ESSENTIALS OF DIAGNOSIS
Long history dating back to childhood.
Recurrent maladaptive behavior.
Difficulties with interpersonal relationships or society.
Depression with anxiety when maladaptive behavior fails.
An individual’s personality structure, or character, is an integral part of self-image. It reflects genetics, interpersonal influences, and recurring patterns of behavior adopted to cope with the environment. The classification of subtypes of personality disorders depends on the predominant symptoms and their severity. The most severe disorders—those that bring the patient into greatest conflict with society—tend to be antisocial (psychopathic) or borderline.
CLASSIFICATION & CLINICAL FINDINGS
Table 25–3.Personality disorders: Classification and clinical findings (listed in alphabetical order). ||Download (.pdf) Table 25–3. Personality disorders: Classification and clinical findings (listed in alphabetical order).
|Personality Disorder ||Clinical Findings |
|Antisocial ||Selfish, callous, promiscuous, impulsive, unable to learn from experience, often has legal problems. |
|Avoidant ||Fears rejection, hyperreacts to rejection and failure, with poor social endeavors and low self-esteem. |
|Borderline ||Impulsive; has unstable and intense interpersonal relationships; is suffused with anger, fear, and guilt; lacks self-control and self-fulfillment; has identity problems and affective instability; is suicidal (a serious problem—up to 80% of hospitalized borderline patients make an attempt at some time during treatment, and the incidence of completed suicide is as high as 5%); aggressive behavior, feelings of emptiness, and occasional psychotic decompensation. |
|Dependent ||Passive, overaccepting, unable to make decisions, lacks confidence, with poor self-esteem. |
|Histrionic (hysterical) ||Dependent, immature, seductive, egocentric, vain, emotionally labile. |
|Narcissistic ||Exhibitionist, grandiose, preoccupied with power, lacks interest in others, with excessive demands for attention. |
|Obsessive compulsive ||Perfectionist, egocentric, indecisive, with rigid thought patterns and need for control. |
|Paranoid ||Defensive, oversensitive, secretive, suspicious, hyperalert, with limited emotional response. |
|Schizoid ||Shy, introverted, withdrawn, avoids close relationships. |
|Schizotypal ||Superstitious, socially isolated, suspicious, with limited interpersonal ability, eccentric behaviors, and odd speech. |
Patients with personality disorders tend to experience anxiety and depression when pathologic coping mechanisms fail and may first seek treatment when this occurs. Occasionally, the more severe cases may decompensate into psychosis under stress and mimic other psychotic disorders.
Social and therapeutic environments such as day hospitals, halfway houses, and self-help communities utilize peer “pressure” to modify the self-destructive behavior. The patient with a personality disorder often has failed to profit from experience, and difficulties with authority can impair the learning experience. The use of peer relationships and the repetition possible in a structured setting of a helpful community enhance the behavioral treatment opportunities and increase learning. When problems are detected early, both the school and the home can serve as foci of intensified social pressure to change the behavior, particularly with the use of behavioral techniques.