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Personality Disorders

Which is Which: An Unclear Diagnostic Overlap

When talking about schizoid and schizotypal personality disorders, it is important to distinguish them from the class of disorders that share the same root: schizophrenia spectrum disorders. Schizophrenia spectrum disorder is defined by the DSM V as a class of psychotic disorders that range from delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorders, as well as some other less commonly known subsets of psychotic disorders. A couple of key features that define this spectrum are delusions, hallucinations, disorganized thinking and speech, disorganized motor behavior, and diminished emotional expression.

The main differences between these psychotic disorders are usually the varying durations of the key symptoms. Brief psychotic disorder displays the symptoms for at least a day but for less than a month. Schizophreniform disorder stretches that duration for over a month but less than six months, and anything displayed in duration longer than 6 months can be diagnosed definitively as schizophrenia. However, other disorders such as schizoaffective disorder, highlight the presence of mood affective symptoms such as depression and bipolar in concurrence with psychotic symptoms. (American Psychological Association, 2013)

Oddly enough, schizotypal PD falls into this spectrum while schizoid PD does not, even when both require an absence of persistent psychotic symptoms. There seems to be a consensus that schizotypal personality disorder should be seen as a precursor of schizophrenia – instead of being seen as an independent personality disorder.

The differential diagnostic basis for personality disorders and schizophrenia spectrum disorders usually lies in the persistent patterns of thinking and behavior. The DSM V stresses that if the personality traits are not prevalent before the onset and during the remission of psychotic symptoms, the personality disorders should not be diagnosed.

There is much debate on how effectively the current edition of the DSM defines different mental disorders, as there are both merits and disadvantages. The broadness of the schizophrenia spectrum allows people who experience psychosis and related traits to be diagnosed, but the boundaries between each illness and their relationship to schizoid and schizotypal personality disorders remain unclear, and hopefully subject to revision.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi:10.1176/appi.books.9780890423349

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Personality Disorders

Biological Links to Eccentric Behavior

The most prevalent symptom of schizotypal personality disorder are the odd or eccentric beliefs and behavior of the individual. Depending on the severity, people with StPD can experience moderate to serious impairment in their day-to-day lives, as these unusual thoughts and consequent behaviors can affect their relationship with the people closest to them. (Bressert, 2014) They may have trouble forming relationships or understanding the impact of their behavior on others, and may also misinterpret others’ motivations and behaviors and develop significant distrust of others. These social misconceptions may lead to severe anxiety and a tendency to turn inward in social situations, causing even further isolation for people with StPD.

For neurotypical people, whose pattern of thinking are more or less organized, (though it may not always feel as so), mental disorders like StPD are a little hard to understand. The specific oddities may vary on an individual basis, but current diagnosis of StPD tends to focus on two criteria:

1. Cognitive-perceptual criteria: ideas of reference, odd beliefs, and perceptual disturbance, and

2. Oddness criteria: that is, odd behavior, odd speech and/or thought processes, and restricted affect. (Hummelen, 2012)

Simply put, the severity of StPD depends on perception, and oddness within that perception, while still not crossing over to any diagnostic criteria for schizophrenia. As a consequence, individuals with StPD often have poor real-world social adjustment, despite having relatively intact mental and social cognition. Studies have been done to map out cognitive structures that may have been unusually affected by the disorder, and how they affect social interaction.

In a study by Hur et. al, people with StPD display higher activity in the part of the brain involved in reward and decision making in response to the stimuli of biological motion, or body language. This suggests that these enhanced responses are possibly related to the peculiar ways that individuals with SPD behave in social contexts. The specific link between higher activation levels and odd thinking and behavior has not been investigated, but the researchers suggest that the hyperactive neurons result in a patient’s eccentric behavior, and inability to form coherent social interactions. It is important to note that despite possible biological links, mental illnesses such as personality disorders still have very real social and psychological implications that can not be dismissed by biological bases. Biological factors are only one facet in a multitude in understanding how neurological disorders work, how it affects the people with it and how we can provide better care for them.

