I tried to choose a few topics that would be relevant to most clinicians who work with patients with personality disorders. I first turned to borderline personality disorder BPD , which seems to give clinicians the most angst. Patients with BPD use more services than those with other personality disorders and in general compose the majority in community treatment for a primary personality disorder.
Over the past 25 years a number of effective treatments have been subjected to rigorous trials. In Part 2 of this Special Report, we review one from the cognitive-behavioral therapy CBT camp, dialectical behavior therapy , and one from the psychodynamic camp, mentalization-based therapy, though there are other effective treatments in both the CBT and psychodynamic camps. Turning from these effective psychotherapeutic treatments, we explore issues that cut across the personality disorders in general while staying close to issues prevalent among patients with BPD.
The first is narcissism and narcissistic personality disorder. The section here is not only well-written but illuminates some of the issues, controversies, and differing views of that concept.
Operational diagnostic criteria for each are provided. On axis 2, an affective recurrent and a schizophrenic continuous with exacerbations subtype can be distinguished. As a consequence, these disorders were designated to Axis II to ensure they received greater attention. Borderline personality disorder BPD is defined by the National Institute of Health NIH as a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning.
There are three clusters of personality disorders: odd or eccentric disorders; dramatic, emotional or erratic disorders; and anxious or fearful disorders. A malignant narcissist is a term used to describe a person who has symptoms of both narcissistic personality disorder and antisocial personality disorder. Combined, these disorders can show up as arrogance, a need for power and recognition, and tendencies to use or exploit others for selfish reasons.
A toxic person is anyone whose behavior adds negativity and upset to your life. Many times, people who are toxic are dealing with their own stresses and traumas. Cluster A is called the odd, eccentric cluster. The common features of the personality disorders in this cluster are social awkwardness and social withdrawal. This information is useful in planning treatment and measuring its impact, and in predicting outcome. These axes are no longer used in the current edition of the DSM.
Borderline personality disorder BPD and other personality disorders are typically diagnosed using the official guidebook for the diagnosis of psychiatric disorders , the Diagnostic and Statistical Manual of Mental Disorders currently in its fifth edition, the DSM This means that when a diagnosis was made, attention was paid to five different areas, or axes, that could affect the individual who was being diagnosed.
Axis I was for the diagnosis of clinical disorders, the conditions that people most often think of when they think of psychiatric disorders. For example, major depressive disorder or post-traumatic stress disorder would have been diagnosed on Axis I. Axis II was reserved for long-standing conditions of clinical significance, like personality disorders and mental retardation.
These disorders typically last for years, are present before adulthood, and have a significant impact on functioning. In theory, personality disorders were relegated to Axis II because this was a way to make sure that they did not get overlooked.
If a person had multiple clinical disorders on Axis I, coding the personality disorders on Axis II helped make the contribution of the personality disorder stand out. Whereas the Axis I disorders tend to be episodic, meaning they are on-again, off-again, personality disorders are thought of as chronic, meaning they occur over years. DSM-5 did away with the axis system, relegating everything to one axis to ostensibly make diagnosing easier, as well as removing what was thought to be an artificial distinction among conditions.
However, diagnosing, assessing, and treating personality disorders are basically the same as in DSM-IV, including the symptoms that need to be present in order to diagnose BPD. The hallmark BPD is a pervasive pattern instability in relationships, self-image, and moods.. To be diagnosed with borderline personality disorder, you must have at least five of the following symptoms:.
Is the patient unstable? In complicated or ambiguous cases, the diagnosis of a personality disorder not otherwise specified is appropriate, indicating that traits need to be clarified. This notation frequently is seen under axis II, and often is carried through the medical record for months or years. Psychiatrists are reluctant to diagnose a personality disorder because of the pejorative nature a diagnosis conveys.
Nevertheless, by the second or third visit—after 2 or 3 hours of interview contact—it should be evident whether a personality disorder exists. This notation can be adjusted if such evidence comes to light. This diagnosis often is made mistakenly when the root problem is in fact a substance abuse disorder. A multi-decade study of alcoholism and antisocial personality attributes in university students illustrated this phenomenon. Substance abusers might become belligerent when intoxicated.
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