Personality Disorders are among the least understood of the recognized psychological disorders. Unfortunately they are also the most common severe mental disorders. Their severity is compounded because personality disordered persons often have other medical or mental illnesses. More specifically, people suffering from personality disorders are more likely than the general population to also suffer from a history of alcohol and/or substance abuse (Bowden-Jones, et. al., 2004; Morganstern & Miller, 1997; Thuo, et. al. 2008; Volkan, 1994.), sexual dysfunction (Bogaerts, et. al., 2006; Maina, et. al. 2007; Neeleman, 2007; Hill, Habermann, Berner, & Briken, P. 2006), generalized anxiety disorder (Brooks, Baltazar, & Munjack, 1989; Hansen, et. al., 2007; Massion, et. al., 2002; Mavissakalian, et. al., 1995), bipolar disorder (George, et. al., 2003; Maina, Albert, Pessina, & Bogetto, 2007; Wilson, et. al., 2007), body-dysmorphic disorder (Semiz, et. al. 2008), obsessive-compulsive disorder (Hansen, et. al., 2007; Maina, Albert, Pessina, & Bogetto, 2007), depressive disorder (Wilson, et. al, 2007), post-partum depression (Akman, Uguz, & Kaya, 2007), eating disorders (Godt, 2002; Marañon, Echeburúa, & Grijalvo, 2004; Sansone, Levitt, & Sansone, 2005), post-traumatic stress disorder (Bollinger, et. al., 2000; Johnson, Sheahan, & Chard, 2003; Mclean & Gallop, 2003), self-mutilation (Andover, et. al., 2005; Dulit, et. al., 1994; Paris, 2005; Rollinick, 2001) and suicidal thoughts or acts (Pompili, Ruberto, Girardi, & Tatarelli, 2004).
Other maladaptive social consequences of personality disorders include decreased academic performance (King, 2000), domestic violence1 (Berger-Jackson, 2003), child molestation and sexual offense (Bogaerts, et. al., 2008; Dudeck, et. al., 2007), incarceration (Lindsay, et. al., 2006; Narisco, 2007), poor work habits and performance (Furnham, 2007; Kyrios, et. al. 2007; Lynch & Horton, 2004), and pathological gambling (Bagby, et. al. 2008; Samuels, et. al., 1994).
People diagnosed with one personality disorder often suffer from other personality disorders. In one study the majority of patients meeting criteria for a diagnosis of a personality disorders also were diagnosed with an additional personality disorder. The most prevalent personality disorders for the first diagnosis were avoidant, borderline, and obsessive-compulsive personality disorders. The authors suggest that patients suffering from personality disorders should be evaluated for additional personality disorders because their presence can influence the course and treatment (Zimmerman, Rothschild, & Chelminski, 2005).
One of the most interesting things about personality disorders is that people around the one with disorder will be more distressed then the person manifesting the disorder. This distress may even be worse when the people close to the personality-disordered person are knowledgeable about the disorder (Hoffman, et. al., 2003; Scheirs & Bok, 2007). This fits in with many of our ideas about bizarre behaviors – they seem strange to us, but not the person exhibiting them.
Understanding personality disorders is important, as the prevalence of these disorders is quite high. For instance, a recent study found that 44% of volunteers for biomedical research studies suffered from a personality disorder (Bunce, et. al. 2005). Nevertheless the prevalence of personality disorders reported in the research is somewhat variable depending on the milieu and populations studied.
A good example of this variability can be seen in two studies conducted by the same first author. Moran et. al. (2000) examined the prevalence of personality disorder along with its relationship to sociodemographic status and common mental disorders in 300 primary care patients in the U.K.. They found a diagnosis of personality disorder in 24% of patients in the study. These personality-disordered patients were more likely to have past and present psychiatric problems, to be single, and to present to the surgery on an emergency basis when compared to non-personality disordered patients. Patients with cluster B personality disorders were particularly associated with psychiatric problems. The authors concluded that there is a high prevalence rate of personality disorders in the primary care setting and that this represents a significant source of burden.
