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David Mrazek, M.D.
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David Mrazek, M.D.
David Mrazek, M.D.
Dr. David A. Mrazek is chair of the Department of Psychiatry and Psychology at Mayo Clinic, Rochester, Minn., and a professor of psychiatry at College of Medicine, Mayo Clinic. Dr. Mrazek has developed a federally funded psychiatric pharmacogenomics research program and implemented clinical psychiatric pharmacogenomics services at Mayo Clinic.
He has received numerous awards including the Award for Creativity in Psychiatric Education from the American College of Psychiatrists and the Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry from the American Psychiatric Association. He currently serves as chairman of the board of the American Board of Psychiatry and Neurology.
Dr. Mrazek has focused his current efforts on using pharmacogenomics testing to improve clinical care. One of his specific goals is to decrease the risks of taking psychiatric medications.
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June 7, 2008
Personality disorders can be managed
By David Mrazek, M.D.
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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.
34 comments posted
June 14, 2011 1:34 p.m.
Hello every one well I was diagnoised w BPD and clinic depression about 7 yrs ago it was due to my child hood and then I had a special needs daughter and it went full blown. I have been on different antideppresents for 7 yrs and now I'm experiencing allergic reactions to most of them weather it be irratability or out burts or even a rash called the prozac rash. I'm currently looking for a good combo or just one because my med doc is afficially a quack. I'm searching for a new one but trying to research as much as possible so any sugesstoins would be helpfull. Ive also taken the DBT classes and they were awsome i believe it should be taught in schools.. Not sure what im going to get as a response or not even sure if im making any sence but here it is any nice feed back is welcome. So far I have takn zoloft,prosac,cymbalta,wellbutrin,celexa and now they put me on Lamictal but im hesitant to take it cause I keep having reactions..? If you know any info on this Lamictal please tell Ive researched and 1 out 1000 can get a rash and im scared that I will be that one. So if you have taken this and can tell me how it made you feel I would appreciate it. Also know of any chat rooms besides this one for us would be cool to ;)) Hey thanks to all who share to its helpfull...
- Sarah
April 26, 2011 5:41 a.m.
Where is the best place to get help without losing your job if company knows i posted im afraid i will lose mine need help but no money family not help no friends or special other they avoid me when can on st john tired of being this way bpd i hate it high stress social problems since school was a loner will i always be alone was a door mat but now lol trying to stand up for my self i have to work 2 jobs just to pay basic bills trying to get better with reading and research i need self help books and phamplets to get well please help in okla i have taken other rx but make me numb or irritated neither is good
- storm
February 26, 2011 9:18 a.m.
DBT can be overwhelming at first, however, I found that sticking with it is worth the discomfort in the beginning. Also, since these are skills that can be used in so many situations in life that I have heard several professionals and clients state that these skills should be taught to children in school!
- Leslie
February 16, 2011 9:24 a.m.
I'm a bipolar with multiple BPD traits, yes it is possible to have to BPD traits but not all...e.g. I don't hallucinate. I'm on three meds - Paxil for BPD; Lamictal for Bipolar mood stabalizers; and Wellbutrin for depression. I've read several of the blogs and please, please realize that we are not bad people, we just have mental health illness instead of a physical illnesss like diabtis (sp?). I'm 47 and was not formally diagnosed until I was in my late thirties, although I acted out inappropriately, was a cutter, depressed, then manic, etc. Thank goodness I have been diagnosed and am living a pretty normal life. There is hope for all of us - don't give up on yourself or your family member who is seeking help. If it is a family member, treat them like a "normal" person, not some kind of freak because they have a diagnosed mental illness. To Mikz - ask him if he is willing to commit himself to a psych hospital for a full evaluation. Sounds like he needs one and you need to talk to a therapist to help you understand why you are attracked to a person with a violent personality. Harming animals and you maybe more than a personality disorder.
- Cheri
February 10, 2011 3:47 a.m.
hi guys!i have just left my husband after 1yr 8mnths of marriage,because of his emotional abuse and violent tendencies against our pets. i immediately went looking for psychological help so that i could deal with the emotions of a divorce. during my session i realised that my husband has some type of personality disorder(either narcissitic or antisocial). He wants me back, i know that i shouldnt, but i still love him so so much! my question is... will medication completely remove the symtoms(bad behaviuor toward my pets n i) or will it continue to a lesser extent? please give me some advice. I cannot speak to my family coz they will not hear of me going back to him!!!
- mikz
October 13, 2010 12:33 p.m.
