Personality disorder natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Priyanka Kumari, M.B.B.S[2]
Overview
Personality disorders usually begin to develop in early adolescence and are diagnosed in early adulthood. The complications can occur at any stage and can add to a worsening prognosis. Suicidality is the most common complication. Others include injuries from fights and accidents, sexually acquired infections from presumptuous sex, and substance use disorder. It also adds to the morbidity by causing personal functional impairment and affecting family life. The mortality in PD is more than in the general population. The life expectancy in such individuals is influenced by psychotherapy initiation, treatment compliance, co-morbid conditions, and social support.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of personality disorder usually develop in the first decade of life and in adolescence. An age of at least 18 years is required for diagnosis of personality disorder.
- The symptoms of personality disorder are typically present for a long duration before diagnosis is made.
- If left untreated, individuals tend to develop multiple complications which can prove a social and financial burden. Conflict-filled relationships, manifold legal issues, poor interpersonal correspondence, and frequent changes in jobs. The co-occuring substance abuse and eating disorder can prove hazardous for health. Frequent alcohol abuse can cause liver cirrhosis, chronic liver failure, dilated cardiomyopathy and heart failure. Tobacco usage can result in chronic obstructive pulmonary disease, permanent lung damage and multiple visceral malignancies. Moreover, acute problems like acute encephalopathy, delirium, seizures, motor vehicle accidents, and heart arrhythmias can result. Intravenous drug abuse can result in infective endocarditis, septic embolism and multi-organ failure.
Complications
- Common complications of personality disorder include:
- Suicide
- Homicide
- Substance Abuse
- Depression
- Sexually Transmitted diseases like HIV, hepatitis C, Syphilis.
- Pathological gambling
- Anorexia Nervosa and Bulimia
- Schizophreniform disorder and Delusional disorder
- Somatization Disorder
Prognosis
Personality disorders usually begin to develop in early adolescence and are diagnosed in early adulthood. The symptoms are usually apparent for a long time, indicating the long-term course of the disorder in life. Moreover, it also affects functioning in several aspects that can cause personal impairment and social distress. Stigmatization exists after the diagnosis is established and prevents individuals from seeking treatment at an earlier stage. However, with appropriate psychotherapy and keeping symptoms under control with medications, disease stability is achieved and even complete remission. A follow-along study performed by Skodol et al. demonstrated that remission was seen in the case of avoidant and schizotypal PD with a greater number of positive experiences and building interpersonal skills at a young age. Another ten years follow-up study to observe remission in BPD was done by Zanarini et al., which revealed that 80% of individuals achieved remission and their 16 years follow-up showed sustained symptomatic remission [1] [2]. The complications can occur at any stage and can add to a worsening prognosis. Among them, suicidality is of foremost significance. Others include injuries from fights and accidents, sexually acquired infections from presumptuous sex, and substance use disorder. It also adds to the morbidity by causing personal functional impairment and affecting family life. The mortality in PD is more than in the general population. A famous study spanning 24 years was performed on patients with PDs, and it was found that 5.9% of patients with BPD died by suicide vs. 1.4% of the comparison group and 14% vs. 5.5% with other non-suicide causes. In addition, those patients who did not achieve recovery were at higher risk of early death [3]. Thus, PDs follow a waxing and waning course throughout life with periods marked by flares and remission. The life expectancy in such individuals is influenced by psychotherapy initiation, treatment compliance, co-morbid conditions, and social support. In most cases, it is lesser than average in the normal individual.
References
- ↑ Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR (2006). "Prediction of the 10-year course of borderline personality disorder". Am J Psychiatry. 163 (5): 827–32. doi:10.1176/ajp.2006.163.5.827. PMID 16648323.
- ↑ Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G (2012). "Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study". Am J Psychiatry. 169 (5): 476–83. doi:10.1176/appi.ajp.2011.11101550. PMC 3509999. PMID 22737693.
- ↑ Temes CM, Frankenburg FR, Fitzmaurice GM, Zanarini MC (2019). "Deaths by Suicide and Other Causes Among Patients With Borderline Personality Disorder and Personality-Disordered Comparison Subjects Over 24 Years of Prospective Follow-Up". J Clin Psychiatry. 80 (1). doi:10.4088/JCP.18m12436. PMID 30688417) Check
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