Adaptive Solutions to Personality Disorders

Peter Tyrer is Emeritus Professor of Community Psychiatry in the Division of Psychiatry in the Department of Brain Sciences, Imperial College, London. His extensive body of work includes over 600 original articles and books, primarily focused on subjects such as anxiety, depression, personality disorders, and their respective treatments. In 1990, he developed nidotherapy, an approach involving collaborative and systematic assessment and manipulation of the environment to assist individuals with chronic mental illnesses.

"This passionate and beautifully written book from a leader in community psychiatry makes the case for providing better care for a sadly neglected population. Patients with personality disorders may recover, but those who do not tend to fall within the cracks of the mental health system. Their access to care may be limited by having a difficult personality. Yet, as Tyrer shows, there are evidence-based ways to manage that obstacle. The concept behind nidotherapy is to intervene in ways that better match patients’ environment to their personality profile. This concept is well illustrated here by a number of telling case histories. This book will be of great value for mental health clinicians who treat these often-forgotten patients."Joel Paris, emeritus professor of Psychiatry, McGill University. Author of Social Factors in the Personality Disorders: Finding a Niche."In this well written and accessible book, Peter Tyrer captures what might be the essence of personality and its disorders. Synthesising a great breadth of research and his own vast experience combined with research and practice in this field, Tyrer asserts that personality is something we all have, and that, to varying degrees, we are all disordered; but the environment in which we find ourselves will in large part determine the extent to which our disordered personality will cause us harm or, indeed, work in our favour. As Donald Trump has just entered the White House for the second time, and using some illustrative case histories, this sensitively written book makes sense of how environments are so important to anyone with a disordered personality. Rather than turning to therapies such as mentalisation or dialectical behaviour therapies, Tyrer argues, we need to adjust environments for our numerous patients who are largely ignored by the rest of health and mental health to theirs and our detriments. This is a genuinely radical approach which has enormous implications for patients, for psychiatrists for policy makers and for the future of mental health. Read it!"Tim Kendall, professor, CBE FRCPsych"This is a very important book. It opens up a unique perspective on the approach to helping people who have a diagnosis of personality disorder, a concept within itself is open to challenge. Peter Tyrer has been at the forefront on innovative practice in the care and treatment of people with psychological challenges for over 50 years and this book is a must read for all members of the multi-disciplinary team. The link with environment and psychological wellbeing is so often overlooked. Far too often a biological approach is taken to the care and treatment for people with severe and enduring mental illness and in the case of people who are diagnosed with personality disorder they are far too often written off as untreatable. This book invites the reader to reappraise their thinking in relation to the environment and psychological difficulties and to realise the benefits of Peter Tyrer’s approach that, if adopted, will do much to improve the outcomes and offer solutions to some of the challenges that mental health services face."Dr Peter Carter, former Chief Executive, Royal College of Nursing

• 1. Defining current thinking in personality disorders and nidotherapy 2. Why ICD-11 helps facilitate treatment of personality disorder 3. Domains of personality 4. The borderline conundrum 5. Understanding personality involves being honest with yourself 6. General principles of adaptation 7. Why nidotherapy can help adaptation 8. Adapting to personality difficulty 9. Adapting to negative affectivity 10. Adapting to the detachment domain 11. Adapting to the dissociality domain 12. Adapting to the disinhibited domain 13. Adapting to the anankastic domain 14. Adaptation in practice 15. Adapting nidotherapy to mental health services 16. Adaptive approaches for Galenic syndromes 17. Adapting to unstable environments 18. The treatment of severe personality disorder 19. Personality disorder and stigma