The space between the rock and the hard place: personality disorder diagnosis in people with intellectual disabilities

Abstract

Purpose The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID). Design/methodology/approach Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID. Findings For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services. Practical implications Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution. Originality/value This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities.