From the Guidelines
Personality disorders should be diagnosed and treated based on the new ICD-11 classification, which characterizes them by problems in functioning of aspects of the self and/or interpersonal dysfunction, and differentiates them according to severity into mild, moderate, and severe. According to the study published in Dialogues in Clinical Neuroscience 1, the ICD-11 personality disorder diagnosis is further differentiated by the presence of one or multiple maladaptive personality traits, such as negative affectivity, detachment, dissociality, disinhibition, anankastia, and borderline pattern.
Key Characteristics of Personality Disorders
- Problems in functioning of aspects of the self (e.g., identity)
- Interpersonal dysfunction (e.g., managing conflict in relationships)
- Severity levels: mild, moderate, and severe
- Presence of one or multiple maladaptive personality traits
Treatment Approaches
- Psychotherapy, such as dialectical behavior therapy (DBT) or cognitive-behavioral therapy (CBT)
- Medication to manage specific symptoms, such as anxiety or mood instability, with selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline, or low-dose antipsychotics like quetiapine, as mentioned in the context of managing symptoms 1.
Underlying Causes
- Complex interaction between genetic predisposition and environmental factors
- Childhood experiences and trauma shape neural pathways and emotional regulation systems during critical developmental periods, as implied by the need for a dimensional approach to understanding personality disorders 1.
The ICD-11 classification provides a more clinically useful and simple approach to diagnosing and treating personality disorders, as it acknowledges the dimensional nature of these conditions and allows for a more nuanced understanding of each patient's symptoms and needs 1.
From the Research
Definition and Characteristics of Personality Disorders
- Personality disorders are characterized by instability of self-image, interpersonal relationships, and affects, as well as impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms 2, 3.
- Borderline personality disorder (BPD) is a specific type of personality disorder that affects approximately 0.7% to 2.7% of adults in the US 3.
- BPD is typically diagnosed by a mental health specialist using semi-structured interviews 2, 3.
Etiology and Risk Factors
- The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse 2, 3.
- The interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD 2.
Treatment and Management
- Psychotherapy is the treatment of choice for BPD, with various approaches including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy 2, 3.
- Dialectical behavior therapy (DBT) has been shown to be effective in reducing symptom severity and improving global functioning in patients with BPD 4, 5.
- There is no evidence that any psychoactive medication consistently improves core symptoms of BPD, although pharmacotherapy may be useful for discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features 2, 3, 6.
Comorbidities and Functional Impairment
- BPD is often comorbid with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders 2, 3.
- The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs 2.