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  • June 7, 2008

    Personality disorders can be managed

    By Gabrielle J. Melin, M.D.

21 comments posted

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Personality traits are a part of all of us and are influenced by our background and genetics. Sometimes a person will have an inflexible, maladaptive personality style. When this begins in early adulthood and results in significant impairment in functioning in life, it is termed a personality disorder. While these can be difficult to treat, recognition of a personality disorder is the first step in managing it. This is relevant to depression as this can impact depressive symptoms directly and can also impact the success of treatment.

There are many different personality disorders. We all may have some of these personality traits, but that doesn't mean that it meets the diagnostic criteria for a disorder. Types include: paranoid, schizotypal, schizoid, borderline, narcissistic, antisocial, dependent, obsessive compulsive (different than obsessive compulsive disorder or OCD) histrionic and avoidant.

Like other psychiatric disorders, the disorder's symptoms can range from mild to severe. When someone is under a lot of stress, the personality disorder can worsen. The person with the personality disorder will tend to blame everyone and everything else for their problems. Not having insight that their behavior affects their life is a hallmark of a personality disorder. You can easily see why an untreated personality disorder could negatively impact the successful treatment of depression.

For instance, borderline personality disorder is characterized by erratic mood swings, poor self-esteem and self-image, chaotic relationships, chronic suicidal ideation, suicide attempts, parasuicidal behavior, (such as cutting) impulsivity, paranoia under stress, hearing voices or seeing things (hallucinations) under stress, chronically feeling lonely and bored, being vulnerable to abandonment.

When reading this, one can see that some of the symptoms may appear to be similar to other psychiatric illnesses. For instance, paranoia under stress or hallucinations may make one think of schizophrenia. Severe mood swings may make one think of bipolar affective disorder. One symptom in isolation does not make a diagnosis as we have talked about before. The treatment for borderline personality disorder is a very specific kind of therapy call Dialectical Behavioral Therapy or DBT.

As always, a thorough evaluation by a trained professional is the best way to ensure proper diagnosis and treatment. Sometimes, symptoms will change or appear over time and the diagnosis may change. With insight, motivation and hard work, one can manage their personality disorder which in turn can help with successful treatment of depression.

21 comments posted

blog index
  • November 7, 2009 5:13 p.m.

    I need help finding someone to help my partner on medicare with BPD 30+ years. I live in NM

    - Becci

  • October 5, 2009 5:59 p.m.

    I know its in here somewhere, what does it mean on your hospital discharge paper. Axis III, denies. What does denies mean? Say as much as you want on this comment. I have Bi-Polar disorder.

    - Mark

  • September 27, 2009 11:44 p.m.

    My son is at a very critical point in his life and if he doesn't get help he will has a breakdown. I think he has some type of depression/anxiety/no confidence in self. He has 3 marriages and this last one is failing. He seems to look for the same type situations in each and needs for them to fix him. Each person has a lot of problems also. The relationships start to go downhill. He has children by the first wife but after that failed marrige when he found wife two and that relationship started going bad he could not focus on anything except her. The kids were all but forgotten. He had another child (wife two) awful relationship from start. Six year later wife three the current one and now all he focuses on is trying to figure out how to make her love him. All the children put on hold never focuses on anything except problem with saving the marriage. She has 4 children and during the 2 year they have been married all he can think of is the present problem at hand. He is so stressed he doesn't sleep for days at a time. Hasn't been able to hold down a job refuses help because he has no insurance and is afraid of medications. He has tried Paxil after second marriage failed and has tried Wellbutrin once for a few days. Says he can't stand the way they make him feel. He wants to talk constantly about how to fix things and it is taking its toll on me. I am so worried I am beginnin to be unable to sleep and am constantly thinking of ways to help.

    - DEE

  • May 24, 2009 3:41 p.m.

    I have a narcissistic personality disorder. I am not a good friend because I lack empathy. I am unable to connect with people. Most of the time , I don`t care. I have no idea why I am writing this & sending it all over the world.

    - A.

  • April 1, 2009 4:35 p.m.

    Borderline Personality Disorder has very good treatment modality available called Dialectical Behavioral Therapy (DBT) Ask your provder about it. It was developed by Marsha Linehan, MD- check out her web materials. All the best to you-

    - Mayo Clinic.Com Staff

  • March 25, 2009 7:05 p.m.

    Anyone seeking medical treatment or evaluation for mental health care services without health insurance, please contact your local county health departments or State Health Centers for guidance and resources.

    - No name given

  • March 25, 2009 12:16 p.m.

    BPD seems to be the latest label that people want to apply to me. After years of being drugged senselessly for "depression" that didn't help at all, or just dismissed as "you're a smart woman, you'll work this out", I'm just about at the end of the line here. I haven't worked anything out; the downward spiral just keeps gong lower and lower. At 60 I'm wondering how much farther down there is to go. And what good is the label? Where does anyone go from there?

    - mary

  • February 13, 2009 4:30 p.m.

    My fiance has what I would describe as "mild" narcissistic personality disorder. We are in therapy and he now admits that his behavior is unacceptable and wants to change it... Thank God! I am concerned about his ability to remain present and consistant while he now explores this issue for the first time. He has very ingraned distructive reactions to stress or criticizm. He alternates between being self destructive and verbally abusive. Are there any medications that can help control his "acting out" that will not have strong side effects? Please advise and perhaps he will agree to a psychiatric evaluation for medication.

