Personality Disorders

=Executive Summary= Three main points =Objectives=
 * 1) Personality disorders are "enduring patterns of perceiving, relating to, and thinking about the environment and one's self exhibited in a wide range of context" that are inflexible and maladaptive. These habits cause significant impairment and distress, deviate from cultural norms of behavior, and tend to be constant across a person's life-time.
 * 2) Borderline personality disorder, with a prevalence of 1-2%, is the most studied. It is associated with instability of interpersonal relationships, self-image, affects, and control over impulses.
 * 3) Caring for a patient with a personality disorder may strain the physician-patient relationship. Physicians must be cognizant of transference, countertransference, and boundary crossing when caring for a patient.

Define the following terms in relation to borderline personality disorder

 * Diagnostic criteria
 * A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. In


 * Differential diagnosis
 * Axis 1 disorders like substance-abuse disorder, alcoholism, posttraumatic stress disorder, and anxiety disorders are frequently diagnosed in patients with borderline personality disorder
 * Other Axis 2 disorders in cluster B


 * Prevalence
 * 1-2% in the general population, but 20-30% in certain ERs and medical wards.


 * Morbidity
 * suicide occurs in up to 10%


 * Life course
 * Patients sometimes sabotage treatment when it seems to be going well.


 * Response to treatment (psychotherapy and medication)
 * Controlled clinical trials demonstrate the efficacy of lithium carbonate in diminishing anger, irritability, and self-mutilation. A more limited body of evidence indicates that carbamazepine increases behavioral control and diminishes anger and impulsivity. Sodium valproate has been used to treat irritability and aggressiveness in borderline patients.
 * Group therapy works okay
 * individual therapy is difficult

Define these words and phrases as applied to personality disorders:

 * transference
 * refers to a patient projecting of feelings about another person upon the physician (e.g.: patient is angry and transfers this anger to his physician).


 * countertransference
 * refers to the physician projecting feelings about another person onto the patient (e.g.: patient reminds the physician of his kid and acts too much like a dad).


 * Acting out
 * attempts to alleviate pain by dumping it onto someone else-for example, by raging, blaming, criticizing, making accusations, becoming physically violent, and engaging in verbal abuse. Acting-out behaviors cause direct anguish for friends, family members, and partners.


 * Boundary crossing
 * a break in the rules of therapy (Ex: a therapist's self-disclosure, touch, exchange of gifts, bartering and fees, length and location of sessions and contact outside the office) but may also increase effectiveness of therapy

=Links & References=