Effects of personality disorder and other variables on professionals' evaluation of treatment features in individuals with mild intellectual disabilities and severe behavior problems.

van den Hazel et al. (2009) asked 88 support staff to read short stories about adults with mild intellectual disability.

Each story ended with severe behavior problems. Half added a note: client also has a personality disorder.

Staff then rated how long treatment would take, odds of success, need for restriction, and focus on context.

When the extra label personality disorder was present, staff predicted longer treatment and lower chance of success.

They also chose more locked-door settings and wanted to look at outside triggers first.

The same client without the label got shorter, less restrictive plans and more optimism.

Munce et al. (2010) looked at real forensic records and found no outcome gap between offenders with ID who had, or lacked, a personality disorder. The secure setting already expects risk, so the label did not worsen results.

Levin et al. (2014) went deeper and mapped seven personality profiles in adults with mild-moderate ID. Knowing the profile predicted aggression better than the yes/no disorder label, giving staff a finer tool than a simple tag.

Cudré-Mauroux (2010) and Matson et al. (2009) both warn that psychotropic meds are over-used for challenging behavior in ID. Teunis shows one reason: once staff expect poor progress, pills look like the next easy step.

Your expectation can become the client’s ceiling. If you see personality disorder on the file, pause and write the behavior plan you would write without it. Then check for needless restriction, medication, or longer timelines. Swap the label for data: do a fresh functional assessment, set ambitious but fair goals, and review intrusiveness with the Treatment Intrusiveness Measure from Ellingsen et al. (2014). Better staff mindset equals better client outcomes.