Most people suffering from severe personality disorder (SPD) have suffered a life of abuse at the hands of family or caregivers when they were young. These same individuals tend to repeat an abusive relationship when they encounter care later in life. Caregivers in psychiatric, forensic, penal, and other institutions who care for SPD patients feel abused by those they attempt to help. The reaction to this abuse is typically the creation of more helping agencies, a palliative solution. However, increased helping agencies may not be the answer without the addition of increased quality of understanding and care. Caregivers and caring institutions must be able to accurately read the plea for help from those suffering from SPD. When a fully trained provision for SPD patients is absent, these individuals often gravitate to where they seem or feel they belong, in prison. They experience the brutality of the prison culture as another episode in their lifelong fear of mindless abuse. Potential recommendations presented to improve the response from caregivers include: (1) distinguish at assessment those who are struggling with meaninglessness from those who are fighting off guilt and dependency; (2) make a general policy of different cultures for each type of deviance and match corresponding services; (3) mandate certain minimal training or rigorous training on a large scale for staff in institutions for SPD; and (4) train staff to use their own personality as an effective tool to guide him/her on when to be sympathetic, confrontational, or what measure of each is appropriate at any given time. References