However, two years later the same author reported relatively low rates for cluster B personality disorders in a similar population. Moran & Mann (2002) examined 303 primary care patients in southeast England for cluster B personality disorders. Using standardized assessment instruments they identified just 13 patients with personality disorders or a prevalence of 4% in their sample. The authors concluded that among primary care patients, cluster B personality disorders were uncommon.
Another study from a nearby geographical area, but situated in a community mental health clinic demonstrated much higher prevalence of personality disorders among their patients. This team of researchers from South London assessed personality disorders, as well as psychotic and affective disorders in their patient population. They found 52% of their patients met the criteria for one or more personality disorders, while 67 % of patients had a psychotic illness and 23 % had a diagnosis of a depressive disorder. Non-psychotic patients seen by nursing staff had extremely high rates of personality disorder, when compared to patients seen by psychiatrists and psychologists (Keown, Holloway, & Kuipers, 2002).
Using data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, Grant et. al. (2004) report that 14.79% of adults in the United States (approximately 30.8 million people) met the criterion for diagnosis of at least one personality disorder. The study did not include diagnoses for borderline, schizotypal and narcissistic personality disorders, which would have likely increased the incidence of personality order diagnoses. Of the personality disorders studied the most prevalent disorder was obsessive-compulsive personality disorder (7.9%), followed by paranoid personality disorder (4.4%), antisocial personality disorder (3.6%), schizoid personality disorder (3.1%), avoidant personality disorder (2.4%), histrionic personality disorder (1.8%), and dependent personality disorder (0.5%). Women had a significantly higher risk of avoidant, dependent, and paranoid personality disorders while men were at greater risk for antisocial personality disorder. No gender differences were seen for risk of obsessive-compulsive, schizoid, or histrionic personality disorders. Other risk factors for the personality disorders studied included being Native American, black, young adulthood, low socioeconomic status, and not having a significant other. Avoidant, dependent, schizoid, paranoid, and antisocial personality disorders were significant predictors of disability, while obsessive-compulsive personality disorder had an inconsistent relationship to disability. Individuals with histrionic personality disorder did not have any disability when compared with those without the disorder.
Bowden-Jones, et. al. (2004) found 37% of substance abusers and 53% of alcohol abusers in their sample also suffered from a personality disorder.
It is estimated that up to 50% of prisoners in the United States have antisocial personality disorder. This is likely due to the fact that behavioral characteristics associated with antisocial personality disorder, such as substance abuse, aggression, violence and vagrancy, are often related to criminal behavior. (Lindsay, et. al. 2006). In the U.K. the number of prisoners with antisocial personality disorder is 26%, less than the prevalence rates in the U.S., but still a substantial number (Hobson & Shine, 1998).
Personality typically refers to those aspects of a person’s character that are not transient, i.e. ‘traits’, and opposed to ‘states’. According to Millon, Blaneyu, & Davis (1999):
Personality is seen today as a complex pattern of deeply imbedded psychological characteristics that are largely non-conscious and not easily altered, which express themselves automatically in almost every area of functioning. (pg. 510)
From this definition of personality the expectation is that traits associated with personality disorders would be stable over time. Recent studies support this idea (McGlashan, et. al. 2005). Therefore we can understand personality disorders (PDs) to be long-term, maladaptive patterns that pervade all aspects of a person’s life. These patterns include problems related to: perception (viewing and understanding the external world), ability to regulate emotions, high levels of anxiety, and poor impulse control. These patterns can lead to significant costs to both the person suffering from a personality disorder and the society he or she functions within. These costs, include lost productivity, increased interaction with law enforcement, imprisonment, a pattern of hospitalization, significant unhappiness, and suicide.
Personality disorders are notoriously difficult to treat. Long-term intensive psychotherapy has been shown to be effective for some personality-disordered patients (Bond, & Perry, 2004, 2006; Chatham, 1989). As Chatham puts it in regards to patients with borderline personality disorder;
I have observed that towards the end of the change process, patients often realize with surprise that early in psychotherapy certain things upset or traumatized them strongly enough to trigger various degrees of aberrant behavior. Basically, genuine improvement in borderline patients can begin only when primitive defenses and internalized pathological object relations have been uncovered and discarded. The patients must recognize that they can get on in the world without this pathology, because they now have moved forward in psychological development. But to get to this point sometimes requires a very long period of intensive psychotherapy (1989, p. 420).
