Principles of Nidotherapy in the Treatment of Persistent Mental and Personality Disorders
Abstract
Background: The principles of a psychological intervention for psychiatric disorders, nidotherapy, are described following its use in the treatment of patients with severe mental illness, most of whom also have personality disorders. Nidotherapy is the collaborative systematic assessment and modification of the environment to minimise the impact of any form of mental disorder on the individual or on society. It is particularly appropriate to consider for chronic and recurring disorders in which there is no prospect of short-term improvement. Methods: An analysis of the treatment suggests its main tenets are the development of a joint consensus (collateral collocation) of environmental change needed, formulation of targets, consequent monitoring and adjustments made to test the effectiveness of intervention, and a joint structure (arbitrage solving) to adjudicate when changes are considered feasible or impractical by one party and not the other. Results: Case vignettes are used to describe the main features of the treatment. Although nidotherapy includes some of the elements of cognitive, occupational and family therapy, and even social work, it is different in that it focuses on changing the environment, not the person. It is therefore much more acceptable to those patients who have repeatedly challenged the justification of conventional therapy for their conditions. Conclusions: Nidotherapy deserves further enquiry as a useful addition to existing psychological treatments.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
For treatment-resisting (Type R) personality disorder, adapting the environment to the personality through nidotherapy may be better than seeking personality change.
“it may be better to try and adapt the envi ronment to the personality and this can be done systemati cally in the form of nidotherapy”
From Personality disorder: a new global perspective (2010) · cites this paper as [34]
Cites
Mischel, W., & Shoda, Y. (1995) · Psychological Review · doi:10.1037/0033-295x.102.2.246 · Cited by 3,889 · see citing works
Bruner, J. S. (1957) · Psychological Review · doi:10.1037/h0043805 · Cited by 2,086 · see citing works
(1985) · Cited by 592 · see citing works
Prevention of Recurrent Depression With Cognitive Behavioral Therapy: Preliminary Findings
Fava, G. A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.9.816 · Cited by 491 · see citing works
The Coherence of Personality: Social-Cognitive Bases of Consistency, Variability, and Organization
Cervone, D., & Shoda, Y. (1999) · Medical Entomology and Zoology · Cited by 487 · see citing works
Weich, S., Blanchard, M. R., Prince, M. J., Burton, E. J., Erens, B., & Sproston, K. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.180.5.428 · Cited by 334 · see citing works
Treatment Rejecting and Treatment Seeking Personality Disorders: Type R and Type S
Tyrer, P., Mitchard, S., Methuen, C., & Ranger, M. (2003) · Journal of Personality Disorders · doi:10.1521/pedi.17.3.263.22152 · Cited by 195 · see citing works
Self-citationHome treatment for mental health problems: a systematic review
Catty, J., Burns, T., Knapp, M. R. J., Watt, H., WRIGHT, C., HENDERSON, J., & Healey, A. (2002) · Psychological Medicine · doi:10.1017/s0033291702005299 · Cited by 133 · see citing works
Personal or Environmental Causes of Happiness: A Longitudinal Analysis
Lu, L. (1999) · The Journal of Social Psychology · doi:10.1080/00224549909598363 · Cited by 117 · see citing works
Management of treatment-resistant depression: psychotherapeutic perspectives.
Thase, M. E., Friedman, E. S., & Howland, R. H. (2001) · PubMed · Cited by 88 · see citing works
Nidotherapy: a new approach to the treatment of personality disorder
Tyrer, P. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2002.01362.x · Cited by 78 · see citing works
Self-citationOutcome Predictors in Anorectic Patients after 6 Months of Multimodal Treatment
Fassino, S., Daga, G. A., Amianto, F., Leombruni, P., Fornas, B., Garzaro, L., DʼAmbrosio, G., & Rovera, G. G. (2001) · Psychotherapy and Psychosomatics · doi:10.1159/000056254 · Cited by 42 · see citing works
Behavioral expressions of a personality system: Generation and perception of behavioral signatures.
