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Personality disorder: Complexity, countertransference and co-production

In 2003, the National Institute for Mental Health England published a landmark document, Personality Disorder: No Longer a Diagnosis of Exclusion, which highlighted the stigma experienced by individuals with personality disorder, their difficulties in accessing services and the widespread belief amongst health professionals that personality disorder was untreatable. Since then, there have been huge advances in the understanding of its aetiology, the emergence of evidence-based psychological therapies tailored to the treatment of specific personality disorders, and the growth of service provision for patients diagnosed with personality disorder in both the National Health Service (NHS) and the Criminal Justice System (CJS) in the UK. With increasing international research collaborations amongst academics and clinicians, and the promise of radical changes in the diagnostic conceptualisation of personality disorders in the forthcoming International Classification of Diseases, 11th revision, these are indeed exciting times in the field of personality disorder. So why are so many psychiatrists, including forensic psychiatrists, seemingly unaware of or lacking interest in these developments?