ABSTRACT
This chapter examines the feasibility of developing a trans-theoretical and trans-diagnostic treatment for personality disorder. The issue is timely: evidence accumulated over the last 25 years shows that although an array of therapies is effective in treating personality disorder, none stands out as better than the others. Thus, it might be time to reconsider how treatment is approached. Rather than pitting therapies against each other or arguing the merits of a given approach, it might be more useful to consider seriously a trans-theoretical approach based on the effective components of all evidence-based treatments. The need for such an approach also gains impetus from changes in the diagnostic classification. Although diagnostic systems continue to rely on categorical diagnoses, it is clear that such diagnoses have limited clinical utility and attention increasingly focuses on severity as a more important prognostic indicator than type of disorder (Crawford, Koldobsky, Mulder & Cottaux, 2011). This raises the question of whether the current emphasis on developing therapies for specific disorders should be replaced by a trans-diagnostic approach applicable to all forms of personality disorder. This of course is a particularly pertinent issue across populations, including forensic populations where personality disorder is a recognised area of treatment and management need for a sizeable proportion (Coid, Yang, Tyrer, Robers & Ullrich, 2006; Fazel & Danesh, 2002).