References:

Bressert, S. (2014). Schizotypal Personality Disorder Symptoms. Psych Central. Retrieved on February 24, 2016, from http://psychcentral.com/disorders/schizotypal-personality-disorder-symptoms/

Hummelen  B, Pedersen  G, Karterud  S.  Some suggestions for the DSM-5 schizotypal personality disorder construct. Compr Psychiatry. 2012;53(4):341-349.

Hur, J., Blake, R., Cho, K. I., Kim, J., Kim, S., Choi, S., . . . Kwon, J. S. (2016). Biological Motion Perception, Brain Responses, and Schizotypal Personality Disorder. JAMA Psychiatry, 73(3), 260. Retrieved April 3, 2016.

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Personality Disorders

The ‘Flat Affect’

Schizoid personality disorder (SPD) is characterized by a long-standing pattern of detachment from social relationships. People with schizoid personality disorder are often detached from social relationships, and experience difficulty in expressing emotions, or do so in a restricted range and intensity.

For people with SPD, they often appear to lack a desire for intimacy, and will avoid close relationships with others. They usually prefer to spend time with themselves rather than socialize or be in a group of people. This behavior does not come from a contempt or anxiety from being around other people; rather, people with SPD are more or less indifferent to social experiences.

Some of the major symptoms of SPD include: showing neither desire nor joy for close relationships, high preference for solitary activities, lacking close friends or confidants, indifference to the praise or criticism of others, and emotional coldness, detachment, or flattened affectivity. (Bressert, 2014)

This ‘flat affect’ is common in people with schizophrenia spectrum disorders, autism spectrum disorders, PTSD, depression, depersonalization disorder and brain damage. The flat affect refers specifically to the severely reduced or no signs of emotional reactivity in an individual, and usually manifests when one would usually show emotion. In people with SPD, the flat affect varies from failure to show emotion even when it is present, and an actual lack of emotional affectivity in certain situations.

Because of the nature of schizoid personality disorder, most people with it are able to function relatively well in their day-to-day lives, and are not as hindered by their personality disorder. People with SPD rarely seek a diagnosis or treatment on their own unless a conflict arises, or aspects of the disorder start to have an impact in their lives. Due to this, treatment plans for people with SPD are rarely long term. Solution-focused therapy are the most common treatments for schizoid personality disorder, although more research needs to be conducted to assess how longer term therapy may benefit people with this disorder.

References:

Bressert, S. (2014). Schizoid Personality Disorder Symptoms. Psych Central. Retrieved on February 11, 2016, from http://psychcentral.com/disorders/schizoid-personality-disorder-symptoms/

Categories
Personality Disorders

Schizotypal Personality Disorder and Socialization

Schizotypal personality disorder (StPD) is characterized by acute discomfort or reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities. (Bressert) Schizotypal personality disorder is a particularly severe personality disorder because of its adverse effects of psychosocial functioning in an individual. In a study by Skodol et. al, “patients with schizotypal and borderline personality disorder have significantly more impairment at work, in social relationships, and at leisure than patients with obsessive-compulsive personality disorder or major depressive disorder; patients with avoidant personality disorder were intermediate.” Some of the reasons for this can be attributed to the nature of the more severe personality disorder. People with borderline personality have heightened emotional responses and therefore unstable interpersonal relationships, which leads to many aspects of their psychosocial impairment. But how do the symptoms of schizotypal personality disorder bring about these effects?

People with schizotypal personality usually have trouble making and maintaining social relationships. Often, their odd beliefs and unusual perceptual experiences can make it harder for them to relate to others. To strangers, people with StPD may come off strange and anxious. To people they have gotten close with, people with StPD may have trouble expressing the appropriate emotions in certain situations, which could weaken their relationship.

When people with StPD experience anxiety, they tend to focus on paranoid fears instead of negative judgments about the self. Sometimes, even with people they are familiar with, they can still become more suspicious and paranoid towards them. These anxieties can often cause them to further isolate themselves, or intensify any feelings of isolation that are already present.

