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Personality disorders are pervasive and largely inflexible patterns of inner thoughts and behaviours markedly different from others of the individuals's culture and leading to significant impairment in social, occupational, or other settings.Two or more of the following are affected:
For more information, please see assessing personality disorders.
Cluster A
Paranoid personality disorder Schiziod personality disorder Schizotypal personality disorder
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Cluster B
Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder |
Cluster C
Avoidant Personality Disorder Dependent Personality Disorder Obsessive-compulsive personality disorder
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Quality of life: complete physical, mental, and social well-being, not just the absence of disease and infirmity.
Cluster A, avoidant, dependent and borderline folks may have lower quality of life.
By definition these folks can be difficult to work with; counter-transference is common. Often co-morbid with Axis I disorders, or Axis I conditions may be mimic a PD.
For the most part, they do not tend to repsond well to medication, but can often respond to certain types of psychotherapy.
Cannot be diagnosed before the age of 18 or due to an underlying medical condition. And cannot be diagnosed because a patient is difficult or we don't like them.
PD Diagnoses can be different because the categories may not be as useful as a 'dimensional' model in which certain personality traits (ie sociability) are considered separately. Patients often fit more than one category, and patients with an untreated Axis I disorder can lead to personality symptoms.
PD diagnoses can also be used in a negative, stigmatizing way.
distrust and suspiciousness
detachment from relationships and restricted range of emotion expression
reduced capacity for close relationships and eccentricity
don't often present to psychiatrists
disregard for and violation of the rights of others
Borderline personaliity disorder (BPD) is one of the most studied and most challenging personality disorders.
Diagnosis requires 4 of the following:
May be related to reactive attachment disorder in children.
There seems to be a preponderance of childhood sexual assault.
Health care providers should set clear boundaries with patients regarding visits. Ensure the patient's concerns are explored quickly at the introduction of the interview; don't allow them to spend too much time asking personal questions.
People with borderline personality disorder are often greatly stigmatized by health.
Suicide assessment is critical.
Admissions should be approached with great caution, especially with long-term stays. Short-stay visits may be necessary for suicidality, crisis-management.
Dialectical behaviour therapy (DBT) can be useful, especially to help people decide on goals. Group therapy can also be useful
Interpersonal therapy can also be good to help people
There is a very high rate of concurrent substance abuse, depression, chronic pain (Sansone and Sansone, 2012), and other conditions.
grandiosity and lack of empathy
Avoiding people and places
unwilling to be in contact with people unless they are certain they will be liked
generally not strong communicators
view themselves
ensure this is not depression.
Need to be cared for, submissiveness
preoccupation with orderliness, perfectionism, and control at the expense of flexibility, openness, and efficiency
No obsessions
Sansone RA, Sansone LA. 2012. Chronic pain syndromes and borderline personality. Innov Clin Neurosci. 9(1):10-4.