According to Kernberg (1985), for this long-term intensive psychotherapy to be effective for people suffering from borderline personality disorders (or low ego strength - a defining characteristic of most personality disorders) the psychotherapy needs to be conducted by a skilled therapist who is in control of his or her own hostility and is not narcissistic. Therefore, while long-term psychotherapy for personality disorders is recommended there are may barriers to this type of treatment. Even if patients could afford and tolerate or afford this kind of treatment, finding the right therapist is crucial for a positive treatment prognosis. Short-term and supportive psychotherapy doesn’t seem to work as well as long-term intensive psychotherapy (Hoglend, 1993; Kernberg, 1985). Caligor, Kernberg, & Clarkin (2007) report on a transference-based object relations psychotherapy specifically designed for the treatment of personality disorders that appears to be effective.
Newer kinds of therapeutic techniques such as Cognitive-Behavior therapy and Dialectic Behavior Therapy (DBT) that was specifically designed to treat personality disorders show promise in effectively treating personality disorders2 (Davidson, et. al., 2007; Fruzzetti, 2002; Linehan, 1993; Linehan, et. al., 2007; Lynch, et. al., 2007; Salsman & Linehan, 2006; Sperry, 2006). Some question the long-term efficacy of these treatments, which seem to be measuring rather simple outcomes when compared to long-term psychodynamic treatment (Kernberg, 1985). Indeed, some research suggests that Cognitive-Behavior therapy works less well for personality disorders than for other types of mental problems (Luk, et. al., 1991). Another study indicates that the psychodynamic approaches may yield better long-term therapeutic results than Cognitive-Behavioral therapy with personality disordered patients (Leichsenring & Leibing, 2003). Nevertheless, Cognitive-Behavior therapy and Dialectic Behavior Therapy have shown efficacy in reducing acting out behaviors such as suicide attempts while being accessible (Davidson, et. al., 2006; Linehan, et. al., 2007). In fact, in one study the four major approaches to treating borderline personality disorders were all found to be successful in reducing behavioral acting out and affective instability, while not eliminating the underlying personality disorder (Lopez, et. al., 2007).
One of the dirty secrets of the psychotherapy profession is that many if not most therapists either consciously or unconsciously screen out patients with personality disorders (Hartman, 1999), or take on a ‘removed’ scientific attitude towards them (Davidtz, 2008). A UK study found that registered mental health nurses perceived patients with a diagnosis of borderline personality disorder more negatively than patients with a diagnosis of schizophrenia. Patients diagnosed with borderline personality disorder were perceived as more dangerous and were subject to more social rejection than those with a diagnosis of schizophrenia (Markham, 2003). Rothschild and Rand (2006) make the case that psychotherapists take on the emotional states of their patients through unconscious mirroring. This can cause vicarious trauma for psychotherapists, especially when they are unaware of their autonomic arousal. Since personality disordered patients have much more unstable emotional states it stands to reason that the psychotherapist will take on a much greater burden and a higher level of vicarious trauma when working with this patient population. As Fonagy says:
Why are these patients designated as difficult? Part of the difficulty undoubtedly arises out of the obligation we quickly feel as clinicians to enact that which is projected onto us. We are forced to be as our patients wish us to be, because we sense that without this, prolonged contact with us might be intolerable. They behave "unreasonably" toward us to elicit the reaction that they require, one which confirms for them that they have successfully externalized the alien part of the self. Because we try not to react in these directions in response to mild provocation, we unwittingly force our patients to become "more difficult." They get under our skin and eventually discover what will make us react with anger, or what will cause us to neglect them, reject them, or feel excited by them, in all instances forgoing our therapeutic identity. (Fonagy, 1998, p. 1)
Indeed, we find that psychotherapists report personality-disordered patients as their most difficult (Davidtz, 2008). This is not only true in individual therapy but for group therapy as well (Liebenberg, 1990; Roth, Stone, & Kibel, 1990). Psychotherapists quickly learn that the amount of progress these patients make in therapy is disproportional to the amount of distress they inflict on the therapist. This sentiment has been born out on research studies that have shown that patients with personality disorders may have a propensity to engage in litigation with their therapist (Gutheil, 2005; Gutheil & Alexander, 1992), or their workplace (McDonald, 2002). This makes sense when examining the relationship between personality disorder-related phenomena such as suicide attempts and memories of child abuse which produce a good deal of the litigation directed towards mental health professionals (Gutheil, 2004). In the defense of psychotherapists, many are not trained to treat people with personality disorders, or only offer therapies that clearly do not work with these kinds of patients. In this way the screening of personality-disordered patients is justified as being better for both the therapist and the patient.