Shoda, Y. (1999) · Cited by 40 · see citing works
Editorial: Dangerous Severe Personality Disorder Bad Tidings from the UK
Moran, P. (2002) · International Journal of Social Psychiatry · doi:10.1177/002076402128783037 · Cited by 33 · see citing works
Recidivism in Major Depressive Disorder
Labbate, L. A., & Doyle, M. E. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289125 · Cited by 31 · see citing works
Rock, B., & Cooper, M. (2000) · Social Work in Health Care · doi:10.1300/j010v31n01_01 · Cited by 24 · see citing works
Outcomes and costs of a community support worker service for the severely mentally ill
Clarkson, P., McCrone, P., Sutherby, K., Johnson, C., Johnson, S., & Thornicroft, G. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb00976.x · Cited by 22 · see citing works
Svensson, B., & Hansson, L. (1999) · European psychiatry · doi:10.1016/s0924-9338(99)00160-1 · Cited by 9 · see citing works
Modestin, J. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2002.t01-1-01362.x · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Personality disorder and the outcome of depression: Meta-analysis of published studies
Newton-Howes, G., Tyrer, P., & Johnson, T. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.188.1.13 · Cited by 537 · see citing works
Self-citationThe Social Functioning Questionnaire: A Rapid and Robust Measure of Perceived Functioning
Tyrer, P. J., Nur, U., Crawford, M., Karlsen, S., Maclean, C., Rao, B., & Johnson, T. L. (2005) · International Journal of Social Psychiatry · doi:10.1177/0020764005057391 · Cited by 348 · see citing works
Self-citationTreatment Rejecting and Treatment Seeking Personality Disorders: Type R and Type S
Tyrer, P., Mitchard, S., Methuen, C., & Ranger, M. (2003) · Journal of Personality Disorders · doi:10.1521/pedi.17.3.263.22152 · Cited by 195 · see citing works
Self-citationPersonality disorder: a new global perspective
TYRER, P., MULDER, R., CRAWFORD, M., NEWTON-HOWES, G., SIMONSEN, E., NDETEI, D., KOLDOBSKY, N., FOSSATI, A., MBATIA, J., & BARRETT, B. (2010) · World Psychiatry · doi:10.1002/j.2051-5545.2010.tb00270.x · Cited by 102 · see citing works
Self-citationCrawford, M., Rutter, D., Price, K., Weaver, T. D., Josson, M., Tyrer, P. J., Gibson, S. L., Gillespie, S., Faulkner, A., Ryrie, I., et al. (2007) · Research Repository (Kingston University London) · Cited by 76 · see citing works
Self-citationRanger, M., Tyrer, P., Miloseska, K., Fourie, H., Khaleel, I., North, B., & Barrett, B. (2009) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00001019 · Cited by 76 · see citing works
Self-citationTyrer, P. J., Tarabi, S. A., Bassett, P., Liedtka, N., Hall, R., Nagar, J., Imrie, A., & Tyrer, H. (2017) · Journal of Intellectual Disability Research · doi:10.1111/jir.12360 · Cited by 61 · see citing works
Self-citationPersonality diatheses: a superior explanation than disorder
Tyrer, P. J. (2007) · Psychological Medicine · doi:10.1017/s0033291707000153 · Cited by 59 · see citing works
Self-citationTyrer, P. J., Oliver, P., Romeo, R., Knapp, M. R. J., Huline‐Dickens, S., Bouras, N., Ahmed, M. Z., Cooray, S., Deb, S. S., Murphy, D., et al. (2009) · Health Technology Assessment · doi:10.3310/hta13210 · Cited by 55 · see citing works
Self-citationNidotherapy: making the environment do the therapeutic work
Tyrer, P., & Bajaj, P. (2005) · Advances in Psychiatric Treatment · doi:10.1192/apt.11.3.232 · Cited by 54 · see citing works
Self-citationTyrer, P. J., Miloŝeska, K., Whittington, C. J., Ranger, M., Khaleel, I., Crawford, M., North, B. V., & Barrett, B. M. (2011) · The Psychiatrist · doi:10.1192/pb.bp.110.029983 · Cited by 51 · see citing works
Self-citationPersonality Functioning, Problems in Living, and Personality Traits
Hopwood, C. J. (2024) · Journal of Personality Assessment · doi:10.1080/00223891.2024.2345880 · Cited by 49 · see citing works
Tyrer, P., & Kramo, K. (2007) · Journal of Mental Health · doi:10.1080/09638230601182102 · Cited by 38 · see citing works
Self-citationThe place for nidotherapy in psychiatric practice
Tyrer, P. J., Kramo, K., Miloŝeska, K., & Seivewright, H. (2006) · Psychiatric Bulletin · doi:10.1192/pb.31.1.1 · Cited by 38 · see citing works
Self-citationClaustration à domicile de l’adolescent. Hikikomori
Guedj-Bourdiau, M.-J. (2011) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2011.10.005 · Cited by 38 · see citing works
The General Neurotic Syndrome: A Re-Evaluation
Tyrer, P., Tyrer, H., & Guo, B. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000444196 · Cited by 32 · see citing works
Self-citationSpencer, S., Rutter, D., & Tyrer, P. J. (2009) · International Journal of Social Psychiatry · doi:10.1177/0020764008095934 · Cited by 29 · see citing works
Self-citationAggressive Behaviour in Adults with Intellectual Disability
Oliver, P., Murphy, D., & Tyrer, P. J. (2009) · CNS Drugs · doi:10.2165/11310930-000000000-00000 · Cited by 27 · see citing works
Self-citationManagement of complex and severe personality disorders in community mental health services
Tyrer, P. J., & Mulder, R. (2006) · Current Opinion in Psychiatry · doi:10.1097/01.yco.0000228761.02861.44 · Cited by 24 · see citing works
Self-citationWhat can clinical behaviour analysis contribute to nidotherapy?