This social anxiety also has a biological link. In a study by McCarley et. al, people with StPD have reduced gray matter in certain areas of the brain. The researchers also looked to see whether gray matter deficits in the schizotypal subjects could be significantly linked to their symptoms such as introversion, social isolation, and reduced emotions.

It is important for people to understand how certain disorders affect the person with them in everyday situations, especially if it affects the social aspect of their functioning. We should extend our empathy and understanding toward someone who makes an effort at making conversation with them even if we can’t truly follow their thought process, and not dismiss them based on how they communicate.

References:

Bressert, S. (2014). Schizotypal Personality Disorder Symptoms. Psych Central. Retrieved on February 24, 2016, from http://psychcentral.com/disorders/schizotypal-personality-disorder-symptoms/

Skodol, A. E., Gunderson, J. G., Mcglashan, T. H., Dyck, I. R., Stout, R. L., Bender, D. S., Oldham, J. M. (2002). Functional Impairment in Patients With Schizotypal, Borderline, Avoidant, or Obsessive-Compulsive Personality Disorder. American Journal of Psychiatry AJP, 159(2), 276-283. Retrieved February 29, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/11823271

Arehart-Treichel, J. (2013, April 5). Schizotypal Personality Disorder Linked to Brain Changes. Retrieved February 29, 2016, from http://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2013.4a1

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Personality Disorders

Schizotypal and Schizoid Personality Disorders: An Overview

By Vidya Koesmahargyo

Personality disorders (PD) can be generalized into three clusters of patterns of thinking and behavior. Cluster A personality disorders are characterized by odd, eccentric thinking or behavior, including schizoid, schizotypal, and paranoid PDs. Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior, including PDs such as borderline and antisocial personality disorder. Cluster C personality disorders are characterized by anxious, fearful thinking or behavior, such as obsessive compulsive and avoidant PDs. (American Psychological Association, 2013)

Schizoid and schizotypal personality disorders are characterized by long-standing patterns of detachment from social relationships and difficulty in establishing and maintaining those relationships. Although the lack of close personal relationships occur in both disorders (attributed to cluster A disorders), each disorder has their own characteristic symptoms.

Symptoms of schizotypal personality disorder can include peculiar, eccentric or unusual thinking, peculiar style of speech, and limited or inappropriate emotional responses. For example, a person with schizotypal PD may have lasting suspicions or paranoid ideas, or express anger at good news, and speak at irregular intervals. In contrast, symptoms of schizoid personality disorder include a high preference of being alone or solitary activities, lack of understanding of social cues, little desire for intimacy or sexual relationships, indifference or lack of motivation at school or work. Most of the symptoms for both these disorders result in the individual’s lack of close social relationships or their difficulty to maintain them. (PsychCentral)

Schizotypal and schizoid personality disorder may somewhat resemble schizophrenia, a severe mental illness that affects the way people perceive reality, emotions, and behavior. People with schizophrenia have symptoms that categorize into positive and negative symptoms. Positive symptoms, which refers to psychotic behaviors that include hallucinations, delusions, and unusual or dysfunctional ways of thinking can relate to patterns of thinking in Schizotypal PD. Similarly Schizoid PD may seem relate to negative symptoms, which are associated with disruptions to normal emotions and behaviors such as reduced expression of emotions, reduced feelings of pleasure and motivation in everyday life.

Despite the resemblance, there is a marked difference between schizoid and schizotypal personality disorders and schizophrenia: neither show symptoms of explicit hallucinations or delusions, especially in schizotypal PD, where the peculiar thoughts and behavior can be seen as mild positive symptoms. In this case, a person with schizophrenia might believe that their thoughts are being controlled by an outside force, and act out in fear, while a person with schizotypal PD may often think about the notion and have similar notions that are not quite delusions.