    - Debra

  • January 11, 2009 4:45 p.m.

    How do you tell if there is something that requires a therapist or if its just hormonal?..I am fairly good looking 47..But I cant' seem to not get mad or should i say jealous when my guy looks at attractive women, scantily clad ,in magazines or in person or movies etc. He says I have borderline personality disorder but i dont have any feeling of harming myself or suicide. I think its a self image/self esteem issue but not sure how to even fix that....any suggestions?? I have no insureance as i am self employed...thanx

    - lisa

  • November 30, 2008 7:55 p.m.

    I have had problems with depression since my teens -- I'm now in my 50's. Several years ago I was hospitalized, and while I was inpatient, the psychiatrist told me I had Borderline Personality Disorder based on my trying to injure myself (not suicidally, just to dull the emotional pain that I was in). In the years since then, I feel like I've made progress, but I still struggle with identity issues and the endless feeling of emptiness that won't go away. But the worst of it is that people with BPD are branded as horrible people -- nasty and manipulative and impossible to deal with. I don't feel like I'm like that at all, but that's the reputation and stigma that goes with the diagnosis. I'm NOT a hopeless case. I'm a good person with some big problems, and I don't deserve to be written off. We're not all evil.

    - Sarah

  • September 22, 2008 11:36 a.m.

    Joni- There is no specific test for schizotypal personality disorder. A clinical exam is important and talk therapy is the treatment. I would contact your community mental health center-sometimes they have a sliding scale. You could also contact your county social services to ask what is available for help in you area. It is great that you have insight and are willing to accept help. Best wishes to you.

    - MC.Com staff

  • September 17, 2008 1:28 p.m.

    I suspect I have schizotypal disorder. I am 52 but this has been with me my whole life. Is there a test to find out? I have no insurance because I can't hold down a job for long.

    - joni

  • September 2, 2008 5:01 p.m.

    Gia, I would recommend you support your friend directly and recommend he get help for his drinking. You could go to Al-Anon yourself for support. You will not be able to change his fiancee'. She doesn't have any insight into her behavior and that is the hallmark of a personality disorder. It is difficult to see someone you care about suffering as well as being in the relationship you describe. He may not see the red flags in her that others see for many reasons. If you didn't already, try getting someone to help you and his family with an intervention without including her. Again, talk to someone at Al-Anon or AA. Good luck.

    - Mayo Clinic .com Staff

  • August 30, 2008 12:01 a.m.

    I suspect that my friend's fiancee suffers from schizotypal or borderline personality disorder. Last year, several family members and I reached out to her due to concerns for his health. We all suspect he is an alcoholic and wanted her help in an intervention. She has since decided that we are evil and trying to hurt him and does not want to have anything to do with us. When family members have tried to talk to her, she distorts the conversation and interprets it in a negative way. It seems that she looks at situations as black and white and if you cross a line, there is no getting back in her life. Recently I reached out to shake her hand at a black tie function, and she pulled her hand away from me in front of several people. This is causing a lot of anguish to my friend and his family. I also noticed that strange dress is a symptom. This woman has a habit of wearing inappropriate clothing, very often revealing underwear lines and plunging necklines. She appears to be an exhibitionist. I noticed that this is a sympton for Schizotypal disorder. This is a woman who is very caring to him and loves him, but cannot give an inch in forgiving his friends and family she believes are evil. Any comments or suggestions?

    - Gia

  • August 12, 2008 7:35 p.m.

    How do you find a reputable person for a dignosis? I am in the Macon area. Thank you a million

    - Terry Parker

  • July 7, 2008 2:33 p.m.

    For more on anxiety -see other links on our web site. This entry is meant to stimulate discussion on personality disorders and their effect on depression management.

    - MC.com staff

  • June 26, 2008 12:49 p.m.

    Anxiety is a range of disorders that includes Panic disorder, Generalized Anxiety Disorder, Post-Traumatic Stress Disorder (PTSD), phobias (for example, heights) to name a few. The diagnosis of Panic disorder is made when a person has recurring panic attacks accompanied by other specific symptoms and criteria. Therefore, a panic attack is a symptom of anxiety. A panic attack can include some or all of the following symptoms: sudden onset of extreme fear (panic), shortness of breath, a choking sensation, numbness or tingling in the fingers and/or toes, sweating, nausea and/or vomiting, and palpitations. (heart pounding) Many medical illnesses can cause the above symptoms, so seeing a professional is important for the right diagnosis. As said in an earlier entry, some people have depression and anxiety together.

    - Mayo Clinic.com Staff

  • June 25, 2008 8:14 p.m.

    I do wish someone would tell us the difference between a anxiety and a panic attack. I, too, have experienced palpitations, etc.

    - Betty

  • June 19, 2008 8:03 a.m.

    on and off i experience palpitations and and extreme sense of discomfort and helplessness. i cannot do anything but wait for it to pass. i am told i'm having panic attacks. but i experience no fear. what am i having?

    - No name given

  • June 17, 2008 9:42 p.m.

    How can I deal with depression from being a caregiver to my husband who has Parkinsons? I never have time to do anything I need time to do.

    - lois

  • June 17, 2008 4:29 p.m.

    what is the difference between an anxiety or panic attack. How should these be treated?

    - Betty

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