/Personality Disorder – Part 3

Personality Disorder – Part 3

Personality Disorder – Part 1
Personality Disorder – Part 2

Enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.

OCPD/ Anankastic Personality Disorder

  • A pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness as indicated by >4 of the following:
  • Preoccupied with details, rules, lists, order or schedules to the extent that the major point of the activity is lost
  • Shows rigidity and stubbornness
  • Perfectionism that interferes with task completion
  • Excessively devoted to work and productivity to the exclusion of leisure activity and friends
  • Over conscientious and inflexible about matters of morals or ethics
  • Is unable to discard worn or worthless objects even those without sentimental value
  • Reluctant to delegate tasks
  • Adopts miserly spending style toward self and others
  • Sex ratio:  M:F=2:1
  • Comorbidity:  Slight increase in mood and anxiety disorders
  • Family:  Obsessive-compulsive personality disorder

Challenge of Working With Personality Disorders

  • Patients typically come for therapy with presenting problems other than personality problems
  • They require more work within the session
  • Longer duration of treatment
  • Greater strain on the therapist’s skills and patience
  • Greater difficulty in treatment compliance

Treatment

 

  • Can reduce symptomatology, improve social and interpersonal functioning, reduce the frequency of maladaptive behaviors and decrease hospitalizations.
  • Always screen for comorbid psychiatric diagnosis
  • If the personality disorder is ego-syntonic (eg. Antisocial and Narcissistic) it will be hard to engage the patient in treatment

Medications

  • Increasing serotonin levels may reduce depression, impulsiveness, rumination and may enhance a sense of well being
  • Low dose neuroleptics and mood stabilizers can be effective in modulating affective stability

Therapy

  • For BPD DBT, Schema-focused therapy, transference-focused therapy and Mentalization-based treatment have all been found to be effective.
  • Therapy for other disorders limited to a small number of open labeled trials and case studies. These findings have been positive.

Screening for comorbid disorders

  • Antisocial PD: Alcohol dependence and depressive disorders
  • BPD: alcohol and drug dependence, mood disorders, anxiety disorders inc PTSD
  • Histrionic PD: alcohol dependence, somatization disorder
  • Avoidant PD: social phobia
  • Any PD puts pt at higher risk than the general population for drug dependency.