Stormy Lives: A Journey through Personality Disorder

The diagnostic label ‘personality disorder’ is usually reserved for patients who are difficult to engage and treat. In clinical practice, we must all have encountered such patients who readily induce counter-transferences in us and are consequently a nightmare for their caregivers. This book gives a sense of what is happening in the mind and heart of the person with personality disorder and how this might affect those around them by describing the treatment journey of a patient referred for personality disorder care in the United Kingdom. The book is in 2 parts — the first 5 chapters define personality disorder by describing the initial care of a patient, Nina, with borderline personality disorder. As the author describes how Nina entered the service, her story and questions that she raises during the referral process — “What is personality disorder?”, “What is wrong with me?”, “Why do I have it?”, “Can you help me?” etc are answered. The following chapters explain evidence-based psychological treatments and how family and friends can help by describing the treatment journey of Nina and the outcome after 2 years of treatment. The author also provides a list of key facts and figures concerning ‘borderline personality disorder’, a glossary of commonly used terms in psychotherapy theories, the treatment contract in the personality disorder service in which the author worked and relevant resources for reference.

Although the book is intended mainly for the public, especially those who might wish to seek help for personality disorder, the information is quite comprehensive. In Hong Kong we are not very familiar with the concepts of personality disorders, so this book will be more suitable for mental health professionals. The author is clearly a very experienced therapist working with personality disorders and the case scenarios he describes will readily resonate with readers. I very much enjoyed reading this book — it was easy to read and understand, and provided a clear overview of the concepts of personality disorders, attachment theory, and the various evidence-based psychological treatments. Nonetheless since it targets the general public, the information is sufficient only to enable patients to have a clear understanding of treatment options and frame of treatment. The book is not suitable for mental health professionals who wish to learn about detailed treatment of personality disorders. Nevertheless it may help increase awareness and thus detection of personality disorders and lessen the misunderstanding and stigmatisation by mental health professionals of those affected. Indeed, one of the most interesting parts of the book was the description by the author of various types of personality disorder along with examples of relevant cases. Linda, the nurse who helped Nina, was given as an example of anankastic personality disorder. As the author pointed out, “we are all prone to narcissistic difficulties and the defences we adopt due to these difficulties are there to protect us from feeling vulnerable or exposed, and then apply this to the individual with more extreme narcissistic difficulties, it could give us some understanding for the individual”. Given a situation where we are traumatised / narcissistically wounded, we too can behave as if we have a personality disorder!

In summary, this book is an enjoyable read and is recommended for mental health professionals who are not so familiar with the concept of personality disorders or who work in areas where specialised treatment for personality disorders is not available (e.g. Hong Kong). In places where specialised treatment is available, this book can help patients understand more about treatment and help them prepare for therapy.

Irene WK Kam, MRCPsych, FHKAM (Psychiatry), FHKCPsych
(email: kwk412@ha.org.hk) Department of Psychiatry Shatin Hospital
Hong Kong SAR, China

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