The prevention and treatment of personality disorders is surrounded with pessimism and controversy. Most clinicians believe that these disorders are untreatable, that individuals with personality disorder have little capacity for change and not surprisingly, many remain sceptical about the prospects for their prevention.
However, whilst the innate temperament cannot be changed, understanding factors that influence the development of personality disorders (genetic risks, predisposing and precipitating factors) or leave the child resilient in response to childhood trauma (protective factors) might help prevention and treatment. Mental health professionals have challenging roles to play in preventing malignant memories of traumatic experiences and subduing their pernicious effects as well as examining the chain of interactions among environment, personality and behavior initiated by early trauma.
Prevention strategies should be multidimensional, continuous, multimodal and ecclectic, and a part of community programs with wide coverage. The identification of high risk groups at an early stage before delivery and the intervention at that stage, should be a target of the primary care group, by providing individuals with information about the problem and organizing antenatal groups and support for women both during pregnancy and during and after delivery.
Primary prevention should include education of current and future parents and primary health care workers, as well as early psychotherapy and protection of traumatised children, which can be carried out in child developing services. The evidence suggests that traditional helper-client relationships are of much less value than programs which enable parents to see their own role as a paramount, their own action able to bring changes for the better in their children's behavior, and an awareness of the family's strengths rather than weaknesses. High quality parenting plays a critical role in the child development.
D. Lecic-Tosevski, MD, PhD
Institute for Mental Health, School of Medecine, Belgrade