Personality Disorders

Original article by Khadija Janoowala | Last updated on 28/5/2014
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Introduction

Defined by ICD-10 and DSM – IV- TR as;

  • Lifelong, persistent, deeply ingrained maladaptive behaviour that:
  • characterizes an individual
  • deviates markedly from culturally expected or accepted ‘normal’ range
  • Onset in late childhood or early adolescence
 
Deviation has to manifest in more than one of the following areas:
  1. Cognition 
  2. Affectivity
  3. Occupational and social performance
  4. Impulse control and need gratification
  5. Interpersonal function
 
Not explained by;
  • Other adult mental disorder
  • Organic disease, injury or dysfunction
 

 

Classification and characteristics

Cluster A

Paranoid – ‘delusional’
Schizoid – ‘socially withdrawn’
Schizotypal – ‘distorted reality’
  1. very sensitive/ easily offended
  2. suspicious
  3. distrusts loyalty
  4. holds grudges
  5. combative sense of personal rights
  6. self referential attitude
  7. unsubstantiated conspiratorial explanations
  1. No pleasure from any activities
  2. emotional coldness or flattened affectivity
  3. limited capacity to express
  4. indifferent to praise or criticism
  5. little interest in sexual experiences
  6. solitary
  7. fantasize and introspective
  1. social and interpersonal deficits
  2. magical thinking
  3. unusual perceptions
  4. vague
  5. circumstantial
  6. suspiciousness
  7. inappropriate affect
  8. excess social anxiety
 

 

 

Cluster B

 

 

Cluster C

Antisocial / Avoidant
  1. tense and apprehensive
  2. inferiority complex
  3. preoccupied with sense of rejection and criticism
  4. unwillingness to get involved
  5. need of security
  6. avoidance of social or occupational activities
 
Dependent / Asthenic
  1. allowing others to important life decisions
  2. subordination
  3. unwillingness to make any demands
  4. uncomfortable or helpless alone
  5. fear of inability to care for oneself
  6. preoccupied with fears of being left to take care of oneself
  7. excessive need for advice and reassurance to make everyday decisions
 

Treatments

Schizoid
Psychodynamic and/or group therapy
Paranoid
Not likely to seek therapy
Dissocial
Highly unresponsive to any form of treatment
Disciplined environment may improve behaviour
Emotionally unstable
Chronic treatment seekers
CBT/ DBT (self-harm & suicide)/ group therapy
Histrionic            
Psychodynamic/ CBT/ Group therapy
Borderline
DBT
Anankastic (Obsessional)
Psychotherapy: insight-oriented psychodynamic techniques & CBT
Anxious [avoidant]
 
Psychodynamic / CBT / group therapy, social skills training
Dependent
 
Psychodynamic and/or CBT and/or group therapy/ assertiveness training
 

Drugs

Most effective if individually tailored and symptom focused
  1. Antipsychotics – cognitive symptoms, impulsivity and intense angry affect
  2. Monoamine Oxidase Inhibitors – borderline PD to alleviate abnormal mood
  3. Carbamazepine and lithium – episodic behavioural dyscontrol and aggression
 
Drug treatment and psychotherapy not mutually exclusive and combination may be summative.
 

Prognosis

Cluster A: no change
Cluster B: varied, some may improve slowly
Cluster C: better outcome
Paranoid
  • Long-term prognosis usually not encouraging
Schizoid              
  • Relapse highly likely at end of treatment
 
Dissocial
  • Unremitting course
  • Early death -accident, homicide or suicide
Emotionally unstable
  • 75–80% attempt or threaten suicide
  • 8– 10% success
Histrionic
  • Symptoms can last lifetime
Anxious (avoidant)
  • Lower-functioning persons more likely to drop out of treatment.