Personality Disorders

Abstract

Personality disorders (PDs) represent some of the most insidious and challenging psychiatric conditions that clinicians encounter, and often create unwarranted and unwanted conflicts in clinical settings. The reasons for these conflicts lie at the core of the PD pathology, namely, a fundamental impairment in interpersonal relationships that leads to a variety of maladaptive, inappropriate, or outrageous behaviors that the affected person seems incapable of fully understanding and controlling. Consider these examples:

• 1. Vincent P. is a 78-year-old retired professor of English literature who is seen in an outpatient VA clinic. He has a consistent pattern of meeting a new doctor, asking repetitively for help with chronic headaches, and then cursing out and vilifying the doctor for failing to help him. On a regular basis he angrily demands meetings with the hospital administrator to complain about his current physician.

• 2. Susan R. is a 24-year-old graduate student who presents to a neurology clinic complaining of muscle twitches, headache, paresthesias, and nervousness. The clinic’s staff notice numerous linear scars on her arms consistent with self-inflicted cutting. A thorough examination is unrevealing, and Susan is told that she should consider seeing a psychiatrist to help deal with stress. She becomes enraged at the neurologist, and accuses him of insensitivity and ignorance. She storms out of the office, cursing the physician and staff for misleading her.

• 3. John D. is a 34-year-old man with multiple sclerosis who lives with his mother. He has never been married and has few friends. He has worked at odd jobs in the past but is currently on disability. He presents to a neurology clinic intermittently for follow-up, but is minimally communicative with staff and rarely compliant with treatment. During previous hospitalizations, nurses have described him as aloof, distant, and odd.