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.
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. 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).
History and exam
Key diagnostic factors
- odd thinking
- restricted range of emotions
- anger and irritability
- excessive emotionality and unstable mood states
- anxiety and tension
- impulsive behaviours
- evidence of self harm (e.g., scars, burns)
- history of abuse
- family history of schizophrenia
- negative parenting interactions
- emotional/disruptive disorder in childhood
1st investigations to order
- clinical interview
Investigations to consider
- suicide risk screening questions
- Standardized Assessment of Personality-Abbreviated Scale (SAPAS)
- Millon Clinical Multiaxial Inventory-III (MCMI-III)
- Structured Clinical Interview for DSM-5-TR Alternative Model for Personality Disorders Version (SCID-5-AMPD)
- Structured Clinical Interview for DSM-5-TR Personality Disorders
- MRI/CT scan of brain
- urine drug screen
- The Primary Care Evaluation of Mental Disorders (PRIME-MD)
- Patient Health Questionnaire-9 (PHQ-9)
- Mood Disorder Questionnaire
- Generalised Anxiety Disorder-7 (GAD-7) and GAD-2
at risk for harming self or others, or unable to attend to basic self-needs
cluster A (odd/eccentric): non-life-threatening
cluster B (dramatic): non-life-threatening
cluster C (anxious): non-life-threatening
multiple features of different personality disorders: non-life-threatening
- Mood disorders
- Psychotic disorders
- Anxiety disorders
- Treatment guidelines for personality disorders
- Screening for suicide risk in adolescents, adults, and older adults in primary care
Personality disorders: what are they?
Personality disorders: what treatments work?More Patient leaflets
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