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Transtornos de personalidade

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 4 May 2025
Última atualização: 02 Apr 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • paranoia
  • pensamentos estranhos
  • amplitude de emoções limitada
  • raiva e irritabilidade
  • estados de humor instáveis e emocionalidade excessiva
  • ansiedade e tensão
  • comportamentos impulsivos
  • grandiosidade
  • evidência de autolesão (por exemplo, cicatrizes, queimaduras)
Detalhes completos

Fatores de risco

  • história de abuso
  • história familiar de esquizofrenia
  • história familiar de transtorno de personalidade limítrofe (TPL)
  • interações parentais negativas
  • transtorno disruptivo/emocional na infância
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • entrevista clínica
Detalhes completos

Investigações a serem consideradas

  • perguntas para o rastreamento do risco de suicídio
  • Standardized Assessment of Personality-Abbreviated Scale (SAPAS)
  • Inventário Multiaxial Clínico de Millon III (MCMI-III)
  • Entrevista Clínica Estruturada para o Modelo Alternativo do DSM-5-TR para Transtornos de Personalidade (SCID-5-AMPD)
  • Entrevista Clínica Estruturada para o DSM-5-TR para Transtornos de Personalidade
  • tomografia computadorizada/ressonância nuclear magnética (TC/RNM) cranioencefálica
  • exame de urina para detecção de drogas
  • Avaliação de Transtornos Mentais na Atenção Primária (PRIME-MD)
  • PHQ-9
  • questionário de transtorno de humor
  • Transtorno de Ansiedade Generalizada-7 (TAG-7) e TAG-2
Detalhes completos

Algoritmo de tratamento

AGUDA

em risco de se prejudicar a si mesmo ou aos outros, ou incapaz de atender às suas próprias necessidades básicas

CONTÍNUA

grupo A (estranho/excêntrico): sem risco de vida

grupo B (dramático): sem risco de vida

grupo C (ansioso): sem risco de vida

características múltiplas dos diferentes transtornos de personalidade: sem risco de vida

Colaboradores

Autores

Michael J. Schrift, DO, MA
Michael J. Schrift

Professor

Department of Psychiatry and Behavioral Sciences

University of Washington

Seattle

WA

Declarações

MJS declares he has no competing interests.

Agradecimentos

Dr Michael J. Schrift would like to gratefully acknowledge Dr Crystal T. Clark, and the late Dr Maria Devens, previous contributors to this topic. He would also like to acknowledge Dr Eric Gausche, who contributed the psychopharmacology sections for the initial version, and Dr Richard Stringham, who reviewed and approved information on the use of imaging and laboratory tests in the diagnosis section in the initial version. MD was an author of references cited in this topic. CTC, EG, and RS declare that they have no competing interests.

Revisores

Anthony W. Bateman, FRCPsych

Consultant Psychiatrist and Visiting Professor

Halliwick Psychotherapy Unit

St Ann’s Hospital

London

UK

Disclosures

AWB declares that he has a bias towards the use of mentalization in the treatment of personality disorder.

Robin L. Kissell, MD

Director

Borderline Personality Disorder Initiative

Semel Institute

UCLA

Los Angeles

CA

Disclosures

RLK declares that she has no competing interests.

Justin Trevino, MD

Medical Director

Opioid Treatment Program

Dayton Veterans Affairs Medical Center

Dayton

OH

Disclosures

JT declares that he has no competing interests.

Dietmar Winkler, MD

Department of Psychiatry and Psychotherapy

Medical University of Vienna

Vienna

Austria

Disclosures

DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.Full text

Storebø OJ, Stoffers-Winterling JM, Völlm BA, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020 May 4;5:CD012955.Full text  Abstract

Cristea IA, Gentili C, Cotet CD, et al. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(4):319-28.Full text  Abstract

Abbass AA, Kisely SR, Town JM, et al. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev. 2014 Jul 1;(7):CD004687.Full text  Abstract

Herpertz SC, Zanarini M, Schulz CS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry. 2007;8(4):212-44.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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