Interpersonal diagnosis and treatment of personality disorders pdf
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Treatment of Personality Disorders pp Cite as.
What Are DSM Personality Disorders?
Personality disorders PD are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability.
The definitions may vary somewhat, according to source, and remain a matter of controversy. Personality , defined psychologically, is the set of enduring behavioral and mental traits that distinguish individual humans.
Hence, personality disorders are defined by experiences and behaviors that deviate from social norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. Personality disorders are characterized by an enduring collection of behavioral patterns often associated with considerable personal, social, and occupational disruption. Personality disorders are also inflexible and pervasive across many situations, largely due to the fact that such behavior may be ego-syntonic i.
In addition, people with personality disorders often lack insight into their condition and so refrain from seeking treatment. This behavior can result in maladaptive coping skills and may lead to personal problems that induce extreme anxiety, distress, or depression and result in impaired psychosocial functioning.
These behavior patterns are typically recognized by adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life. While emerging treatments, such as dialectical behavior therapy , have demonstrated efficacy in treating personality disorders, such as borderline personality disorder ,  personality disorders are associated with considerable stigma in popular and clinical discourse alike.
They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations. The ICD system is a collection of numerical codes that have been assigned to all known clinical disease states, which provides uniform terminology for medical records, billing, and research purposes.
The DSM defines psychiatric diagnoses based on research and expert consensus, and its content informs the ICD classifications. Both have deliberately merged their diagnoses to some extent, but some differences remain. For example, ICD does not include narcissistic personality disorder as a distinct category, while DSM-5 does not include enduring personality change after catastrophic experience or after psychiatric illness.
ICD classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other. Both diagnostic systems provide a definition and six criteria for a general personality disorder.
These criteria should be met by all personality disorder cases before a more specific diagnosis can be made. The ICD lists these general guideline criteria: . The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. In DSM-5 , any personality disorder diagnosis must meet the following criteria: . Chapter V in the ICD contains the mental and behavioral disorders and includes categories of personality disorder and enduring personality changes.
They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks, and feels, particularly in relating to others.
The specific personality disorders are: paranoid , schizoid , dissocial , emotionally unstable borderline type and impulsive type , histrionic , anankastic , anxious avoidant and dependent. In the proposed revision of ICD , all discrete personality disorder diagnoses will be removed and replaced by the single diagnosis "personality disorder".
Instead, there will be specifiers called "prominent personality traits" and the possibility to classify degrees of severity ranging from "mild", "moderate", and "severe" based on the dysfunction in interpersonal relationships and everyday life of the patient.
The most recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders stresses that a personality disorder is an enduring and inflexible pattern of long duration leading to significant distress or impairment and is not due to use of substances or another medical condition.
The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously. DSM-5 lists ten specific personality disorders: paranoid , schizoid , schizotypal , antisocial , borderline , histrionic , narcissistic , avoidant , dependent and obsessive-compulsive personality disorder. The DSM-5 also contains three diagnoses for personality patterns not matching these ten disorders, but nevertheless exhibit characteristics of a personality disorder: .
The specific personality disorders are grouped into the following three clusters based on descriptive similarities:. Cluster A personality disorders are often associated with schizophrenia: in particular, schizotypal personality disorder shares some of its hallmark symptoms with schizophrenia, e. However, people diagnosed with odd-eccentric personality disorders tend to have a greater grasp on reality than those with schizophrenia. Patients suffering from these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships.
Though their perceptions may be unusual, these anomalies are distinguished from delusions or hallucinations as people suffering from these would be diagnosed with other conditions. Significant evidence suggests a small proportion of people with Cluster A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders.
These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder. Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. Examples include sadistic personality disorder pervasive pattern of cruel, demeaning, and aggressive behavior and self-defeating personality disorder or masochistic personality disorder characterized by behavior consequently undermining the person's pleasure and goals.
Psychologist Theodore Millon , who has written numerous popular works on personality, proposed the following description of personality disorders:. In addition to classifying by category and cluster, it is possible to classify personality disorders using additional factors such as severity, impact on social functioning, and attribution.
In addition to subthreshold personality difficulty and single cluster simple personality disorder , this also derives complex or diffuse personality disorder two or more clusters of personality disorder present and can also derive severe personality disorder for those of greatest risk. There are several advantages to classifying personality disorder by severity: .
