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
- 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
- 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
- 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.