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) |
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 |
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 |
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 |
I. | Mindfulness | ||||||||||||||||||||||||
| |||||||||||||||||||||||||
II. | Distress tolerance | ||||||||||||||||||||||||
| |||||||||||||||||||||||||
III. | Emotion regulation | ||||||||||||||||||||||||
| |||||||||||||||||||||||||
IV. | Interpersonal effectiveness | ||||||||||||||||||||||||
|
Cloninger CR, Srvakic DM, Pryzbeck TR: A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50:975–990Crossref, Google Scholar
Gabbard GO: Combining medication with psychotherapy in the treatment of borderline personality disorder, in Psychotherapy and Personality Disorders (Review of Psychiatry Series; Oldham JM and Riba MB, series eds.), vol 19. Edited by Gunderson JG, Gabbard GO. Washington, DC, American Psychiatric Press, 2000, pp 65–90Google Scholar
Links PS, Heslegrave R, vanReekum R: Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and axis II comorbidity. Can J Psychiatry 1998; 43:265–270Crossref, Google Scholar
Links PS, Mitton JE, Steiner M: Stability of borderline personality disorder. Can J Psychiatry 1993; 38:255–259Crossref, Google Scholar
McGlashan TH: Prediction of outcome in BPD, in The Borderline: Current Empirical Research. Edited by McGlashan TH. Washington, DC, American Psychiatric Press, 1985, pp 61–98Google Scholar
McGlashan TH: The Chestnut Lodge Follow-up Study, III: long-term outcome of borderline personalities. Arch Gen Psychiatry 1986; 43:20–30Crossref, Google Scholar
McGlashan TH: The longitudinal profile of BPD: contributions from the Chestnut Lodge Follow-up Study, in Handbook of the Borderline Diagnosis. Edited by Silver D, Rosenbluth M. Madison, CT, International Universities Press, 1992Google Scholar
Paris J, Nowlis D, Brown R: Developmental factors in the outcome of borderline personality disorder. Compr Psychiatry 1988; 29:147–150Crossref, Google Scholar
Plakun EM: Prediction of outcome in borderline personality disorder. J Personal Disord 1991; 5:93–101Crossref, Google Scholar
Soloff PH: Algorithms for pharmacological treatment of personality dimensions: symptom-specific treatments for cognitive-perceptual, affective, and impulse-behavioral dysregulation. Bull Menninger Clin 1998; 62:195–214Google Scholar
Stone MH: Long-term outcome in personality disorders. Br J Psychiatry 1993; 162:299–313Crossref, Google Scholar
Stone MH: The Fate of Borderline Patients: Successful Outcome and Psychiatric Practice. New York, Guilford, 1990Google Scholar