Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

BACKGROUND
1) Openness (seeking out new experience , being curious, versus
being more consistent and cautious)
2) Conscientiousness (the extent to which someone shows selfdiscipline
and is dutiful, organized and plans in advance, versus
someone being more carefree or careless)
3) Extraversion (whether someone is outgoing and sociable and
seeks stimulation in the company of others, or whether they are
more solitary and reserved)
4) Agreeableness (whether someone is friendly and shows concern for
others, or whether they are more suspicious or antagonistic to others)
5) Neuroticism (whether someone tends to experience a range of
unpleasant emotions easily, such as anger, anxiety and
depression, or whether they are secure and confident).
An international group of experts have been working on a revision
of ICD10 that will lead to an up-dated system, ICD 11. They question
the usefulness and validity of ‘categories’ of personality disorder,
and propose a more dimensional model. In ICD11, personality
disorder is likely to be diagnosed by the severity of personality
problems, rather than whether they match a defined ‘category’
such as borderline or avoidant personality disorder. Apart from
normal personality, there are likely to be four graded levels,
‘personality difficulty’ which will not be coded as a mental health
disorder,‘mild personality disorder’,‘moderate personality disorder’,
and ‘severe personality disorder’. 3 In addition to establishing
degrees of severity, personality will be assessed in four domains:
Internalising/
emotional/neurotic
Externalising/
antagonistic/
sociopathic
Detached/schizoid
Anankastic
Anxious, poor self-esteem, shyness,
dependence on others
Irresponsible, lack of regard for the needs
of others, aggressive, deceitful
Aloof, indifferent, reduced expression of
emotion, suspicious
Over-conscientious, excessive orderliness,
perfectionism, inflexibility, cautiousness
This dimensional model fits with the idea that we all have
personalities that vary on roughly similar dimensions.
3) PSYCHOLOGICAL
FORMULATION BASED
APPROACH
Clinicians who provide therapy
to people with personality
difficulties and disorders
(this includes psychiatrists,
psychologists, psychotherapists
and counsellors) may use
diagnosis as a starting point,
but usually they also attempt
to develop a psychological
formulation that will guide the
psychological treatment.
A psychological formulation is
an attempt to describe and
explain a person’s problems in
terms of the range of factors
which contribute to the
development and maintenance
of the problems. Its purpose is
to guide interventions and risk
management strategies. Unlike
psychiatric diagnosis, it aims to
capture what is individual and
unique about the person.
There are a range of
psychological theories that can
be used to structure a
formulation, including learning
theory, information processing
theory, psychoanalytic theory
and attachment theory. Each
of these theories provides a
framework for organizing and
linking the information that we
have collected about a person
during the assessment process.
3 The exact names of these degrees of severity and domains may differ in the final document.
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