There is some indication that there is a strong genetic relation between the disorders, and relatives of people with schizophrenia are at increased risk of developing either schizotypal or schizoid personality disorder.  Some experts argue that schizotypal personality disorder might be a mild form of schizophrenia, whereas other researchers suggest there are also important differences in other brain functions that prevent people with schizotypal and schizoid personality disorders from developing schizophrenia. (Hoermann)

Works Cited:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi:10.1176/appi.books.9780890423349

Bressert, S. (2014). Schizoid Personality Disorder Symptoms. Psych Central. Retrieved on February 11, 2016, from http://psychcentral.com/disorders/schizoid-personality-disorder-symptoms/

Hoermann, S. (2009, August 09). Schizotypal Personality Disorder and Schizophrenia. Retrieved February 13, 2016, from https://www.mentalhelp.net/blogs/schizotypal-personality-disorder-and-schizophrenia/

Categories
Personality Disorders

Let’s Play a Game

…about solving interpersonal conflicts!

If you’ve been feeling anxious, upset, or angry lately, and maybe need a little nudge in the right direction to resolve it, we’ve got something that might help:

Player 2 is a game where you get to fill in the blanks and make sense of what you’re going through. If you’ve had a falling out with someone that’s put you in one of your worse moods,  this game will help you confront those feelings and hopefully sort them out for the better.

Happy playing!

(No jump scares, I promise.)

 

Categories
Personality Disorders

Testing the Waters: Borderline Personality Disorder and Therapy

Borderline Personality Disorder often presents as a pattern complex and damaging thought processes and behaviors. People with this disorder are emotionally dependent, which means that their emotions have adverse affects on their day-to-day living because they can overwhelm regular cognitive functioning. (Grohol, 20213) These individuals will find it more difficult to distinguish between reality from their own perceptions of the world and their surrounding environment.

People with BPD have very heightened emotional responses to everyday situations. Recall the last bad day you had, maybe you had gotten sick during a busy week, or fought with a best friend, or had a significant other break up with you. The emotions you feel in those moments may be intense enough for you to not pay attention to much else. Now imagine, experiencing this not only during times of crisis, but on a daily (sometimes even on a more frequent) basis. A small disagreement with someone can make a person with BPD extremely angry, irritable, and impulsive, or an offhanded remark can result in a depressive state, loss of motivation, and hopelessness. While a person without a mental illness may feel this way from time to time, a person with BPD will act on these emotions and every time they encounter them. Worse yet, because of their intense fear and frantic efforts to avoid abandonment, perceived neglect by a loved one can cause a person with BPD to engage in self-damaging behaviors and suicide ideation.

The most common form of psychotherapy used to treat borderline personality disorder works to differentiate between emotion and behavior, and is called Dialectical Behavior Therapy (DBT). Research conducted on this treatment have shown it to be more effective than most other psychotherapeutic and medical approaches to helping a person to better cope with this disorder. DBT helps patients take control of their emotions and themselves through self-knowledge, emotion regulation, and cognitive restructuring. It is a comprehensive approach that is most often conducted within a group setting. (Linehan, 1999)

Other psychological treatments that have been used, to lesser effectiveness, to treat this disorder include those which focus on conflict resolution. People with BPD are often deemed as a source of drama and never-ending crises, shown through numerous derisive book titles to help other people ‘deal’ with someone close to them who have BPD. These often reinforce the stigma around people with BPD that they are just attention seekers or drama makers who live off of negative energy. Solution-focused therapies neglect the core problem of people who suffer from this disorder — difficulty in expressing appropriate emotions and subsequent behaviors to significant people in their lives.

Because people with this disorder often try and “test the limits” of the therapist or professional when in treatment, boundaries must be set between the patient and therapist. Individuals with borderline personality disorder are often unfairly discriminated against because their problematic impulsive behaviors, but it is the job of the clinician to maintain professionalism and work through their own biases in order to help the patient. While individuals with BPD may need more care than other patients, their behavior is caused by their disorder.  Discriminating against them, especially during treatment, is detrimental to their mental health.