There are currently no drugs that directly treat personality disorders. Instead a number of different kinds of drugs are used to treat the symptoms associated with the personality disorder (Quante, et. al., 2008).
The onset of personality disorders is usually in adolescents or early adulthood. However, a careful observer may be able to identify children who are likely to express these disorders later on. People who suffer from personality disorders, particularly Hysteric, Borderline, or Paranoid, end up with a greater chance of being hospitalized throughout their lives. This is due to a good deal of a suicidal behaviors, depression, alcohol/drug abuse, obsessive compulsive behaviors, eating disorders, domestic violence and other types of drama which are co-morbid with these personality disorders.
Next - Origins & Neurobiology of Personality Disorders
Akman, C., Uguz, F., & Kaya, N. (2007). Postpartum-onset major depression is associated with personality disorders. Comprehensive Psychiatry, 48(4), pp. 343-347.
Andover, M. S., Pepper, C. M., Ryabchenko, K. A., Orrico, E. G., & Gibb, B. E. (2005). Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder. Suicide and Life-Threatening Behavior, 35(5), pp. 581-591.
Bagby, R. M., Vachon, DD., Bulmash, E., & Quilty, L. C. (2008). Personality disorders and pathological gambling: a review and re-examination of prevalence rates. Journal of Personality Disorders, 22(2), pp. 191-207.
Berger-Jackson, L. (2003). Domestic violence link with personality disorders. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(10-B), pp. 4952.
Bogaerts, S., Vanheule, S., Leeuw, F., & Desmet, M. (2006). Recalled parental bonding and personality disorders in a sample of exhibitionists: A comparative study. Journal of Forensic Psychiatry & Psychology, 17(4), pp. 636-646.
Bogaerts, S., Daalder, A., Vanheule, S., Desmet, M., & Leeuw, F. (2008). Personality disorders in a sample of paraphilic and nonparaphilic child molesters: A comparative study. International Journal of Offender Therapy and Comparative Criminology, 52(1), pp. 21-30.
Bollinger, A. R., Riggs, D. S., Blake, D. D., & Ruzek, J. I. (2000). Prevalence of Personality Disorders Among Combat Veterans with Posttraumatic Stress Disorder. Journal of Traumatic Stress, 13(2), p. 255.
Bond, M., & Perry, J.C. (2004). Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. American Journal of Psychiatry, 161(9), pp. 1665-1671.
Bond, M., & Perry, J.C. (2006). Psychotropic medication use, personality disorder and improvement in long-term dynamic psychotherapy. Journal of Nervous and Mental Disease, 194(1), pp. 21-26.
Bowden-Jones, O., Iqbal, M. Z., Tyrer, P., Seivewright, N., Cooper, S., Judd, A., & Weaver, T. (2004). Prevalence of personality disorder in alcohol and drug services and associated comorbidity. Addiction, 99(10), pp. 1306-1314.
Brooks, R. B., Baltazar, P. L., & Munjack, D. J. (1989). Co-occurrence of personality disorders with panic disorder, social phobia, and generalized anxiety disorder: A review of the literature. Journal of Anxiety Disorders, 3(4), pp. 259-285.
Bunce, S. C., Noblett, K. L., McCloskey, M. S., & Coccaro, E. F. (2005). High prevalence of personality disorders among healthy volunteers for research: implications for control group bias. Journal of Psychiatric Research, 39(4), pp. 421-430.
