Lousia Ovington independent investigation report ... - NHS North East

CHAPTER 3 – OUTLINE OF MENTAL ILLNESS AND PERSONALITY DISORDER
Chapter 3 – Outline of mental illness and personality disorder
There are three main categories of mental disorder: mental illness, personality
disorders and learning difficulties. The disorders are defined and diagnosed, on the
basis of the existence of specific clusters of symptoms. However, symptoms and
signs of ill health are subjective: experienced, described and interpreted according
to the bias of the patient and / or the clinician. There are very few symptoms that
are pathognomonic of (i.e. relate just to) particular diagnoses: individual symptoms
are common to numerous disorders and thus it is the existence of particular clusters
and numbers of symptoms that is important. In addition, disorders evolve over time
both in terms of their natural history (for example, psychotic symptoms becoming
less pronounced in chronic schizophrenia) and in terms of the understanding of the
individual and their clinician as to what the person is experiencing. It is, therefore,
quite common for a person’s diagnostic “label” to change over time.
Diagnosis informs management. The natures of specific mental disorders are well
known and the risk factors, life histories, likely responses to treatment and prognoses
are therefore reasonably predictable. Mental illnesses, such as post traumatic stress
disorder, bipolar affective disorder and schizophrenia are easier to diagnose than
personality disorders: in lay terms, persons suffering from such conditions are more
clearly “mentally ill” than persons with personality disorders, because personality
characteristics are present in all people, whereas symptoms such as hallucinations and
delusions are not the norm.
An individual’s personality dictates their characteristic lifestyle and mode of relating
to themselves and others. These behaviour patterns tend to be deeply ingrained and
enduring. A person with a personality disorder shows extreme or significant deviations
from the way in which the average individual in a given culture perceives, thinks, feels
and, particularly, relates to others. The behaviour patterns tend to be stable and to
encompass multiple domains of behaviour and psychological functioning. They are
frequently, but not always, associated with various degrees of subjective distress and
problems of social performance. Personality disorders have historically been regarded
as innate and untreatable. They cannot be “cured” by treatment with medication.
It is only over recent years that specific psychological tests have been created to
formalise the diagnosis of the disorders and that effective psychological therapies such
as dialectical behaviour therapy and cognitive behaviour therapy have been developed.
Historically, there was a hierarchy of diagnoses within psychiatric practice. Within this
system, mental illnesses were regarded as more significant and worthy of investment
than personality disorders, in terms of provision of resources for management,
treatment and research. The diagnosis of personality disorder was effectively seen as
a diagnosis of exclusion: patients with such diagnoses were seen as untreatable and
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