Personality disorders frequently arouse multiple reactions.
The diagnosis of a personality disorder, especially of some, often scares both patients and clinicians themselves, bringing with them a deception of conviction.
The definition of this condition, as we know, is that of a stable and pervasive pattern of inner experience and behavior that deflects from the norm, which creates clinically significant discomfort or social disdainment and arises in the early adulthood.
Until the fourth edition of the statistical manual of mental disorders (DSM-IV-TR, APA 2000) i Personality disorders have been divided into diagnostic categories. In the fifth edition of DSM (DSM-5, APA 2013), a classification (also criticized) based on dimensional concepts (as explained in this article) is inserted alongside the consolidated (but criticized) category diagnosis.
The debate has been and is still very heated, but the insertion of the possibility of formulating a dimensional diagnosis reflects the evolution of thought on mental health.
The biomedical model, in fact, which considers health as an absence of illness continues to imitate even in the field of mental health. Although the biopsicosocial model (Engel, 1977) which focuses on psychological and social factors as significant variables in the onset of diseases, is recognized and supported with emphasis, however also in the field of psychological discomfort, healing is identified as the absence of illness.
It is understandable how to move towards a dimensionality for the diagnosis, rather than a categorization that provides for a stroke or absence, it can be the direction to be taken to understand and direct the treatments within the complex world of psychopathological personality.
In this regard, the research was interested in the Recovery concept in personality disorders.
The concept of recovery
The word recovery It has been present for decades, especially in the field of psychiatric rehabilitation.
This concept, not translatable into Italian as healing, has been widespread in the Anglo-Saxon world also thanks to the help of socio-political movements in defense of the rights of people with psychiatric disabilities. Moving the focus on the person and the ability of this to recover gods satisfactory operating levels in one’s life.
As Carozza (2006) points out “..The concept of recovery It has been translated and defined in many ways, but no meaning corresponds with the disappearance of the disease, rather it reflects the recovery of skills compromised by the disease and the recovery of a valid and satisfactory role within the society “.
For Liberman and Kopelowicz (2005) “People are in recovery When the symptoms of their disease do not interfere with their functioning in daily life … “.
The concept of recovery It is imaginable as a path of learning of its disorder management, living a satisfactory life within the company.
So thanks to the paradigm change, from the disease to the person, in psychiatric rehabilitation they were able to implement effective interventions (Liberman, Kopelowitz, Ventura & Gutkind, 2002) who aimed precisely at that recovery mentioned in the wide definition of Recovery, as well as starting to do research on the factors that influence it and define it both from the point of view of clinicians and patients.
The processes implicated in the Recovery
A review of the literature on the Recovery identified five processes they characterize (Tew et al., 2011):
- enhancement and recovery of control over one’s life
- reconstruction of a positive personal and social identity
- Connection with others
- Hope and optimism for the future
- Find meanings and purposes in life
Recovery concept for personality disorders
Thus returning to the dimensionality also in the field of pathological personality, the research has been interested in the possibility of introducing the concept of recovery also within this vast area.
Studies on the effectiveness of therapies for personality disorders They are mainly concerning the borderline personality disorder (Bateman et al., 2015) as well as studies on the recovery process.
However, the research is numerous (Balaratnasingam & Janca, 2020; Shepherd et al., 2016; Gillard et al., 2015; Stone, 2010) and provide interesting ideas for the implementation, in the therapeutic approaches of proven effectiveness, of an attitude oriented towards the Recovery.
Overall, in work with personality disorders there is a close articulation between the recovery And the development of self -understanding, the connection with itself and with society and the reorganization of existence (Leamy et al., 2011; Whitley & Drake, 2010).
The domains of the recovery
In a recent meta -analysis on the experience of borderline patients in the treatment and in the process of recovery (Katsakou & Pistang, 2018) 3 distinctive domains are identified.
The first domain, “Areas of change“, It suggests that customers make changes in four main areas:
- develop self -acceptance and self -confidence
- Check difficult thoughts and emotions
- practice new ways of relating to others
- implement practical changes and the development of hope
The second domain, “Useful and not useful treatment characteristics“, Highlights the elements of the treatment that supported the process of recovery:
- Safety and containment
- be respected
- be an equal partner in the treatment
- focus on change
The third domain, “The nature of change“, It refers to the experience of the change of customers as an endless journey in a series of successes and setbacks.
Research on personality disorders still has a long way, but the Recovery concept It is essential to pass the thought that a diagnosis of personality disorder is not something immutable and definitive. You can do a lot from users and clinical services to evolve from the aftermath and outside the pathology and to regain a perspective centered on the experiences of the person and not on the label.
Bibliography
- American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Rev.) Washington, DC: American Psychiatric Publishing
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed). Washington, DC: American Psychiatric Publishing
- Bateman, AW, Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. Lancet (London, England), 385(9969), 735–743.
- Balaratnasingam, S., & Janca, A. (2020). Recovery in Borderline Personality Disorder: Time for Optimism and Focussed Treatment Strategies. Current Opinion in Psychiatry, 33(1), 57–61.
- Carozza, P. (2006). Principles of psychiatric rehabilitation. Milan: FrancoAngeli.
- Gillard, S., Turner, K., & Neffgen, M. (2015). Undersanding Recovery in The Context of Lived Experience of Personalities Disorders: collaborative, Qualitative Research Study. BMC Psychiatry, 15183.
- Katsakou, C., & Pistang, N. (2018). Clients’ Experiences of Treatment and Recovery in Borderline Personality Disorder: A Meta-Synthesis of Qualitative Studies. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 28(6), 940–957.
- Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual Framework for Personal Recovery in Mental Health: Systematic Review and Narrative Synthesis. The British Journal of Psychiatry: The Journal of Mental Science, 199(6), 445–452.
- Liberman, RP, & Kopelowicz, A. (2005). Recovery from Schizophrenia: A concept in Search of Research. Psychiatric Services (Washington, DC), 56(6), 735–742.
- Liberman, Robert & Kopelowicz, Alex & Ventura, Joseph & Gutkind, Daniel. (2002). Operational Criteria and factors Related to recovery from Schizophrenia. THENiternational Review of Psychiatry
- Shepherd, A., Sanders, C., Doyle, M., & Shaw, J. (2016). Personal Recovery in Personality Disorder: Systematic Review and Meta-Synthesis of Qualitative Methods Studies. The International Journal of Social Psychiatry, 62(1), 41–50.
- Stone MH (2010). Recovery from Borderline Personality Disorder. The American Journal of Psychiatry, 167(6), 618–619.
- Tew, Jerry & Ramon, Shaula & Slade, Mike & Bird, Victoria & Melton, Jane & Le Boutillier, Clair. (2011). Social Factors and Recovery from Mental Health Difficulties: A review of the evidence. British Journal of Social WorldK. 42. 443-460.
- Whitley, R., & Drake, Re (2010). Recovery: a dimensional approach. Psychiatric Services (Washington, DC), 61(12), 1248–1250.
