Personality disorder
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Personality disorder from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Personality Change Due to Another Medical Condition
Diagnosis
Treatment
Psychotherapy
Psychotherapy is the mainstay and core management for PDs. It is a collaborative treatment that aims to improve the perception of the disease and rectify the response to social and personal problems with ameliorated behavior. Psychodynamic psychotherapy (PDT) focuses on self-reflection and the identification of perceptual distortions. It then enables an individual to develop adaptive responses to varying stimuli. Emotional conflicts, defence mechanisms and unconscious thoughts are recognised and analysed. This is then used to counter and resolve the unconscious conflicts and relational difficulties. It is performed twice to four weeklies for many months. Cognitive-behavioral therapy (CBT) is based on recognizing distortion in thought processes and rectify the cognition pattern, thus establishing emotional stability and behavioral regulation. It is done once weekly for many months to years. It is used in ASPD, BPD, and substance use disorder. Dialectical-behavioral therapy is s subtype of CBT that reinforces and integrates positive emotions, thoughts, and behaviors by changing the negative thinking patterns. The word 'dialect' means 'synthesis or integration of opposites.' It equips patients with new enhanced coping skills to manage their painful conflicting emotions and control their impulses and self-destructing behavior. It is a significant therapy in cluster-B PDs. Interpersonal therapy comprises individual sessions that focus on improving interpersonal and social relationships. It involves finding triggers such as adjustment difficulty, role transition or dispute, and interpersonal deficit; and working together with the individual to challenge them and establish new positive roles. It is used for mood disorders and can be used in BPD. It is conducted weekly for 6-12 months. Dynamic Group psychotherapy harnesses the dynamic existing among individuals and utilizes it to bring out constructive and optimistic behaviors. Feedback from patients is beneficial to produce a therapeutic response. It is also carried out weekly for months. A multi-wave study done by Clarkin et al. in 2007 studied the PDT, Dialectal behavioral therapy, and dynamic supportive therapy in the management of BPD. It demonstrated that PDT and DST were associated with improvement in anger and impulsivity, PDT and dialectical behavioral therapy lead to improvement in suicidality, and only PDT was found to be a predictor of verbal and direct assault [1]. European guidelines have the strongest recommendation for psychotherapy for BPD. Cognitive-behavioral therapy for ASPD is recommended by British and German guidelines. American society of Psychiatry recommends dialectical behavioral therapy and psychodynamic therapy for BPD.
Medical Therapy
No medical therapy is approved by Food and Drug administration, FDA for treatment of personality disorders. Pharmacotherapy is utilised to manage symptoms during acute decompensation and trait vulnerabilities. Mood dysregulatory symptoms like emotional lability, anger outbursts, depressive crashes, and other affective dysregulation symptoms are managed with (selective serotonin reuptake inhibitors) SSRIs or selective norepinephrine reuptake inhibitors (SNRIs) like venlafaxine. Mood stabilizers like lithium, valproate, carbamazepine, lamotrigine or topiramate are used as second line. Impulse control dyscontrol symptoms are self-mutilation, aggression, eroticism, reckless sex, extravagant spending and uncontrolled substance use. They are managed with SSRIs as first line and monoamine oxidase inhibitors (MAOIs) as second line [2]. British guidelines recommend against the use of medications for these symptoms [3]. Cognitive perceptual symptoms incorporate paranoia, delusions, hallucination, derealisation, depersonalization and suspiciousness. Low dose neuroleptics or antipsychotic medications are used. They help with psychotic symptoms as well as mood issues.
Case Studies
Related Chapters
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- ↑ Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF (2007). "Evaluating three treatments for borderline personality disorder: a multiwave study". Am J Psychiatry. 164 (6): 922–8. doi:10.1176/ajp.2007.164.6.922. PMID 17541052. Review in: Evid Based Ment Health. 2008 Feb;11(1):24
- ↑ "psychiatryonline.org" (PDF).
- ↑ "European guidelines for personality disorders: past, present and future | Borderline Personality Disorder and Emotion Dysregulation | Full Text".