Veale, D. M., Smith, G., & Drossel, C. (2009) · Personality and Mental Health · doi:10.1002/pmh.104 · Cited by 22 · see citing works
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403 · Cited by 22 · see citing works
Self-citationCommunity mental healthcare for people with severe personality disorder: narrative review
Koekkoek, B., van Meijel, B., & Hutschemaekers, G. J. M. (2010) · The Psychiatrist · doi:10.1192/pb.bp.108.022426 · Cited by 19 · see citing works
Crisis Resolution and Home Treatment
McGlynn, P. (2006) · Cited by 17 · see citing works
Controversies Surrounding Classification of Personality Disorder
Kim, Y., & Tyrer, P. J. (2010) · Psychiatry Investigation · doi:10.4306/pi.2010.7.1.1 · Cited by 16 · see citing works
Self-citationNidotherapy: Harmonising the Environment with the Patient
Tyrer, P. J., & Tyrer, H. (2009) · Cited by 15 · see citing works
Self-citationDay, A., & Bryan, J. (2007) · Psychology Crime and Law · doi:10.1080/10683160600869692 · Cited by 11 · see citing works
Nidotherapy in the successful management of comorbid depressive and personality disorder
Spears, B., Tyrer, H., & Tyrer, P. J. (2017) · Personality and Mental Health · doi:10.1002/pmh.1370 · Cited by 10 · see citing works
Self-citationGetting to grips with severe personality disorder
Tyrer, P. J. (2004) · Criminal Behaviour and Mental Health · doi:10.1002/cbm.555 · Cited by 10 · see citing works
Self-citationStaff Training and Supervision
Rose, J., & Gallivan, A. (2019) · Autism and child psychopathology series · doi:10.1007/978-3-030-20843-1_10 · Cited by 9 · see citing works
Tyrer, P. J. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15050972 · Cited by 7 · see citing works
Self-citationSilk, K. R. (2011) · Personality and Mental Health · doi:10.1002/pmh.187 · Cited by 7 · see citing works
New Approaches to the Diagnosis of Psychopathy and Personality Disorder
Tyrer, P. (2004) · Journal of the Royal Society of Medicine · doi:10.1177/014107680409700803
Self-citationNidotherapy: a cost‐effective systematic environmental intervention
Tyrer, P. J. (2019) · World Psychiatry · doi:10.1002/wps.20622 · Cited by 6 · see citing works
Self-citationTyrer, P. J. (2011) · World Psychiatry · doi:10.1002/j.2051-5545.2011.tb00026.x · Cited by 6 · see citing works
Self-citationLock, J., Yang, M., & Tyrer, P. J. (2024) · Personality and Mental Health · doi:10.1002/pmh.1648 · Cited by 5 · see citing works
Self-citationRamos, J. M., Broco, L., Sánchez, A., & Doll, A. (2019) · Clínica y Salud · doi:10.5093/clysa2019a18 · Cited by 5 · see citing works
Tyrer, P. J., Duggan, C. F., Yang, M., & Tyrer, H. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02520-1 · Cited by 4 · see citing works
Self-citationMansell, C., Yang, M., & Tyrer, P. J. (2024) · International Journal of Social Psychiatry · doi:10.1177/00207640241239540 · Cited by 4 · see citing works
Self-citationNidotherapy in the treatment of personality disorder
Tyrer, P. J. (2008) · Psychiatry · doi:10.1016/j.mppsy.2008.01.008 · Cited by 3 · see citing works
Self-citationManagement of personality disorder
Newton‐Howes, G., & Davidson, K. M. (2012) · doi:10.1093/med/9780199696758.003.0114 · Cited by 3 · see citing works
Other treatments for persistent disturbances of behaviour
Tyrer, P. J., & Tyrer, S. P. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544392.046 · Cited by 3 · see citing works
Self-citationTyrer, P. J. (2004) · Medicine · doi:10.1383/medc.32.7.26.36675 · Cited by 3 · see citing works
Self-citationCooray, S. E., Alexander, R., Purandare, K. N., Chester, V., & Tyrer, P. J. (2022) · Springer eBooks · doi:10.1007/978-3-319-95720-3_31 · Cited by 3 · see citing works
Self-citationMultimodal approaches to the treatment of personality disorder
Tyrer, P., King, J., & Mulder, R. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2515066 · Cited by 2 · see citing works
Self-citationNidotherapy for people with schizophrenia
Chamberlain, I. J., & Sampson, S. J. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009929.pub2 · Cited by 2 · see citing works
Psychotherapy for personality disorder
BATEMAN, A. W., & Fonagy, P. (2012) · doi:10.1093/med/9780199696758.003.0113 · Cited by 2 · see citing works
