Personality disorders

Personality disorders are a relatively common, chronic pattern of perceptual and behavioral 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

Personality disorders involve a chronic pattern of both internal perception and observable behavior 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 categorized 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, such as depression.[2]Bajaj P, Tyrer P. Managing mood disorders and comorbid personality disorders. Curr Opin Psychiatry. 2005 Jan;18(1):27-31. http://www.ncbi.nlm.nih.gov/pubmed/16639180?tool=bestpractice.com [3]Gunderson J, Weinberg I, Daversa M, et al. Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder. Am J Psychiatry. 2006 Jul;163(7):1173-8. http://www.ncbi.nlm.nih.gov/pubmed/16816221?tool=bestpractice.com [4]Oldham JM, Skodol AE, Kellman HD, et al. Comorbidity of axis I and axis II disorders. Am J Psychiatry. 1995 Apr;152(4):571-8. http://www.ncbi.nlm.nih.gov/pubmed/7694906?tool=bestpractice.com