Quick Reference for Personality Disorders
| Poor Prognosis | Good Prognosis |
|---|---|
| Parental brutality/incest (Stone 1990) | High IQ (McGlashan 1985; Stone 1990) |
| Greater affective instability (McGlashan 1992) | Absence of narcissistic entitlement (Plakun 1991) |
| Magical thinking (McGlashan 1992) | Absence of parental divorce (Plakun 1991) |
| Impulsivity and substance abuse (Links et al. 1993) | |
| Comorbid schizotypal, antisocial, or paranoid features (Links et al. 1998; McGlashan 1986; Stone 1993) | |
| Presence of maternal psychopathology (Paris et al. 1988) | |
| Family history of mental illness (Paris et al. 1988) |
Note: Reference list is at the end of this section.
Source: Gabbard GO: Psychodynamic Psychiatry in Clinical Practice, 4th ed. Washington, DC, American Psychiatric Publishing, 2005, p 434
| Affective-Dysregulation | Impulsive-Behavioral | Cognitive-Perceptual |
|---|---|---|
| SSRI | SSRI | Low-dose antipsychotic |
| Low-dose antipsychotic | Low-dose antipsychotic | SSRI |
| Clonazepama | Lithium carbonate | |
| MAOIb | MAOIb | |
| Lithium | Carbamazepine | |
| Divalproex | ||
| Naltrexonec |
MAOI=monoamine oxidase inhibitor; SSRI=selective serotonin reuptake inhibitor
a Do not use alprazolam, as it may result in disinhibition.
b MAOIs should be used with considerable caution because of dietary restrictions.
c If self-mutilation and/or alcohol abuse is present.
Source: Gabbard GO: Psychodynamic Psychiatry in Clinical Practice, 4th ed. Washington, DC, American Psychiatric Publishing, 2005, p 447 (based on Gabbard 2000 and Soloff 1998)
| Need for admiration and affirmation from the therapist |
| Idealization of the therapist |
| Assumption of twinship between therapist and patient |
| Proneness to feel shamed and humiliated by the therapist |
| Contempt and devaluation toward the therapist, often related to envy |
| Denial of the therapist’s autonomy |
| Omnipotent control of the therapist |
| Insistence on exclusive dyadic relatedness that does not allow for a third party |
| Use of the therapist as a sounding board without empathy for the therapist’s experience |
| Denial of dependency on the therapist |
| Inability to accept help from the therapist |
Source: Gabbard GO: Psychodynamic Psychiatry in Clinical Practice, 4th ed. Washington, DC, American Psychiatric Publishing, 2005, p 503
| Cluster | Type | Characteristic Features |
|---|---|---|
| A | Odd or eccentric | |
| Paranoid | Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent | |
| Schizoid | Pervasive pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal settings | |
| Schizotypal | Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior | |
| B | Dramatic, emotional, or erratic | |
| Antisocial | History of conduct disorder before age 15; pervasive pattern of disregard for and violation of the rights of others; current age at least 18 | |
| Borderline | Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity | |
| Histrionic | Pervasive pattern of excessive emotionality and attention seeking | |
| Narcissistic | Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy | |
| C | Anxious or fearful | |
| Avoidant | Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation | |
| Dependent | Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation | |
| Obsessive-compulsive | Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency |
Source: Skodol AE: Manifestations, clinical diagnosis, and comorbidity, in The American Psychiatric Publishing Textbook of Personality Disorders. Edited by Oldham JO, Skodol AE, Bender DS. Washington, DC, American Psychiatric Publishing, 2005, chapter 4, p 60 (adapted from DSM-IV-TR, p 685)
| I. | Mindfulness |
A. Focusing on the moment B. Awareness without judgment | |
| II. | Distress tolerance |
A. Crisis survival strategies B. Radical acceptance of reality | |
| III. | Emotion regulation |
A. Observe and identify emotional states B. Validate and accept one’s emotions C. Decrease vulnerability to negative emotions D. Increase experience of positive emotions | |
| IV. | Interpersonal effectiveness |
A. Assertiveness training B. Cognitive restructuring C. Balancing objectives with maintaining relationships and self-esteem |
Source: Stanley B, Brodsky BS: Dialectical behavior therapy, in The American Psychiatric Publishing Textbook of Personality Disorders. Edited by Oldham JO, Skodol AE, Bender DS. Washington, DC, American Psychiatric Publishing, 2005, chapter 19, p 312
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