This is a rich collection of papers that I strongly recommend for trainees and seniors alike. Over the past decade, there have been really useful developments in the study of personality function and its disorders and Yeomans & Levy are to be congratulated for commissioning reviews that provided excellent summaries of the current state of play in terms of evidence, as well as raising questions for further research. The preface alone is helpful, but a highlight for me was the introduction by Otto Kernberg, who argues for a truly biopsychosocial approach to understanding all disorders of personality, not just borderline personality disorder. Other highlights include the review by Buchheim & Diamond about the relationship between attachment insecurity and affect dysregulation and the evidence for the mediating role of amygdala dysfunction; and the lucid and pragmatic chapter on treatment by Levy et al, which concludes that probably all techniques are effective for symptom reduction and implies (without directly stating this) that professional competition between the different ‘schools’ of therapy is outdated.
Such books are valuable because there are still mental health professionals out there (including psychiatrists, I'm sad to say) who claim that personality disorders either (a) do not exist as disorders but are just ‘stigmatising labels’ or (b) are disorders but not the kind that mental health services should help. Particularly malignant comments about personality disorder include statements such as ‘It's not mental illness’ or ‘It's just behavioural’ (neither of which is meaningful without elaboration) and the grim ‘We're not commissioned to provide services for this’, which in the UK's National Health Service is both false and illegal. Space does not permit a discussion of how such attitudes arise (although this book has a useful chapter about stigma and patient experience); but the best way to change such views is to educate professionals and empower them to help people with borderline personality disorder with the same confidence and compassion they extend to any other patients. Books such as this make valuable contributions to stigma reduction and we need more of them.
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