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Chapter 61. Treatment of Personality Disorders

Daphne Simeon, M.D.; Eric Hollander, M.D.
DOI: 10.1176/appi.books.9781585623860.424865

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Excerpt

Personality disorders are some of the more challenging psychiatric conditions and have traditionally been viewed by many clinicians as more difficult to treat than numerous Axis I conditions, often requiring investment in more lengthy treatments that involve a variety of modalities and approaches. It is also common to attain lesser and more modest degrees of success in treating personality disorders, with a recognition, however, that even partial modifications in people's dysfunctional interpersonal relationships, coping mechanisms, and symptomatology can bring about notably better adaptations. Psychotherapy continues to be the treatment foundation for all personality disorders, and psychotherapy studies of personality disorders on the whole find that patients with these disorders improve with treatment, with large treatment effects—two to four times greater than the improvement found in the control conditions (Perry and Bond 2000). In more recent years, the traditional psychodynamic therapy approaches have become enriched with more eclectic possibilities and structured therapies, such as dialectical-behavioral therapy for borderline personality disorder (BPD) (Linehan 1993) and various other cognitive psychotherapies (Tyrer and Davidson 2000). Although medications continue to be an adjunct to the treatment of personality disorders, and research medication treatment trials in personality disorders continue to be much fewer than those available in Axis I disorders, medications undoubtedly can play a useful role in the treatment of personality disorders, at least in some disorders and for some patients.

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Table Reference Number
TABLE 61–1. Summary of medication treatment trials with antipsychotics in borderline personality disorder (BPD)
Table Reference Number
TABLE 61–2. Summary of medication treatment trials with antidepressants in borderline personality disorder (BPD)
Table Reference Number
TABLE 61–3. Summary of medication treatment trials with mood stabilizers in borderline personality disorder (BPD)
Table Reference Number
TABLE 61–4. Psychopharmacological treatment guidelines for borderline personality disorder

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Cloninger’s psychological model of personality delineates four basic and independent temperaments. Which of the following is not one of these basic temperaments?
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Some personality disorders are typically viewed (with some supporting evidence) as more biologically driven than others. Which of the following is conceptualized as a biologically driven personality disorder?
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You have been treating a 36-year-old woman who has a diagnosis of borderline personality disorder (BPD) with psychotherapy for a year, and you now believe that she may benefit from treatment with a newer atypical antipsychotic agent. She agrees but wants to receive the one that has been studied the most for treatment of BPD. Knowing the literature, you recommend
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