Personality Disorders

A Personality Disorder is an enduring, stable, pervasive, and inflexible pattern
of internal experiencing. They often manifest in adolescence or early adulthood and include behaviors that deviates significantly from cultural norms. In addition, symptoms cause significant leading distress and impairment in personal and social functioning. Journal of Clinical Psychiatry (2004): “14.8% of Americans (30.8M adults) meet diagnostic criteria for at least one personality disorder.”  

TYPES and PREVALENCE (% of general population)

Antisocial – (3.6%) marked with disregard for and violation of the rights of others (often starts as Conduct Disorder in childhood)

Avoidant – (2.4%) characterized by social inhibition, feelings of inadequacy, and hypersensitivity to criticism

Borderline – (2%) high in impulsivity and interpersonal relationships, self image, and affect are unstable

Dependent – (0.5%) submissive and clinging behavior in response to a need to be taken care of

Histrionic – (1.8%) excessive emotionality and attention seeking

Narcissistic – (6%) grandiosity, need for admiration, and lack of empathy

Obsessive-Compulsive – (7.9%) preoccupation with orderliness, perfectionism, and
control.

Paranoid – (4.4%) distrust and suspiciousness that others’ motives are malevolent

Schizoid – (3.1%) detachment from social relationships

Schizotypal – acute discomfort in close relationships plus cognitive or perceptual distortions and   eccentric behavior

Personality disorders generally require psychotropic medication and psychotherapy treatment due to the prolonged and severe nature of symptomology and level of impaired functioning. Unfortunately, treatment may be difficult to initiate or maintain due to barriers, such as patient denial, medication attrition, expense, and duration of treatment. Despite these obstacles, therapy is warranted as most of the types have severe consequences not only for the patient but for his/her family and social networks.

Psychotherapy for personality disorders is often focused on improving perceptions of and responses to social and environmental stressors, as well as social skills training. Some treatment options include but are not limited to…

  • Psychodynamic psychotherapy: assumes perceptions are shaped by early life experiences. Thus the focus of treatment is aims to identify perceptual distortions and their historical sources.  Goals may include the development of more adaptive modes of perception and response. Treatment is long term; usually extended over a course of several years at a frequency from several times a week to once a month. 
  • Cognitive therapy (also called cognitive behavior therapy [CBT]): assumes cognitive errors based on long-standing beliefs influence the meaning attached to interpersonal events. Focus of treatment is how people think about and perceive heir world. Goals may include reformulating perceptions and behaviors. This therapy is typically limited: duration of 6-20 weeks (still more than the national average), once weekly; however, in the case of personality disorders, episodes of therapy are repeated often over the course of years. Mindfulness therapy may be useful in treating PDs.
  • Group psychotherapy allows interpersonal psychopathology to display itself among peer patients, whose feedback is used by the therapist to identify and correct maladaptive ideas, communication, and behavior. Sessions are usually once weekly over a course that may range from several months to years. Ease of access and duration of services, as well as the interpersonal nature of groups can make them a good option for those with PDs.
  • Dialectical behavior therapy (DBT): This is a skills-based therapy (developed by Marsha Linehan, PhD) that can be used in both individual and group formats. Assumes maladaptive coping and focuses on development of coping skills to improve affective stability and impulse control and on reducing self-harmful behavior. Tested for BPD, weekly one-on-one counselor and group training sessions on skills such as distress tolerance, interpersonal effectiveness, emotion regulation and mindfulness skills can be helpful. More research is needed on other PDs.
  • Systemic Therapy (e.g., family therapy) are about contextualizing issues and examining
    relationship patterns in human systems (Jenkins and Asen, 1992). Family therapy is usually suggested when either PD symptoms are negatively impacting the functioning of the family, or when problems in the family may be making the PD symptoms worse. Sometimes these two problems interact — the BPD symptoms impair family functioning, and poor family functioning makes the BPD symptoms worse.
  • Integrative Relational Psychotherapy (IRP): Combining a rigorous biopsychosocial model of personality with a relational framework for patient assessment and treatment planning, IRP is designed to produce rapid and sustained systemic change in patients suffering from virtually all DSM-identified personality disorders.

Sources

http://www.nih.gov/news/pr/aug2004/niaaa-02.htm

http://pn.psychiatryonline.org/cgi/content/full/43/15/38

http://www.apa.org/monitor/mar04/treatment.aspx5;’?<M

http://emedicine.medscape.com/article/294307-treatment

Linehan, M.M. (2000). The empirical basis of dialectical behavior therapy: Development of new treatments versus evaluation of existing treatments. Clinical Psychology: Science and Practice,(1), 113-119.

Verheul, R., Van Den Bosch L.M., Koeter, M.W., De Ridder, M.A., Stijnen, T., Van Den Brink, W. (2003). Dialectical behavior therapy for women with borderline personality disorder: 12-month, randomized clinical trial in The Netherlands. British Journal of Psychiatry, 182, 135-40.

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