Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from cultural expectations. This article reviews diagnosis and treatment approaches.
GENERAL CRITERIA
- Enduring pattern affecting cognition, affectivity, interpersonal functioning, and impulse control
- Pattern is inflexible and pervasive across situations
- Leads to clinically significant distress or impairment
- Pattern is stable and of long duration (onset in adolescence or early adulthood)
- Not better explained by another mental disorder, substance, or medical condition
CLUSTER A (Odd/Eccentric)
Paranoid PD
- Pervasive distrust and suspiciousness
- Interpretation of others' motives as malevolent
Schizoid PD
- Detachment from social relationships
- Restricted range of emotional expression
Schizotypal PD
- Acute discomfort in close relationships
- Cognitive/perceptual distortions and eccentricities
CLUSTER B (Dramatic/Emotional/Erratic)
Antisocial PD
- Disregard for and violation of rights of others
- Pattern of deceitfulness, impulsivity, aggressiveness
- Age ≥18 with conduct disorder history before age 15
Borderline PD
- Instability in interpersonal relationships, self-image, and affects
- Marked impulsivity
- Frantic efforts to avoid abandonment
- Recurrent suicidal behavior or self-harm
Histrionic PD
- Excessive emotionality and attention-seeking
Narcissistic PD
- Grandiosity, need for admiration, lack of empathy
CLUSTER C (Anxious/Fearful)
Avoidant PD
- Social inhibition, feelings of inadequacy, hypersensitivity to criticism
Dependent PD
- Excessive need to be taken care of
- Submissive and clinging behavior
ObsessiveCompulsive PD
- Preoccupation with orderliness, perfectionism, and control
- Different from OCD (no true obsessions/compulsions)
TREATMENT OF BORDERLINE PD
Psychotherapy (Firstline)
1. Dialectical Behavior Therapy (DBT) - Most evidence
2. Mentalization-Based Treatment (MBT)
3. Transference-Focused Psychotherapy (TFP)
4. Schema Therapy
Pharmacotherapy
- Target specific symptoms (mood instability, impulsivity, transient psychosis)
- No FDA-approved medications specifically for BPD
- SSRIs, mood stabilizers, low-dose antipsychotics may help
PROGNOSIS
- Many patients improve over time
- BPD symptoms often diminish by age 40-50
- Early intervention improves outcomes
- Mortality from suicide approximately 10% in BPD