Sharma, V. K. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99967-0.00250-7 · Cited by 2 · see citing works
Editorial: Nidotherapy as a treatment strategy in stress
Tyrer, P. J. (2003) · Stress and Health · doi:10.1002/smi.972 · Cited by 1 · see citing works
Self-citationLa nidoterapia en el tratamiento del trastorno de la personalidad
Tyrer, P. J. (2009) · Psiquiatría Biológica · doi:10.1016/s1134-5934(09)71895-0
Self-citationGuideline Development Group Membership
Tyrer, P. J., Kendall, T., BATEMAN, A. W., Psychiatrist, C., Bayliss, L., & Bouras, N. (2005)
Self-citationInterview: Professor Peter Tyrer
Procter, S., & Tyrer, P. J. (2006) · British Journal of Music Therapy · doi:10.1177/135945750602000202
Self-citationBornstein, R. F. (2017) · Personality and Mental Health · doi:10.1002/pmh.1383
Teaching psychiatry to large groups in society
Bejerot, S., Lindgren, A., Rosén, J., Bejerot, E., & Elwin, M. (2019) · BMC Medical Education · doi:10.1186/s12909-019-1596-9
Methods of Delivering Treatment
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.007
Self-citationEconomic Benefits of Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.013
Self-citationThe General Philosophical Principles of Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.004
Self-citationTyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.015
Self-citationThe Four Phases of Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.006
Self-citationWhat Are the Qualities of a Good Nidotherapist?
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.010
Self-citationHow to Develop Skills in Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.009
Self-citationNidotherapy for People with Intellectual Disability and Dementia
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.008
Self-citationCommon Misconceptions about Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.014
Self-citationTyrer, P. J., & Tyrer, H. (2018) · doi:10.1017/9781911623403.001
Self-citationAssessing the Patient for Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.005
Self-citationTyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.012
Self-citationTyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.016
Self-citationNidotherapy for people with schizophrenia
Chamberlain, I. J., & Sampson, S. J. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009929
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.003
Self-citationNidotherapy, Physical and Occupational Health and Social Care
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.011
Self-citationSpecific Mental Health Disorders: Personality Disorders
Crawford, M. (2008) · Elsevier eBooks · doi:10.1016/b978-012373960-5.00054-x
Tyrer, P. J., & Tyrer, H. (2018) · doi:10.1017/9781911623403.002
Self-citationTyrer, P. J. (2025) · doi:10.1093/9780191964343.003.0028
Self-citationTyrer, P. J., Crawford, M., Ahmad, A., Barrett, B. M., Caan, W., Duggan, C. F., Frisira, E., Kendall, T., King, J. D., Daley, D., et al. (2025) · BJPsych Open · doi:10.1192/bjo.2024.861
Self-citationSpecific Mental Health Disorders: Personality Disorders
Barnicot, K., & Crawford, M. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-803678-5.00428-8
- Authors
- Tyrer, P., Sensky, T., & Mitchard, S.
- Affiliations
- Imperial College London (GB)
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2003
- Volume
- 72
- Issue
- 6
- Pages
- 350-356
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W2028512493
- Cited by
- 75
- References
- 19
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 1 · 2022: 1 · 2019: 4 · 2018: 18 · 2017: 3 · 2016: 2 · 2013: 1 · 2012: 3
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- personality disorders, severe mental illness, environmental modification, psychological intervention, collaborative assessment, treatment goals, treatment monitoring, treatment acceptability, case vignettes
- MeSH terms
- Adult, Aged, Mental Disorders, Combined Modality Therapy, Family Therapy, Female, Humans, Male, Middle Aged, Occupational Therapy, Personality Disorders, Social Adjustment, Social Conformity, Social Work, Psychiatric, Socioenvironmental Therapy, Cognitive Behavioral Therapy, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
