Kolt, Gregory S and Andersen, Mark B (2004) Personality disorders. In: Psychology in the physical and manual therapies. Churchill Livingstone, Edinburgh, pp. 321-332.

Abstract

This chapter serves as a primer for physical and manual therapists to help them recognize another class of psychopathologies, the Axis II disorders in the DSM-IV-TR (American Psychiatric Association 2000). Personality disorders are characterized by inflexible, long-lasting, and generally maladaptive patterns of thinking, feeling, perceiveng, and behaving that are often at odds with social norms and may cause some level of distress. Many people with personality disorders do not recognize (as is the case with many anxiety disorders) that there is a problem, and are resistant to referral to mental health practitioners. Personality disorders have been grouped into three clusters: those with strange or odd features (schizoid, schizotypal, paranoid), those with dramatic or fluxuating features (antisocial, borderline, histrionic, narcissistic), and those with anxiety-like features (avoidant, dependent, obsessive-compulsive). The disorders in this chapter were presented by cluster. These clusters, however, are primarily a convenience, and there is probably a lot of overlap between disorders with some people manifesting features of two or three disorders at the same time. Each section described the features of the personality disorder in general terms. Then there was a part of each section that contained descriptions of how a person with that personality disorder might behave in a physical or manual therapy setting. Each section then addressed the possibility of referral, and if referral was possible, how one might go about it. The chapter concluded with some comments about referral and a case example of a therapist working with a client with a borderline personality disorder who was reporting suicidal ideation. People with personality disorders make interesting clients, but are often challenging, frustrating, and demanding. Learning how to work with such people will have substantial benefits for both practitioners and the clients they serve.

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