Works cited:

Grohol, J. (2013). Borderline Personality Disorder Treatment. Psych Central. Retrieved on November 20, 2015, from http://psychcentral.com/lib/borderline-personality-disorder-treatment/

Linehan, M. M., Schmidt, H., Dimeff, L. A., Kanter, J. W., Craft, J. C., Comtois, K. A., & Recknor, K. L. (1999). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. American Journal on Addiction, 8, 279-292.

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Personality Disorders

Stop Calling it Drama: Misconceptions and Borderline Personality Disorder

By Vidya Koesmahargyo

Borderline personality disorder has a long history shrouded in misconceptions. The term ‘borderline’ itself originated from an old psychiatric convention, as some categorized patients with the disorder as being on the ‘border’ of psychosis and neurosis since they overlapping symptoms of both (Gunderson, 2008). Over the years, however, borderline personality disorder gained its own diagnostic criteria, and is no longer only characterized as being on the border of two neurological symptoms. Though many efforts have been made to change the name, so far none have been successful despite the term’s inaccuracy. Valerie Porr, president of Treatment and Research Advancement Association for Personality Disorders states that, “the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma. (Porr, 2001)

According to Psych Central, borderline personality disorder is characterized by pervasive patterns of instability in interpersonal relationships, self-image and emotions. Although these patterns are the diagnostic criteria for this disorder, they might manifest themselves in different ways for each individual, and each experience is unique.

An example of a symptom of this disorder is emotional instability. A person with borderline personality disorder may feel intense episodic dysphoria, anxiety, mania and anger in the span of a few hours or days. This is where the label ‘drama queen’ stems from, which effectively invalidates the experiences of people with BPD.

Because of their cyclic and intense moods, people with BPD are often impulsive in an effort to relieve their distress. These periods of anxiety or anger may be so extreme as to cause transient, stress-related paranoid thoughts and even brief psychosis. (Psych Central, 2014)

Another symptom is a lack of self-identity or identity disturbance. People with BPD typically do not feel as if they have a base identity, and instead adopt temporarily meaningful personalities that they observe in other people. Their intense mood shifts also play a role: during periods of mania, a person might display extreme confidence and recklessness, while in extreme anger they might say nasty remarks or act out in aggression.  These shifts may include drastic changes in beliefs and morals, making it even harder for the individual to build a stable sense of self.

Another symptom among people with BPD is the concept of ‘splitting,’ which is the act of constantly idealizing and devaluing something. Due to their severe moods, people with BPD often fall into a ‘black’ or ‘white’ mindset. According to Goin, splitting is a primitive defense characterized by a polarization of good feelings and bad feelings, of love and hate, of attachment and rejection. Splitting, acts as an unconscious force to protect against dangerous anxiety. If a person with BPD suddenly feels good or bad about a particular person or situation, they can instantly modify their opinions, memories or attitudes to be consistent those feelings, regardless of any apparent contradictions. (Goin, 1998)

Many believe that people with the disorder and manipulative, attention seeking, and even abusive. Even psychiatric professionals often dismiss their clients with BPD in the same manner. While emotional and identity instability may cause some to extreme actions, these actions are not deliberate. In the same way individuals with depression cannot change their mood on a whim, individuals with BPD are unable to regulate their emotions in a healthy way. It is important to remember these individuals deserve respect and compassion, not to be treated condescendingly or vilified.

 

Works Cited:

Gunderson, J.G., Links, P.S. Borderline Personality Disorder: A Clinical Guide. Washington, DC, American Psychiatric Publishing, 2008, 1-9.

Porr, V. (2001). How Advocacy is Bringing Borderline Personality Disorder Into the Light. Retrieved November 22, 2015, from http://www.tara4bpd.org/how-advocacy-is-bringing-borderline-personality-disorder-into-the-light/

Psych Central. (2014). Borderline Personality Disorder Symptoms. Psych Central. Retrieved on November 21, 2015, from http://psychcentral.com/disorders/borderline-personality-disorder-symptoms/

Goin, M. (1998, November 1). Borderline Personality Disorder: Splitting Countertransference. Retrieved November 22, 2015, from http://www.psychiatrictimes.com/borderline-personality/borderline-personality-disorder-splitting-countertransference-0/page/0/1

