Personality Disorders

 

• Definition

  • Personality – i.e. enduring traits – which causes distress to self/others and/or impairs social functioning.
  • 3 DSM-5 clusters: odd/eccentric (A), dramatic/emotional (B), and anxious/avoidant (C).

• Odd or eccentric personality disorders

  Cluster A in DSM-5.

  Paranoid

  • Resentful and self-important.
  • Suspicious and distrustful.
  • Bears grudges and may counter-attack.

  Schizoid

  • Cold, aloof, introspective, and misanthropic.
  • Lacks enjoyment.

  Schizotypal

  • Social anxiety.
  • Odd behaviours and beliefs.

• Dramatic or emotional personality disorders

  Cluster B in DSM-5.

  Antisocial

  • Aka dissocial PD, psychopathy, dangerous and severe personality disorder.
  • Disregard for rights of others.
  • Little remorse for actions.

  Borderline

  • Aka emotionally-unstable PD.
  • Rapid-fluctuating mood and strong emotions.
  • Impulsive. Often self-harm and misuse substances.
  • Intense unstable relationships.
  • Commonest in young women.

  Histrionic

  • Shallow and labile affect.
  • Dramatic and suggestible.
  • Concern with physical attractiveness.

  Narcicisstic

  • Preoccupied with prestige and appearance. Attention-seeking.
  • Think they're superior and have a strong sense of entitlement.
  • Lack empathy or true intimacy in relationships.
  • Critical of others but cannot handle criticism.

• Anxious or avoidant personality disorders

  Cluster C in DSM-5.

  Avoidant

  • Aka anxious PD.
  • Want acceptance but expect rejection and fear embarrassment.
  • Severely hurt by criticism.
  • Consequently, avoid others.

  Dependant

  • Submissive.
  • Feel they can't look after themselves and allow others to make decisions for them.

  Obsessive-compulsive

  • Aka anankastic PD.
  • Perfectionist, pedantic, and inflexible. Like routines, lists, and organisation. May be obsessed with work. Morally rigid.
  • Unlike OCD, they derive contentment and enjoyment from perfection and rituals. Tend to seek help when friends/relatives tell them to, unlike in OCD where people seek help for their distress.

• Management of personality disorders

  There are few specific therapies for personality disorders. Often, providing psychoeducation and support is the most effective intervention.

  Biological:

  • Little evidence of direct benefit for personality disorders.
  • More likely to be used for treatment of psychiatric co-morbidities, which is key.

  Psychosocial:

  • Psychotherapy may focus on problem-solving for difficult emotions and behaviours, and negotiating the interpersonal problems they face.
  • Approaches include CBT and dialectical behavioural therapy (DBT). DBT involves individual and group sessions, and combines elements of mindfulness and CBT, as well as building self-esteem.
  • Where relevant, involve family in treatment, including for crisis management.