Little, Hannah
(2018)
Clinicians’ talk about 'emerging personality disorder' in adolescents: a discursive psychological exploration.
DClinPsy thesis, University of Nottingham.
Abstract
Introduction
Recently, a growing focus within the literature on the application of personality disorder diagnoses to adolescent populations has been met with concern from mental health professionals. Existing research highlights a reluctance to use the diagnoses among professionals, with concerns including their legitimacy in a younger population and the stigmatising impact of the label. The term ‘emerging personality disorder’ is being used increasingly in clinical practice to describe adolescents’ difficulties, however, it remains a largely undefined construct. Some researchers have suggested that its continued use relates to uncertainty surrounding diagnostic criteria, and to the perceived negative effects of labelling. However to date, no research has specifically focused on the use and function of ‘emerging personality disorder’ as a construct.
Objective
This study uses discourse analysis to explore how clinicians working in Child and Adolescent Mental Health Services (CAMHS) construct ‘emerging personality disorder’ in reference to their work with adolescents. The research aims to contribute to the growing literature on personality disorder in adolescence, and is to the authors’ knowledge the first study to specifically explore ‘emerging personality disorder’ as a construct.
Method
Clinicians were recruited from a large Child and Adolescent Mental Health Service (CAMHS), from varied teams and professional backgrounds (n=10). Semi-structured interviews were used to elicit talk relating to the topic of personality disorder in adolescence. The analysis of the interview transcripts was informed by discursive psychology (Potter & Wetherell, 1987) and Foucauldian discourse analysis (Foucault, 1979).
Results
Clinicians constructed ‘emerging personality disorder’ by firstly building up constructions of personality disorder as an adult diagnosis with lifelong stigmatising consequences. Within this discourse, clinicians were positioned as moral guardians, with the role of protecting adolescents from the effects of a diagnosis. There was tension however between this position and a need to talk about the difficulties faced by adolescents. For some, ‘emerging personality disorder’ was constructed as an alternative to an ‘adult’ personality disorder diagnosis that offered greater hope, flexibility and room for recovery. For others, a discourse of concern surrounding the use of ‘emerging personality disorder’ was used to justify alternative ways of talking about the same difficulties that provided distance from personality disorder terminology. Some clinicians drew on discourses of attachment and trauma to explain the distress young people presented with, and others constructed behavioural descriptions for the same difficulties. Across accounts, clinicians spoke about personality disorders with marked hesitance and tentativeness, employing a range of discursive devices to negotiate disputed territory, present accounts as factual, and clinicians as reflective, considerate and reasonable professionals.
Discussion
This study offers a detailed exploration of clinicians’ talk around personality disorder in adolescence, with a specific focus on the use of ‘emerging personality disorder’. The current findings draw attention to the discourses of concern and caution surrounding the use of personality disorder terminology in an adolescent population. Implications are discussed in terms of the potential impact of the varied conceptualisations of the same presenting difficulties, and the potential value of a reflective space for clinicians to consider the impact of these for their adolescent clients.
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