 

Categories
Personality Disorders

The Stigmatization of Borderline Personality Disorder and High Comorbidity Rates

By Vidya Koesmahargyo

Comorbidity is defined as the simultaneous presence of two chronic conditions in a patient. (Comorbidity) One particular personality disorder, borderline personality disorder (BPD) has a markedly high rate of comorbidity with a variety of other mental health conditions. In fact, the majority of people diagnosed with BPD are comorbid with depression, anxiety, and substance abuse. This makes it harder to treat patients with BPD given only few have straightforward clinical presentations with no comorbidity. (Biskin & Paris, 2013)

Borderline personality disorder itself is characterized by symptoms such as identity disturbance, unstable and intense interpersonal relationships, chronic feelings of emptiness, inappropriate and intense anger, and emotional instability. (American Psychiatric Association, 2013) Individuals with BPD are affected by pervasive patterns of instability in interpersonal relationships, self-image and emotions.

Due to the nature of these patterns, they can cause significant distress and impairment across a broad range of social, work, and interpersonal situations.

Borderline personality disorder is one of the most highly stigmatized mental illnesses. However, unlike other illnesses, the stigma associated with BPD often comes from mental health professionals (NAMI). Many psychiatrists will not treat BPD patients, or claim they are “treatment resistant.” Often, attempts to treat these people fail, and some professionals blame the patient for not responding to treatment. (Brain Blogger)

If the bias in psychiatric resources and high rates of comorbidity among these individuals are taken into account, functioning in day-to-day life can be even more complicated.

One specific disorder with the highest comorbidity with BPD is major depressive disorder. According to psych times, 70% of patients with BPD were found to be comorbid with depression. Almost 96% of patients were comorbid with at least one mood disorder, a category of mental disorders in which the underlying problem primarily affects a person’s persistent emotional state or mood. (McGlashan, et al. 2012) Other comorbidities, such as any anxiety disorder (88%) and alcohol and substance abuse (50%) also frequent. (Robert & Biskin, 2013)

The high comorbidity rate in individuals with borderline personality disorder is disconcerting. It creates an added strain on the people who have multiple conditions, and often adds further complications to the course of their treatments. Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. (Valderas, et al. 2009) This further decreases the outlook, or prognosis, of these patients and their quality of life.

The high rates of comorbidity in these individuals warrant more research done on successful treatments for co-occurring illnesses and how it further impacts the individual. Further assessment and prevention of risk factors that contribute to the development of borderline personality disorder is also important. It is crucial that mental health care is rid of their biases against patients who are in need of their help, and understanding the facets of this disorder is a step towards progress.

 

Sources:

Comorbidity. (n.d.). In New Oxford American Dictionary. Retrieved October 23 2015, from http://www.oxforddictionaries.com/us/definition/american_english/comorbidity

Biskin, R., & Paris, J. (2013, January 9). Comorbidities in Borderline Personality Disorder. Retrieved October 23, 2015, from http://www.psychiatrictimes.com/borderline-personality/comorbidities-borderline-personality-disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi:10.1176/appi.books.9780890423349

NAMI. (2007). Borderline Personality Disorder: A Most Misunderstood Illness. National Alliance on Mental Illness. Retrieved October 21, 2015.

Elisa, S. (2006, June 20). Psychiatry Discriminates Against People with Borderline Personality Disorder. Retrieved October 25, 2015, from http://brainblogger.com/2006/06/20/anti-stigmatization-psychiatry-discriminates-against-people-with-borderline-personality-disorder/

McGlashan, T. H., Skodol, A. E., Gunderson, J. G., Shea, M. T., Morey, L. C., Sanislow, C. A., Stout, R. L. (2005). THE COLLABORATIVE LONGITUDINAL PERSONALITY DISORDERS STUDY (CLPS): OVERVIEW AND IMPLICATIONS. Journal of Personality Disorders, 19(5), 487–504. http://doi.org/10.1521/pedi.2005.19.5.487

Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., & Roland, M. (2009). Defining Comorbidity: Implications for Understanding Health and Health Services. Annals of Family Medicine, 7(4), 357–363. http://doi.org/10.1370/afm.983

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Personality Disorders

Treating the Untreatable: An Unfortunate Outlook on Antisocial Personality Disorder

By Vidya Koesmahargyo 

Antisocial personality disorder (ASPD) is one of the hardest personality disorders to treat. Not much is known on ASPD compared to more common mental illnesses. According to Lenzenweger, et al. only 0.6% of the U.S population has been diagnosed with ASPD (2007). 

