This condition comprise deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They represent either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels, and particularly relates to others. They are developmental conditions, which appear in childhood or adolescence and continue into adulthood and nearly always associated with considerable personal and social disruption.
Major themes and clusters include Cluster A ( the paranoid, the schizoid, the schizotypal) Cluster B (the anti social, the emotionally unstable borderline type, the emotionally unstable impulsive type, the histrionic, the narcissistic) Cluster C (the anxious avoidant, the dependent, the anakastic personality disorder).
Assessment and diagnosis
Only a trained professional can make a personality disorders assessment. Assessment includes a good psychiatric history of the problematic behaviours, comorbid conditions, severity, duration and impairment. Clinical interview of patient and other sources of information helps to gain a fuller understanding of the problems. Numerous assessment instruments like structured interviews, self rated questionnaires, projective testing ( Rorschach and TAT).
Personality disorders generally share the reputation of difficult to treat conditions as patients are reluctant to start treatment and also drop out of treatment very often. Treatment mostly involves some form of talking therapy along with medications for co morbid conditions like anxiety, depression, psychosis or substance abuse.
The duration of treatment depends upon the type of personality disorder, the severity of the disorder and the presence of co existing conditions. Initial assessment helps in making a clear diagnosis and formulating the sessions goals.
Psychotherapy is typically limited to once to twice weekly treatments over 6 to 20 weeks. All types of psychotherapy are aimed at improving a person’s ability to regulate emotions, thoughts and actions. The commonly used therapy modules for various personality disorders are:
Borderline Personality: Dialectic Behavior Therapy (DBT), Mentalization based treatment
Anti Social: Schema Therapy
Narcissistic: Psychodynamic, Schema Therapy
Histrionic: Psychodynamic Therapy
Schizoid, Schizotypal, Paranoid: Medication, Social Skills Training
Avoidant, Obsessive- Compulsive, Dependent: Behavioral, Social Skills training, Psychodynamic, Medication
DBT is a cognitive behavioural approach based on a combination of mindfulness, interpersonal skills, distress tolerance and emotional regulation. It is the most scientifically supported treatment for people with borderline PD.
Psychodynamic psychotherapy: this is based on the belief that inappropriate and damaging behaviours are a result of negative childhood experiences. The therapy guides the individual to explore the distorted thinking and identify its origins and develop ways to break these thinking patterns and their influence on life.
Mentalization- Based therapies: this is a form of psychodynamic approach that helps clients to mentalize or to picture / imagine what other people are feeling in response to their behavior.
Schema Therapy: the goal of treatment is to challenge the maladaptive schemas or core assumptions/ beliefs/feelings that the patient learned from childhood.
Cognitive Behavior therapy: this is highly targeted therapy focused on certain maladaptive behaviours, thoughts and perceptions. CBT identifies how cognitive distortions effect perceptions and beliefs. Social skills training: cluster A Personality disorders benefit from social skills training.