Giles Newton-Howes - Is the label too taxing? Where to for the diagnosis personality disorder #BIGSPD23

The Mental Elf

Before his keynote talk at the 2023 BIGSPD conference in Glasgow, Prof Giles Newton-Howes from the University of Otago in New Zealand, talks about the history of the term personality disorder and how thinking about taxonomy can help us consider the benefits and harms of diagnosis.

Professor Giles Newton-Howes, Professor & Consultant Psychiatrist, University of Otago. A consultant psychiatrist and academic who works in Wellington New Zealand. After completing degrees in classical studies and chemistry he went on to finish medical school at Otago University and then psychiatric training at Imperial College in London. Family drew him back to New Zealand and he has worked and lived there since then. He currently works for Ngā Tai Oranga, the translation of which is the healing tides. They support people with a lived experience of complex psychopathology that has traditionally been conceptualized as personality disorder. He has been the psychiatrist in this team for over a decade, working with patients, families, mental health teams and the wider medical system. Professionally he is a doctor first, and researcher second. Academically he has an interest in how personality shapes psychopathology and how personality disorder is used in clinical practice. He also has interests in personhood, capacity and medical decision making and is an affiliate of the Bioethics Centre at the University of Otago. Outside of medicine he is a father, enjoys playing bridge, trail running and is training for a black belt in Tae Kwon-do.

In this talk I will consider the diagnosis of personality disorder, where it has come from, the taxonomy within which it is based and the possible global direction it is heading. Considerations of the intersection of psychology and psychiatry help us to understand where and how the term ‘personality disorder’ developed. Psychology lay the scientific foundation for the understanding of personality and the analytic tradition superimposed personality disorder onto this. Pragmatic reasoning led to the growth of the term and its global understanding as ‘no longer a diagnosis of exclusion’. Despite this the term is not widely used in national data collection, albeit doing so may provide for increased resources and support. Over the last two decades various models have been developed to better understand psychopathology generally and the HiTOP model holds clinical promise in reconceptualising psychiatric diagnosis, including personality diagnoses. I will conclude by considering current use and how in combination with developments in psychiatric taxonomy the term ‘personality disorder’ may develop over the next two decades.

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