Personality Disorder

What are personality disorders?

Personality disorders are a persistent pattern of inner experiences and behaviors with onset in adolescence or early adulthood that differs significantly from the individual’s cultural norms, is inflexible and stable over time, and results in distress or impairment. A personality disorder (PD) typically becomes evident during adolescence or early adulthood. Multiple types have been defined:

• Paranoid PD.
• Schizoid PD.
• Schizotypal PD.
• Antisocial PD.
• Borderline PD.
• Histrionic PD.
• Narcissistic PD.
• Avoidant PD.
• Dependent PD.
• Obsessive-compulsive PD.

Antisocial personality disorder (PD) is more common in men, while borderline, histrionic, and dependent PDs are more common in women. About 75 percent of the customers with borderline PD are women. Other PDs that are more commonly diagnosed in males are narcissistic PD (50 to 70 percent), obsessive-compulsive PD (2:1 male/female ratio), paranoid PD, schizoid PD, and schizotypal PD. Avoidant PD occurs with similar frequency in males and females.

How are personality disorders diagnosed?

The diagnosis of personality disorder (PD) should be established only after a persistent pattern of behavior occurring over time has been observed. Although the features may develop during adolescence, typically a diagnosis is not made in customers under the age of 18.

General diagnostic criteria for personality disorder includes an enduring pattern of inner experience and behavior that diverts substantially from the individual’s expected cultural norms manifested in at least two of the following areas:

• Cognition.
• Affectivity.
• Interpersonal functioning.
• Impulse control.
• The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
• The pattern leads to clinically significant distress or impairment in social, occupational, or other areas of functioning.
• The pattern is stable, long-standing, with onset by adolescence or early adulthood.
• The pattern is not attributable to another mental disorder.
• The pattern is not caused by a substance or a general medical condition.

If your healthcare provider suspects you have a personality disorder, a diagnosis may be determined by:

• Physical exam: Your healthcare provider may do a physical exam and ask in-depth questions about your health. In some cases, your symptoms may be linked to an underlying physical health problem. Your evaluation may include lab tests and a screening test for alcohol and drugs.
• Psychiatric evaluation: This includes a discussion about your thoughts, feelings and behavior and may include a questionnaire to help pinpoint a diagnosis. With your permission, information from family members or others may be helpful.
• Diagnostic criteria in the DSM-5: Your healthcare provider may compare your symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

How are personality disorders treated?

Personality disorders characteristically remain stable over time and typically are refractory to acute interventions. Pharmacologic treatment may be helpful for managing associated symptoms such as anxiety, depression, irritability, aggressiveness, or thought disorders.

Aggressive behavior associated with antisocial PD may be treated with beta-blockers or neuroleptics, selective serotonin reuptake inhibitors (SSRI), and Depo-Provera for sexually violent offenders. Benzodiazepines may be used to relieve anxiety associated with borderline PD, dependent PD, and avoidant PD. Distorted thinking pattern, which may be present in individuals with obsessive-compulsive PD, schizotypal PD, and paranoid PD, may require treatment with antipsychotic medications.

Psychotherapy may be an effective treatment modality for personality disorders.

What are personality disorder care options?

During your first appointment, your healthcare provider or mental health professional will likely ask you a number of questions about your mood, thoughts, behavior and urges, such as:

• What symptoms have you noticed or have others said they notice in you?
• When did you or they first notice symptoms?
• How is your daily life affected by your symptoms?
• What other treatment, if any, have you had?
• What have you tried on your own to feel better or control your symptoms?
• What things make you feel worse?
• Have your family members or friends commented on your mood or behavior?
• Have any relatives had a mental illness?
• What do you hope to gain from treatment?
• What medications, vitamins, herbs or supplements do you take?

North Memorial Health’s evidence based, customer-centered program

North Memorial Health’s comprehensive continuum of individualized treatment offers evidence based clinical services including:

• Diagnostic assessments.
• Neuropsychological and personality assessment.
• Evidenced-based individual psychotherapy for psychosis, bipolar disorder, depression, anxiety, and post traumatic stress mental health.

Treatment includes:

• Group psychotherapy.
• Psychiatry and medication management.
• Addiction medicine.
• Care coordination/case management.