Caligor, E., Kernberg, O. F., & Clarkin, J. F. (2007). Handbook of dynamic psychotherapy for higher level personality pathology. Washington, DC: American Psychiatric Publishing, Inc.
Chatham, P. (1989). Treatment of the borderline personality. Northvale, NJ: Jason Aronson.
Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., & Palmer, S, (2006). The effectiveness of cognitive behavior therapy for borderline personality disorder: Results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of Personality Disorders, 20(5), pp. 450-465.
Davidson, K., Livingstone, S., McArthur, K., Dickson, L., & Gumley, A. (2007). An integrative complexity analysis of cognitive behaviour therapy sessions for borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice, 80(4), pp. 513-523.
Davidtz, J. (2008). Psychotherapy with difficult patients: Personal narratives about managing countertransference. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(7), 4818.
Dudeck, M., Spitzer, C., Stopsack, M., Freyberger, H.J., & Barnow, S. (2007). Forensic inpatient male sexual offenders: The impact of personality disorder and childhood sexual abuse. Journal of Forensic Psychiatry & Psychology, 18(4), pp. 494-506.
Dulit, R. A., Ryer, M. R., Leon, A. C., & Brodsky, B. S. (1994). Clinical correlates of self-mutilation in borderline personality disorder. American Journal of Psychiatry, 151(9), pp. 1305-1311.
Fonagy, P. (1998). An attachment theory approach to treatment of the difficult patient. Bulletin of the Menninger Clinic, 62(2), 147-169.
Fruzzetti, A. E. (2002). Dialectical behavior therapy for borderline personality and related disorders. In Kaslow, F. W., & Patterson, T. Comprehensive handbook of psychotherapy: Cognitive-behavioral approaches, Vol. 2. Hoboken, NJ: John Wiley & Sons Inc. pp. 215-240.
Furnham, A. (2007). Personality disorders and derailment at work: The paradoxical positive influence of pathology in the workplace. In: Langan-Fox, J., Cooper, C. L., & Klimoski, R. J. Research companion to the dysfunctional workplace: Management challenges and symptoms. Northampton, MA: Edward Elgar Publishing. pp. 22-39.
George, E. L., Miklowitz, D. J., Richards, J. A., Simoneau, T. L., & Taylor, D. O. (2003). The comorbidity of bipolar disorder and axis II personality disorders: prevalence and clinical correlates. Bipolar Disorders, 5(2), pp. 115-122.
Godt, K. (2002). Personality disorders and eating disorders: the prevalence of personality disorders in 176 female outpatients with eating disorders. European Eating Disorders Review, 10(2), pp. 102-109.
Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S. P., Ruan, W. J., & Pickering, R. P. (2004). Prevalence, Correlates, and Disability of Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 65(7), pp. 948-958.
Hansen, B., Vogel, P. A., Stiles, T. C., & Götestam, K. G. (2007). Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder. Cognitive Behaviour Therapy, 36(3), pp. 145-155.
Hartman, D. (1999). Regarding the difficult patient.’. British Journal of Psychiatry, 175, 192.
Gutheil, T. G. (2004). Suicide, Suicide Litigation, and Borderline Personality Disorder. Journal of Personality Disorders, 18(3), 248-256.
Gutheil, T. G., & Alexander, V. (1992). Medicolegal issues between the borderline patient and the therapist. In D. Silver, M. Rosenbluth, D. Silver, M. Rosenbluth (Eds.) , Handbook of borderline disorders (pp. 389-413). Madison, CT, US: International Universities Press, Inc.
Hill, A., Habermann, N., Berner, W., & Briken, P. (2006). Psychiatric disorders in single and multiple sexual murderers. Psychopathology, 40(1), pp. 22-28.
Hobson, J., & Shine, J. (2008). Measurement of psychopathy in a UK prison population referred for long-term psychotherapy. British Journal of Criminology, 38(3), pp. 504-515.
Hoffman, P. D., Buteau, E. Hooley, J. M., Fruzzetti, A. E., & Bruce, M. L. (2003). Family members' knowledge about borderline personality disorder: Correspondence with their levels of depression, burden, distress, and expressed emotion. Family Process, 42(4), pp. 469-478.