Social function is affected by many other aspects of mental functioning apart from that of personality. However, whenever there is persistently impaired social functioning in conditions in which it would normally not be expected, the evidence suggests that this is more likely to be created by personality abnormality than by other clinical variables. Many who have a personality disorder do not recognize any abnormality and defend valiantly their continued occupancy of their personality role.
This group have been termed the Type R, or treatment-resisting personality disorders, as opposed to the Type S or treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment. There is a considerable personality disorder diagnostic co-occurrence.
Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another.
It is generally assumed that all personality disorders are linked to impaired functioning and a reduced quality of life QoL because that is a basic diagnostic requirement. But research shows that this may be true only for some types of personality disorder.
In several studies, higher disability and lower QoL were predicted by avoidant, dependent, schizoid, paranoid, schizotypal and antisocial personality disorder. This link is particularly strong for avoidant , schizotypal and borderline PD. However, obsessive-compulsive PD was not related to a compromised QoL or dysfunction.
A prospective study reported that all PD were associated with significant impairment 15 years later, except for obsessive compulsive and narcissistic personality disorder. One study investigated some aspects of "life success" status, wealth and successful intimate relationships.
It showed somewhat poor functioning for schizotypal, antisocial, borderline and dependent PD, schizoid PD had the lowest scores regarding these variables. Paranoid, histrionic and avoidant PD were average. Narcissistic and obsessive-compulsive PD, however, had high functioning and appeared to contribute rather positively to these aspects of life success.
There is also a direct relationship between the number of diagnostic criteria and quality of life. For each additional personality disorder criterion that a person meets there is an even reduction in quality of life. Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace—potentially leading to problems with others by interfering with interpersonal relationships.
Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as substance abuse and co-morbid mental disorders, can plague sufferers. However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.
In and again in , psychologists Belinda Board and Katarina Fritzon at the University of Surrey , UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK.
They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:. According to leadership academic Manfred F. Kets de Vries , it seems almost inevitable that some personality disorders will be present in a senior management team.
Early stages and preliminary forms of personality disorders need a multi-dimensional and early treatment approach. Personality development disorder is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood. Krueger's review of their research indicates that some children and adolescents do suffer from clinically significant syndromes that resemble adult personality disorders, and that these syndromes have meaningful correlates and are consequential.
Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual. Hence, they are less likely to encounter the first risk they described at the outset of their review: clinicians and researchers are not simply avoiding use of the PD construct in youth.
However, they may encounter the second risk they described: under-appreciation of the developmental context in which these syndromes occur. That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases. The disorders in each of the three clusters may share with each other underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively.
But they may also have a spectrum relationship to certain syndromal mental disorders: . The issue of the relationship between normal personality and personality disorders is one of the important issues in personality and clinical psychology. The personality disorders classification DSM-5 and ICD follows a categorical approach that views personality disorders as discrete entities that are distinct from each other and from normal personality.
In contrast, the dimensional approach is an alternative approach that personality disorders represent maladaptive extensions of the same traits that describe normal personality. Thomas Widiger and his collaborators have contributed to this debate significantly. Specifically, he proposed the Five Factor Model of personality as an alternative to the classification of personality disorders.
For example, this view specifies that Borderline Personality Disorder can be understood as a combination of emotional lability i. Many studies across cultures have explored the relationship between personality disorders and the Five Factor Model.
In clinical practice, individuals are generally diagnosed by an interview with a psychiatrist based on a mental status examination , which may take into account observations by relatives and others. One tool of diagnosing personality disorders is a process involving interviews with scoring systems. The patient is asked to answer questions, and depending on their answers, the trained interviewer tries to code what their responses were. This process is fairly time-consuming.
As of , there were over fifty published studies relating the five factor model FFM to personality disorders. The five factor model has been shown to significantly predict all 10 personality disorder symptoms and outperform the Minnesota Multiphasic Personality Inventory MMPI in the prediction of borderline, avoidant, and dependent personality disorder symptoms.
Research results examining the relationships between the FFM and each of the ten DSM personality disorder diagnostic categories are widely available. For example, in a study published in titled "The five-factor model and personality disorder empirical literature: A meta-analytic review",  the authors analyzed data from 15 other studies to determine how personality disorders are different and similar, respectively, with regard to underlying personality traits. In terms of how personality disorders differ, the results showed that each disorder displays a FFM profile that is meaningful and predictable given its unique diagnostic criteria.