As the living parent of a niece recently diagnosed with Borderline Personality Disorder, I am wondering where I go to get help to help her As she was inpatient and soon to go to outpatient, there a most hours of the day that she will need guidance. I want to know how best to help her and the others that live us
- gia
October 9, 2010 7:58 a.m.
Among 3 other mental illnesses, I have been diagnosed with Personality Disorder NOS. I am on 7 psychiatric medications which I take regularly and correctly. As I read in another comment, it is an ordeal getting through each additional day, especially from my "depression side" of my bipolar disorder. I feel very very helpless and hopeless much of each day because of having mental illness instead of being "normal," typical, or average as my 2 sisters are with their "normal" lives of being married, having kids, having the breadwinner job to take care of everything and pay the typical bills, their kids being degreed which I cannot do at this time because of mental illness, and with me having more negative mental illness issues. I've missed the boat, missed out on "normal," typical, average things in life that most people experience, and this tears me apart every day. Because of the above, I want to die to end the suffering of living with mental illness, but I am too afraid to be suicidal after a failed suicide attempt in about 1994. I wish everybody, with or without mental illness, the very very best!!!
- Morris
September 16, 2010 9:16 p.m.
First of all thank you all for sharing. You have to "shop"for a psychiatrist that you feel comfortable with. I have bipolar disorder, bpd, ptsd, panic attacks, major depressive disorder. YOU are not your disorder! Mental disorders are no diffent than a medical issue,example, diabetes, high blood pressure etc......you follow your doctor's instructions take your meds.as prescribed, contact ur doctor if you have any side effects. Give the medication time to work, usually a antidpressant takes 4-6wks to get in your system. .. It is bad when our doc's do not know or tell us about life threating side effect's. I have been told only once by a psych doctor. The medication is Lamictal (a mood stabilizer) if you develope a rash, STOP taking Lamictal immediatiely! notify your doctor. The antidepressant Remeron, if you develope flu-like symptoms,such as muscle aches's, ,STOP taking the remeron immediately!f/up with your dr. I was diagnosed w/ major depressive disorder when I was 24, I am 48 now. Please do not give up! there are so many different meds. If you can't pay, a county or state mental health will not turn u away. Also you do not have to have all of the symptons to be diagnosed with any disorder. I have been in all of these situations. I made this mistake when first diagnosed and ended up back in the psych unit. When I felt better, I stopped taking my medications. My psych. doc. failed to tell me that a mental disorder is managed not cured. Even when you feel fine.
- Cathy
August 24, 2010 10:10 a.m.
I have PTSD, anxiety issues, sleep disorders and bpd. DBT is helpful - found a very good on line support site. I also found Al-Anon and exercise to be helpful. I was seeing a therapist weekly for a few years...decided to cut back to monthly-somedays I ponder that decision because it takes all I have to get through the day in spite of everything.
- Beth
June 19, 2010 11:50 p.m.
i have schizotypal personality disorder. im only 14 years old and its already ruining my relationship with everyone i love. i am waiting for treatment and im on my own right now... no one has told me it will be alright...
- Nick
April 23, 2010 11:30 a.m.
Mayo Clinic Staff,,,,I looked into DBT.Found it to be a lot to manage.I have PTSD,anxiety issues,panic disorders ,sleep disorders,suicidal issues and am selfharming .See a therapist weekly and take several meds.It takes all I have to get through another day .
- no name
February 26, 2010 11:39 a.m.
Lynn (Dec 17)- Please tell husband to read Dr. Bob's story in the Big Book of AA. He if one of the founders of AA, took drugs and had to seek outside help. Also Bill Wilson(the other founder of AA) suffered from horrible depression. Not believing in medication is extremely old school. I have been sober almost 20 years, and take meds for bi-polar, still have had a pretty chaotic life, but used AA as my life line (along with shrinks and therapy). I am only starting to talk about my disorder in meetings, butI figured all this time if you didn't sign MD behind your name you really weren't qualified to comment on my mental health. But the one thing for absolutely sure is NO ONE can make anyone do what they want them to, in recovery or not. Good Luck!
- No name given
December 17, 2009 10:49 a.m.
My girlfriend's husband is bipolar. He is on Paxil and now the doctor wants to reduce his dose and add Seroquel, which he refuses to take. How do you convince a person with bipolar into believing they need help. At this point, we are desperate. He trusts only his AA friends and other recovered alcoholics' opinions. This whole process is as difficult as the alcohol recovery process, which was successful, so far.
- Lynn
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

34 comments posted