Abstract
Background: There have not been any previous investigations into the illness models of individuals with the traditionally difficult to engage presentation of personality disorder (PD). Within physical illness there is an evidence base supporting the use of the Self Regulatory Model (SRM) as a framework for explaining treatment adherence. PD develops from difficulties within a person's childhood and is intertwined with the way that they make attachments to significant others. This contributes to self and other perception and also has an impact on how they understand what is happening to them and the responses they have to treatment. This study aimed to describe the attachment styles, subtype and severity of PD of the sample group and investigate whether the SRM can be used to understand how people made sense of their experience of having PD. Methods: A sample of 13 clients on the waiting list for entry into a Therapeutic Community for the treatment of PD, completed measures to assess their personality and their attachment related dimensions of anxiety and avoidance. Of these, 6 participated in a semi-structured interview exploring their experience of PD. Interpretative Phenomenological Analysis was used to analyse verbatim , interview transcripts. Results: Participants were classified as having severe PD. There was a level of attachment insecurity for the group higher than the general population norm. Participants made sense of their PD through the identity that they gave to their difficulties and the identity that they gave to their self. These identities appeared to be being maintained by incoherent narratives and an external locus of control. Conclusion: The SRM highlighted areas in which illness representations for the PD population in this study may differ from previously researched mental illness. Such difference may be linked to the condition's link with insecure attachment. Findings suggested that any illness representation of PD has to also consider the impact upon sense of self that a non-optimal attachment environment may have and how this may impact upon both locus of control and coherence of narrative. Findings also highlighted the importance of psychoeducation as a building block to more in-depth work.