Høglend, P. (1993). Personality disorders and long-term outcome after brief dynamic psychotherapy. Journal Of Personality Disorders, 7(2), 168-181. doi:10.1521/pedi.1922.214.171.124
Johnson, D. M., Sheahan, T. C., & Chard, K. M. (2003). Personality Disorders, Coping Strategies, and Posttraumatic Stress Disorder in Women with Histories of Childhood Sexual Abuse. Journal of Child Sexual Abuse, 12(2), pp. 19-39.
Keown, P., Holloway, F., & Kuipers, E. (2002). The prevalence of personality disorders, psychotic disorders and affective disorders amongst the patients seen by a community mental health team in London. Social Psychiatry & Psychiatric Epidemiology, 37(5), p. 225.
Kernberg, (1985). Borderline Conditions and Pathological Narcissism. New York, NY: Rowman & Littlefield,
Kyrios, M., Nedeljkovic, M., Moulding, R., & Doron, G. (2007). Problems of employees with personality disorders: The exemplar of obsessive-compulsive personality disorder (OCPD). In Langan-Fox, J., Cooper, . L., & Klimoski, R. J. Research companion to the dysfunctional workplace: Management challenges and symptoms. Northampton, MA: Edward Elgar Publishing, pp. 40-57.
King, A. R. (2000). Relationships between CATI personality disorder variables and measures of academic performance. Personality and Individual Differences, 29(1), pp. 177-190.
Liebenberg, B. (1990). The unwanted and unwanting patient: Problems in group psychotherapy of the narcissistic patient. In B. E. Roth, W. N. Stone, H. D. Kibel, B. E. Roth, W. N. Stone, H. D. Kibel (Eds.) , The difficult patient in group: Group psychotherapy with borderline and narcissistic disorders (pp. 311-322). Madison, CT, US: International Universities Press, Inc.
Leichsenring, F., & Leibing, E. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. American Journal of Psychiatry, 160(7), pp. 1223-1232.
Lindsay, W., Hogue, T., Taylor, J., Mooney, P., Steptoe, L., Johnston, S., O'Brien, G., & Smith, A. (2006). Two studies on the prevalence and validity of personality disorder in three forensic intellectual disability samples. Journal of Forensic Psychiatry & Psychology, 17(3), pp. 485-506.
Linehan MM. (1993). Cognitive-Behavioral Treatment of BPD. New York, NY: Guilford Press.
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63(7), pp. 757-766.
López, D., Cuevas, P., Gómez, A., & Mendoza, J. (2007). Psicoterapia focalizada en la transferencia para el trastorno límite de la personalidad. Un estudio con pacientes femeninas. Salud Mental, 27(4), pp. 44-54.
Luk, J.M. (1991). Cognitive-behavioural group therapy for Hong kong Chinese adults with mental health problems. Australian and New Zealand Journal of Psychiatry, 25(4), pp. 524-534.
Lynch, T. R., & Horton, L. E. (2004). Personality Disorders. In Thomas, J. C. & Hersen, M. Psychopathology in the workplace: Recognition and adaptation. New York, NY: Brunner-Routledge, pp. 147-160.
Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology, 3, pp. 181-205.
Maina, G., Albert, U., Pessina, E., & Bogetto, F. (2007). Bipolar obsessive-compulsive disorder and personality disorders. Bipolar Disorders, 9(7), pp. 722-729.
Manelski, J. (2005). Distinguishing characteristics of victims of domestic violence: Personality disorders and communication skill deficits. Dissertation Abstracts International: Section B: The Sciences and Engineering, 65(8-B), p. 4294.
Markham, D. (2003). Attitudes towards patients with a diagnosis of 'borderline personality disorder': Social rejection and dangerousness. Journal of Mental Health, 12(6), pp. 595-612.
Massion, A. O., Dyck, I. R., Shea, M. T., Phillips, K. A., Warshaw, M. G., & Keller, M. B. (2002). Personality disorders and time to remission in generalized anxiety disorder, social phobia and panic disorder. Archives of General Psychiatry, 59(5), pp. 434-440.
