Personality Disorders

Dr Tom Leach

8 years ago

Contents

Introduction
Classification and characteristics
Treatments
- Drugs
Prognosis
References
Related Articles

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:

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Paranoid – ‘delusional’	Schizoid – ‘socially withdrawn’	Schizotypal – ‘distorted reality’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

Cluster B

Cluster C

Antisocial / Avoidant

tense and apprehensive
inferiority complex
preoccupied with sense of rejection and criticism
unwillingness to get involved
need of security
avoidance of social or occupational activities

Dependent / Asthenic

allowing others to important life decisions
subordination
unwillingness to make any demands
uncomfortable or helpless alone
fear of inability to care for oneself
preoccupied with fears of being left to take care of oneself
excessive need for advice and reassurance to make everyday decisions

Treatments

<td “>Borderline

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
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

Antipsychotics – cognitive symptoms, impulsivity and intense angry affect
Monoamine Oxidase Inhibitors – borderline PD to alleviate abnormal mood
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% suicide rate

Histrionic

Symptoms can last lifetime

Anxious (avoidant)

Lower-functioning persons more likely to drop out of treatment.