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Personality Disorders

Personality Disorders

People who suffer from personality disorders (PD) have a way of perceiving and understanding reality that deviates considerably from the social and cultural expectations. This perception of reality makes these people tend to respond to external demands in a more dysfunctional way, often experiencing discomfort or suffering.

The General Personality disorder according to the DSM-5 (APA, 2013) is characterized by a rigid and inflexible pattern of functioning, and by experiencing difficulties in adapting to the environment (social, academic or work area, etc.), which often produces important frustrations for them and for their families.

The classification proposed by the DSM-5 (APA, 2013) contemplates a total of 10 different PT divided in three groups:

  • GROUP A: Paranoid, schizoid, and, schizoid, schizotypical
  • GROUP B: Antisocial, Borderline, Histrionic, Narcissistic
  • GROUP C:Evasive, Dependent, Obsessive Compulsive
  • OTHER PERSONALITY DISORDERS:

 

Specifically, the borderline personality (BPD) refers to a persistent pattern of unstable interpersonal relationships, affect and self-image, with difficulties in impulse control. BPD is one of the most complex psychopathological conditions that a therapist can encounter. In recent years, there has been a growing interest in this disorder, mostly due to the fact that, on the one hand, there is a high frequency of this type of patients in mental health units and, on the other, this psychological condition can reach a high level of severity due to the risk of self-injury and suicide inherent to it.

This pattern is translated into a high mood reactivity, extreme impulsivity, recurrent behaviours of self-mutilation or suicide, ambivalent thoughts and attitudes toward others and toward him/herself, chaotic and intense interpersonal relationships, feelings of emptiness and boredom (Caballo, Gracia, López-Gollonet & Bautista, 2004). Moreover, BPD presents an important comorbidity with other disorders, mainly:

  • Childhood conduct disorders
  • Attention deficit and hyperactivity disorder
  • Eating disorders
  • Post-traumatic stress disorder
  • Use or abuse of substances (alcohol, drugs and medication)
  • Impulse control disorder
  • Emotional disorders (mood disorders and anxiety disorders)

 

All of this produces important problems and suffering, both in the people who have BPD and in their families.

  • 70% of those with BPD perform suicidal or para-suicidal behaviours.
  • Admission in Acute-care Units.
  • 8-10% actually commit suicide.
  • Extreme dependence on the family and/or serious problems of co-existence.
  • High level of unemployment, absenteeism and job instability due to maladaptation to work settings.
  • Risk for the children of BPD sufferers.

Currently, the comprehension and treatment of the disorder is one of the main challenges to psychiatry and psychology, producing special interest among professionals across the world. In Spain, they have come to be considered “invisible disorders” in mental health, as their diagnosis is increasingly common among therapeutic communities and at younger ages.

Throughout the history of psychiatry, BP have received a certain amount of rejection when intervening therapeutically based on the idea that they are unmodifiable traits and only certain symptoms can be treated. Fortunately, this idea has changed considerably in the past 20 years, since the publication of the evidence-based treatments.

 

Patient care process
Treatment
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