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Advances in Psychiatric Treatment (2006) 12: 297-305
© 2006 The Royal College of Psychiatrists

Personality disorders as disorganisation of attachment and affect regulation

Jaydip Sarkar and Gwen Adshead

Jaydip Sarkar is a consultant forensic psychiatrist, currently working at the Shaftesbury Clinic (South West London and St George’s Mental Health NHS Trust, Springfield University Hospital, 61 Glenburnie Road, London SW17 7DJ, UK. Email: amdeep176{at}aol.com). Gwen Adshead is consultant forensic psychotherapist at Broadmoor Hospital, Crowthorne, UK.

If personality disorder is no longer to be a diagnosis of exclusion it needs a conceptual framework that fits both the symptoms of the illness and the behavioural problems that constitute its current diagnostic criteria. In this article, we suggest that personality disorder is best understood as disorganisation of the capacity for affect regulation, mediated by early attachments. We present evidence for this argument based on both developmental and neurobiological research.