With regard to their similarities, the findings revealed that the most prominent and consistent personality dimensions underlying a large number of the personality disorders are positive associations with neuroticism and negative associations with agreeableness.
At least three aspects of openness to experience are relevant to understanding personality disorders: cognitive distortions , lack of insight and impulsivity.
Problems related to high openness that can cause problems with social or professional functioning are excessive fantasising , peculiar thinking, diffuse identity, unstable goals and nonconformity with the demands of the society.
Lorna Smith Benjamin
WARD, M. Patients with personality disorders are common in primary care settings; caring for them can be difficult and frustrating. These chronic, inflexible styles of perceiving oneself and interacting with others vary widely in presentation. Knowledge of the core characteristics of these disorders allows physicians to recognize, diagnose, and treat affected patients. The goal of management is to develop a working relationship with patients to help them receive the best possible care despite their chronic difficulties in interacting with physicians and the health care system. Effective interpersonal management strategies exist for these patients.
NCBI Bookshelf. Borderline Personality Disorder: Treatment and Management. Whatever the purported underlying psychological structures, the cluster of symptoms and behaviour associated with borderline personality were becoming more widely recognised, and included striking fluctuations from periods of confidence to times of absolute despair, markedly unstable self-image, rapid changes in mood, with fears of abandonment and rejection, and a strong tendency towards suicidal thinking and self-harm. Transient psychotic symptoms, including brief delusions and hallucinations, may also be present.
Personality is vital to defining who we are as individuals. It involves a unique blend of traits—including attitudes, thoughts, behaviors, and moods—as well as how we express these traits in our contacts with other people and the world around us. A personality disorder can develop if certain personality traits become too rigid and inflexible. People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning.
Personality disorders in general are pervasive, enduring patterns of perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. Many gradually become less severe with age, but certain traits may persist to some degree after the acute symptoms that prompted the diagnosis of a disorder abate. Diagnosis is clinical. Treatment is with psychosocial therapies and sometimes drug therapy. Personality traits represent patterns of thinking, perceiving, reacting, and relating that are relatively stable over time. These social maladaptations can cause significant distress in people with personality disorders and in those around them.
Relatively common, chronic pattern of perceptual and behavioral abnormalities. These manifest as problems in at least two of the following domains: cognitive-perceptual, affect regulation, interpersonal functioning, or impulse control. Typical presentation involves comorbid disorders more than one personality disorder or additional diagnoses of depression, anxiety, somatoform, or substance abuse disorder. Ongoing relationship with primary care physician is essential but may be challenging to maintain.
Because personality disorders are associated with significant impairment in interpersonal relationships, special issues and problems arise in the formation of a therapeutic alliance in the treatment of patients with these disorders. In particular, patients with narcissistic, borderline, and paranoid personality traits are likely to have troubled interpersonal attitudes and behaviors that will complicate the patient's engagement with the therapist. While a strong positive therapeutic alliance is predictive of more successful treatment outcomes, strains and ruptures in the alliance may lead to premature termination of treatment. Therefore, clinicians need to consider the patient's characteristic way of relating in order to select appropriate interventions to effectively retain and involve the patient in treatment. Research has shown not only the importance of building an alliance but also that this alliance is vital in the earliest phase of treatment.
Glen A. Eskedal, Jamie M. Journal of Mental Health Counseling 1 January ; 28 1 : 1— Of challenge to mental health counselor's MHCs is the management and treatment of personality disorders. This article will elaborate on the etiological development of Cluster C personality disorders avoidant, dependant, and obsessive-compulsive , review the self-maintenance functions they provide, and review the cognitive-behavioral, group, and psychodynamic treatments for each of the three Cluster C personality disorders. The central aim of this manuscript is to assist MHCs in better understanding biological and environmental antecedents, treatment interventions, and to ensure that personality dynamics are not overlooked in the treatment process. Sign In or Create an Account.
Personality disorders in general are pervasive, enduring patterns of perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. Many gradually become less severe with age, but certain traits may persist to some degree after the acute symptoms that prompted the diagnosis of a disorder abate. Diagnosis is clinical. Treatment is with psychosocial therapies and sometimes drug therapy. Personality traits represent patterns of thinking, perceiving, reacting, and relating that are relatively stable over time.
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