Quick Medical Diagnosis & Treatment 2024

Personality Disorders

For further information, see CMDT Part 27-10: Personality Disorders

KEY FEATURES

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

General Considerations

Personality results from the interaction of genetics, interpersonal influences, and recurring patterns of behavior adopted to cope with the environment
Classification of personality disorder subtypes depends on the predominant symptoms and their severity
The most severe disorders are those that bring the patient into greatest conflict with society and tend to be classified as antisocial (psychopathic) or borderline
Types of personality disorders
- Antisocial (selfish, callous, promiscuous, impulsive)
- Avoidant (fear rejection, low self-esteem)
- Borderline (impulsive, unstable and intense relationships, affective instability, suicidal)
- Dependent (passive, unable to make decisions, poor self-esteem)
- Histrionic (dependent, immature, seductive, egocentric, emotionally labile)
- Narcissistic
- Obsessive-compulsive
- Paranoid
- Schizoid (introverted, withdrawn)
- Schizotypal (socially isolated, suspicious, eccentric behaviors)

CLINICAL FINDINGS

Symptoms and Signs

See Table 27–2

Table 27–2.Personality disorders: Classification and clinical findings (listed in alphabetical order).

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Table 27–2. 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.

Differential Diagnosis

Anxiety disorder (eg, general anxiety disorder)
Major depressive disorder
Psychotic disorder (eg, schizophrenia)
Substance abuse
Bipolar disorder
Personality change due to medical illness (eg, central nervous system tumor, stroke)

DIAGNOSIS

Laboratory Tests

These are mainly clinical diagnoses

TREATMENT

Medications

Pharmacotherapy can be directed to specific symptom clusters, but there is limited evidence for its efficacy in personality disorders
Medications may be ...

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