Personality disorder and public mental health.

The diagnosis of personality disorder often appears to tell as much about the diagnoser as the diagnosed. For many it describes those who are deemed personally offensive, and as such it is not so much a diagnosis as a value judgment, the product of a negative interaction between two people that is given spurious respectability by a medical label. It is argued that these attitudes constitute a disastrous misperception of the truth, as personality disturbance (diathesis) in its many forms, including the unsatisfactory term 'disorder', is a highly significant contributor to human misery and handicap and a major cost to public mental health. It achieves this sorry record largely through stealth, because the current categorical system fails to embrace the breadth and heterogeneity of abnormal personality and the notion of offensive immutability makes the diagnosis a stigmatic one. This can be avoided by recoding personality in terms of severity. New treatments are now beginning to show evidence of efficacy and it is not unreasonable to hope that a condition that has been muttered about for years in parentheses will now be better recognised and defined, exposed without misunderstanding, and managed appropriately and well.