Personality disorders

Personality disorders are a relatively common, chronic pattern of perceptual and behavioural abnormalities. These manifest as problems in at least two of the following domains: cognitive-perceptual, affect regulation, interpersonal functioning, or impulse control.

Onset of symptoms in childhood/adolescence with stability over time.

Typical presentation involves comorbid disorders (more than one personality disorder or additional diagnoses of depression, anxiety, somatoform, or substance use disorder).

Ongoing relationship with a primary care physician is essential but may be challenging to maintain.

Potential for self-harm must be monitored. There is also potential for social withdrawal.

Psychotherapy is indicated in most cases. Selective use of pharmacotherapy can provide added benefit.

Personality disorders refer to enduring patterns of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in the various aspects of life.

In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition text revision (DSM-5-TR), the personality disorders fall into 10 distinct types: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr ​ The International Classification of Diseases (ICD-11) states that personality disorder is characterised by disturbances in functioning aspects of the self (e.g., self-worth, accuracy of self-view) and/or interpersonal dysfunction. This disturbance manifests in patterns of cognition, emotional experience, and maladaptive behaviour, across a range of personal and social situations, and is associated with significant distress or functional impairment.[2]World Health Organization. ICD-11 for mortality and morbidity statistics. 2022 [internet publication]. https://icd.who.int/browse11/l-m/en

Personality disorders involve a chronic pattern of both internal perception and observable behaviour in at least two of the following four symptom domains: cognitive-perceptual, affect, interpersonal functioning, and impulse control.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr Personality disorders are associated with significant distress across these domains. 

Personality disorders have been categorised into three general categories or clusters: cluster A (odd/eccentric); cluster B (dramatic); cluster C (anxious/fearful).[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr

In primary care settings, physicians are most likely to encounter patients with personality disorders in the context of treating the patient for a comorbid condition. Anxiety disorders, mood disorders, and substance use disorders are highly comorbid with personality disorders.[3]Tomko RL, Trull TJ, Wood PK, et al. Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning. J Pers Disord. 2014 Oct;28(5):734-50. http://www.ncbi.nlm.nih.gov/pubmed/25248122?tool=bestpractice.com