Correspondence
In Reply
We thank our correspondents for the comments on our review article (1). The feedback targeted the two crucial problem areas:
- An unsatisfactory care situation
- The stigmatization of the group of affected patients.
Dr Baur’s comment related to current gaps in healthcare provision. The prevalence of the patient group in general practice—but even more so their high disease burden, not only psychological but also somatic—requires healthcare provision in general practices and somatic specialty practices. The diagnostic evaluation will entail the assessment of the general criteria and the severity, nothing more—and exactly for this purpose we wanted to offer an orientation aid. If a personality disorder is suspected, the patient could, for example, be handed the self assessment questionnaire with nine items that we mentioned in the article. All further diagnostic evaluation is optional and usually done only by specialists in psychiatric medicine and psychotherapists, which may require a referral.
At the same time, recognizing the problems in interactions should make dealing with the patient who is experienced as difficult easier. We agree with the correspondent’s comment. Such patients need more time for the consultation, and they demand more from their doctors. It is very important in this setting to not only listen to the described symptoms and to observe these patients’ behaviors, but also look behind their behaviors and to build a relationship with them. As Dr Baur rightly assumes, this article therefore also implies the health political demand for more time for primary care physicians.
This leads us directly to the dilemma addressed by Dr Bader. By introducing the category “personality difficulty”, the World Health Organization wants to allow more time for doctors practicing in somatic medicine, which affected patients actually really need. At the same time—and we agree entirely—stigmatization is a risk, and in the worst case scenario, discrimination and disincentives. But in this setting it is of crucial importance when, and with which objective, we define the diagnosis.
We hope that our article (1) makes a contribution towards paying attention to the interaction style of patients, to reflect on one’s own, and to facilitate in this way the correct diagnosis and ultimately satisfactory treatment, which will then mostly be provided in collaboration with specialists in psychiatry and psychotherapy and psychotherapists. Balint groups, as Dr Bauer suggests, are enormously helpful in this context. As a further contribution to lightening the load for non-psychiatrically trained specialists we recently developed online materials in the sense of an interactive skills lab with a focus on this group of patients, which support the creation of t trusting relationship and—this is also a concern for us—which can contribute to the psychological hygiene of medical colleagues.
DOI: 10.3238/arztebl.m2022.0191
On behalf of the authors
Prof. Dr. med. Sabine C. Herpertz
Klinik für Allgemeine Psychiatrie
Universitätsklinikum Heidelberg
sabine.herpertz@med.uni-heidelberg.de
Conflict of interest statement
Prof Herpertz receives support for developing a skills lab for primary care physicians in the context of the competence network preventive medicine BW, which receives funding from the Baden-Wuerttemberg Ministry of Science, Research and Art. As president of the International Society for the Study of Personality Disorders (ISSPD), she was between 2015 and 2017 a member of an advisory group at WHO on ICD-11 classification of personality disorders. She received support for studies into personality disorders from the German Research Foundation (DfG), the Federal Ministry of Education and Research, and the European Union.
disorder in everday clinical practice –– implications of the ICD-11. Dtsch Arztebl Int 2022; 119: 1–7 VOLLTEXT
| 1. | Herpertz SC, Schneider I, Renneberg B, Schneider A: Patients with personality disorder in everday clinical practice –– implications of the ICD-11. Dtsch Arztebl Int 2022; 119: 1–7 VOLLTEXT |
