which traits of personality disorder can change.
2.1.1 Overview 
Explanations of personality disorders have been
developed by psychiatrists and psychologists
working in clinical contexts. They attempt to
identify the important aspects of behaviour,
emotion or interpersonal relationships that
need to change. The links between academic
research into personality and the clinical work
of therapists are often very tenuous. For
example, treatment is rarely chosen in relation
to personality traits. There is also a gap between
the theories commonly used by therapists and
the diagnostic descriptions of personality
disorders based on traits (see Section 1.1).
Some clinicians, however, argue that an
understanding of personality traits is important
in therapy because (a) traits are relatively fixed
and there are limits to the possibilities for
change, and (b) helping a person to express
their personality traits in more effective ways is
an important goal of therapy (Beck 
et al
., 1990;
Livesley, 2001; Paris, 1998).
Psychological perspectives on personality
disorder reflect approaches developed earlier in
the treatment and understanding of other
psychological disorders by psychodynamic,
behavioural, and cognitive therapists. These
approaches make different assumptions about
the organisation of personality and theoretical
integration is currently unlikely. However, an
integrated approach in which components of
different treatments might be used flexibly for
different personality problems is described by
Livesley (2003). What follows is a brief overview
of the main psychological approaches guiding
current attempts to treat personality disorder.
Treatment applications are discussed in Section 3.2.