There are a number of concepts and terms commonly used in relation to personality disorder. Here is our guide.
Advance directive/crisis plan
You may find that different types of support, activity and treatment are helpful for you at different times. It can be useful to think about what you would like to happen if you go into a crisis. During a crisis, you may find it difficult to express your wishes or others may not trust your judgement, so writing down want you want in advance can be a good idea. A written plan about how you would like to be treated if your mental health gets worse is often called an advance directive or crisis plan. When you are planning your advance directive, you might find it useful to talk to the mental health professional you usually see and anyone who supports you (such as a partner, family member, friend or carer). Advance directives are not legally binding but mental health staff should do their best to follow your wishes. This means that your wishes can be overruled if it is felt necessary to treat you in a different way than planned in order to protect yourself or others.
An advocate is someone who supports you to get your point of view across if you need support to talk to someone about your mental health needs. Each area should have a service providing mental health advocates. To find out about mental health advocates in your area, you can search the Action for Advocacy website (http://www.actionforadvocacy.org.uk ) or ask your local Mind association.
Borderline is a term sometimes used to refer to an individual given a diagnosis of borderline personality disorder. Many people find it offensive because, like ‘schizophrenic’ or manic depressive’, it reduces people to their diagnosis, removing all reference to us as human beings and erasing all other aspects of our identity.
Depersonalisation refers to the feeling of being 'unreal' or detached from yourself. This can include:
- Feelings of watching yourself from a distance (akin to an 'out of body experience')
- Feeling as if you were in a dream
- Feeling that your voice or movements are not under your control
- Inability to experience feelings
- Inability to experience emotions 'normally' - which may lead to difficulties in daily living
Depersonalisation can be brought about by sleep deprivation, stress, trauma, use of drugs, alcohol, caffeine, and during meditation. Within the psychiatric system, it is seen as a symptom of many mental health diagnoses (e.g. depression, anxiety etc) as well as occurring on its own. Depersonalisation can be a symptom of a dissociative disorder; however, in everyday speech people often use ‘dissociation’ and ‘depersonalisation’ interchangeably. Suggestions for how to treat depersonalisation depend on what is thought to have caused it and this varies from one person to the next. Recently, research has been carried out to test whether Cognitive Behavioural Therapy or a medication called lamotrigine might be helpful. More information and help is available from the Depersonalisation Research Unit at The Maudsley Hospital, South London (http://www.iop.kcl.ac.uk/departments/?locator=911)
Experts by experience
This term is used to refer to people who have direct personal experience of mental health issues or using mental health services and who draw on this experience in the work that they do. Mental health professionals develop their expertise through training, education and work experience. They are experts by training. In contrast, experts by experience have developed their expertise through their own personal experience of distress and/or using mental health services.
Forensic services are specialist services for people with mental health problems who are in, or have been through, the criminal justice system i.e. people who have committed a criminal offence and have been given a mental health diagnosis.
Mentalising refers to the ability to make sense of our own and other people’s actions by thinking through what is going on in our own and other people’s minds. It may be understood as an ability to empathise or put ourselves in their shoes. For example, to understand someone’s reaction to our behaviour, we need to think about their point of view, what mood they are in, what they are motivated by, etc.
The term "psychosis" is used to refer to the experience of perceiving, understanding and interpreting reality in a way that is not shared by others from your culture. It can include:
- Hallucinations – Hearing voices, having visions, tactile sensations and other sensory experiences not shared by others.
- Paranoia – the belief that other people or groups are trying to harm you.
- Delusions – beliefs which are not based on a shared reality and which others perceive to be false. This can include:
- believing you have special powers or characteristics (sometimes called delusions of grandeur)
- believing other people are making secret references to you, for example in newspapers or on the television (sometimes called delusions of reference)
- believing others are plotting against you (sometimes called delusions of persecution)
- believing other people can put thoughts in your head (sometimes called thought insertion)
- believing your thoughts are being broadcast out loud (sometimes called thought broadcasting)
Many people assume that someone experiencing psychosis has or should be given a diagnosis of schizophrenia. In fact, it is estimated that between ten and fifteen percent of the population will have at least one of the above experiences at some point in their lives. Although the mainstream mental health system draws on a medical framework and views these as symptoms of a mental illness, many people who actually have these experiences draw on different ways of understanding their distress.
Psychosis can be caused by sleep deprivation, hormone changes (e.g. during PMT or following childbirth), the use of drugs/alcohol, infection, and head injury. It is associated with a number of mental health issues including depression, bipolar disorder, schizophrenia and borderline personality disorder. It is thought people given a diagnosis of BPD are most likely to experience psychosis when under extreme stress and that the psychosis will pass with time.
Further information and details of hearing voices groups can be found via the Hearing Voices Network at http://www.hearing-voices.org
A person who uses services, such as mental health, drug and alcohol or criminal justice services. This is commonly used shorthand which many people are not comfortable with but which has become widely used because nothing more popular has been found to replace it.
Service user researcher/survivor researcher
A person who carries out research and draws on their own personal experience of using or surviving mental health services to inform the way that they work. They are open about the fact they have personal experience of mental health issues and the insight this has given them is seen as a positive asset in their work.
Transference is a subconscious process where an individual transfers or redirects the feelings attached to someone significant in their life (either past or present) onto their therapist. The individual then feels and acts towards the therapist as they might have done towards the other person. For example, if an individual felt very angry towards their father, this anger may become redirected to the therapist and they would behave as if angry towards the therapist without knowing why. Any feelings in the broad spectrum of emotion can be transferred; the key is that these feelings do not relate to the client-therapist relationship but have arisen from elsewhere in the client’s life.
Transference is extremely common within therapy, particularly psychodynamic psychotherapy which focuses on our early childhood experiences. Transference is seen by many as an important part of therapy as it can enable the client to better understand how interpersonal relationships from childhood continue to affect them in adult life and help to resolve some of these patterns.
Counter-transference describes the feelings that the client evokes in the therapist (e.g. excessive involvement, dislike, attachment.) Therapists are encouraged to examine these feelings, in order to understand them and prevent them from affecting the working relationship. Counter-transference is believed to offer insight into the client’s subconscious but is also influenced by the therapist's past experiences.
Counter-transference is thought to be a particular issue when working with people who switch between idealisation and hatred of others. (This is known as splitting and is often associated with the diagnosis of borderline personality disorder.) In this situation, therapists may react to the splitting as well as the individual’s transference.
User involvement or service user involvement
This refers to involving people who have personal experience of using mental health services in decisions about how mental health services should be designed, delivered and evaluated. This term can also refer to involving service users in decisions about their own support, in research, training and education, as well as broader decisions about the future direction of plans related to mental health.
The term used to explain that the leadership of an organisation or service comes from people who have personal experience of using mental health services. How this is achieved will be different in each organisation but the principle remains constant: the organisation or service is driven and directed by people with personal experience of using service.