Now, 0.6 % percent may not seem like a large percentage. However, when multiplied with the U.S. population of 318 million people, over 1.9 million people in the U.S. are living with ASPD. Even though it is not as prevalent as mood or anxiety disorders, it does not discount the importance of ensuring individuals with ASPD receive the treatment and care they deserve.

One of the factors that contribute to the lack of success in treating ASPD is tied to the nature of the disorder. The symptoms associated with ASPD are: consistent irresponsibility, failure to conform to social norms, and lack of remorse (American Psychiatric Association, 2013).  This might contribute to an individual’s reluctance to seek or go through with treatment. People may only start therapy when required to by a court. In fact, court referrals for assessment and treatment for individuals with ASPD are likely the most common referral source for this disorder. (Grohol, 2013)

The situation for these individuals is not ideal. According to a study by James & Glaze, almost 61% of prisoners in the United States have a mental health disorder. These individuals face a markedly higher chance of abuse from other inmates and staff than non-mentally ill prisoners, further decreasing a successful prognosis. (2006) In another study done throughout several correctional facilities in Connecticut, 34.6% percent of inmates have ASPD. (Trestman, et al. 2007) Mental illness in the United States is highly criminalized, which poses as a problem because incarceration is an abhorrent and inefficient way to treat mental illness. (NYTimes)

For individuals with ASPD who aren’t facing a jail sentence, their outlook isn’t necessarily any better. There is simply not enough research that has been conducted on antisocial personality disorder. Many psychotherapists argue that treatment for this disorder does not yield much success. However, only one randomized controlled trial has been conducted, which tested cognitive-behavioral therapy (CBT) as a viable treatment for ASPD. The study concluded that the treatment didn’t work. This contrasts other illnesses such as depression or bipolar disorder, where researchers have conducted numerous studies looking at the effectiveness of medications and psychotherapies. Psychologists do not have enough information to determine which approach is best to treat this disorder. (Tartakovsky)

It is safe to conclude that additional research on antisocial personality disorder is highly needed. The information gathered can help find better diagnostic techniques, treatment options, and outreach possibilities to reduce the criminalization and under treatment of individuals with ASPD.

 

Sources:

Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication.Biological Psychiatry, 62(6), 553–564. http://doi.org/10.1016/j.biopsych.2006.09.019

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi:10.1176/appi.books.9780890423349

Grohol, J. (2013, October 9). Antisocial Personality Disorder Treatment. Retrieved from http://psychcentral.com/disorders/sx7t.htm

James, D. & Glaze, L. (2006, December 14). Mental Helth Problems of Prison and Jail Inmates. Retrieved from http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Trestman, R., Ford J., Zhang W., and Wiesbrock, V. (2007). Current and Lifetime Psychiatric Illness Among Inmates Not Identified as Acutely Mentally Ill at Intake in Connecticut’s Jails. The Journal of the American Academy of Psychiatry and the Law, volume 35(4), 493-495.

Kristof, N. (2014). Inside a Mental Hospital Called Jail. New York Times. Retrieved from http://www.nytimes.com/2014/02/09/opinion/sunday/inside-a-mental-hospital-called-jail.html?_r=0

Tartakovsky, M. (2013). Surprising Myths & Facts About Antisocial Personality Disorder. Psych Central. Retrieved on October 6, 2015, from http://psychcentral.com/blog/archives/2013/04/06/surprising-myths-facts-about-antisocial-personality-disorder/