Mavissakalian, M. R., Hamann, M. S., Haidar, S. A., & de Groot, C. M. (1995). Correlates of DSM-III personality disorder in generalized anxiety disorder. Journal of Anxiety Disorders, 9(2), pp. 103-115.
McDonald, J. J. (2002). Personality Disorders in Employment Litigation. Psychiatric Times. 19(4), pp. 1-5.
McGlashan, T. H., Grilo, C. M., Sanislow, C. A., Ralevski, E., Morey, L. C., Gunderson, J. G., Skodol, A. E., Shea, M. T., Zanarini, M. C., Bender, D., Stout, R. L., Yen, S., & Pagano, M. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: Toward a hybrid model of axis II disorders. American Journal of Psychiatry, 162(5), pp. 883-889.
McLean, L. M., Gallop, R. (2003). Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder. American Journal of Psychiatry, 160(2), pp. 369-371.
Millon, T., Blaneyu. P. H., & Davis R. (eds.) (1999). Oxford Textbook of Psychopathology. New York: Oxford University Press. pp. 510.
Moran, P., Jenkins, R., Tylee, A., Blizard, R., & Mann, A. (2000). The prevalence of personality disorder among UK primary care attenders. Acta Psychiatrica Scandinavica, 102(1), p. 52.
Moran, P., & Mann, A. (2002). The prevalence and 1-year outcome of cluster B personality disorders in primary care. Journal of Forensic Psychiatry, 13(3), pp. 527-537.
Morgenstern, J., & Miller, K. J. (1997). The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence. Journal of Abnormal Psychology, 106(1), p. 74.
Narcisco, B. (2007). The relationships among trauma, self-concept, dissociation, Cluster B Personality Disorders and adult attachment style in incarcerated women. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(1-B), pp. 630.
Neeleman, A. J. F. (2007). The relevance of sexuality in the treatment of borderline personality disorder. Tijdschrift voor Psychiatrie, 49(4), pp. 233-240.
Paris, J. (2005). Understanding Self-mutilation in Borderline Personality Disorder. Harvard Review of Psychiatry, 13(3), pp. 179-185.
Pompili, M., Ruberto, A., Girardi, P., & Tatarelli, R. (2004). Suicidality in DSM IV Cluster B personality disorders: An overview. Ann ist Super Sanità, 40(4), pp. 475-483.
Quante, A., Röpke, S., Merkl, A., Anghelescu, I., & Lammers, C. (2008). Psychopharmakologische behandlung von und bei persönlichkeitsstörungen. Fortschritte der Neurologie, Psychiatrie, 76(3), 139-148. doi: 10.1055/s-2007-996179.
Roth, B. E., Stone, W. N., & Kibel, H. D. (1990). The difficult patient in group: Group psychotherapy with borderline and narcissistic disorders. , American Group Psychotherapy Association monograph series, Monograph; 6. Retrieved September 3, 2008, from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=1990-97241-000&site=ehost-live.
Rollnik, J. D., Schneider, U., Wedegaertner, F. Huber, T. J., & Emrich, H. M. (2001). Uncommon self-mutilation in a borderline personality disorder patient. Australian and New Zealand Journal of Psychiatry, 35(1), pp. 133-134.
Rothschild, B., & Rand, M. (2006). Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. NY, New York: W.W. Norton & Company.
Salsman, N. L., & Linehan, M. M. (2006). Dialectical-behavioral therapy for borderline personality disorder. Primary Psychiatry, 13(5), pp. 51-58.
Samuels J. F., Nestadt, G., Romanoski A. J., Folstein, M. F., & McHugh, P. R. (1994). DSM-III personality disorders in the community. American Journal of Psychiatry, 151, pp. 1055-1062.
Sansone, R. A., Levitt, J. L., & Sansone, L. A. (2005). The prevalence of personality disorders among those with eating disorders. Eating Disorders, 13(1), pp. 7-21.
Scheirs, J. G. M., & Bok, S. (2007). Psychological distress in caretakers or relatives of patients with borderline personality disorder. International Journal of Social Psychiatry, 53(3), pp. 195-203.
Sperry, L. (2006). Cognitive behavior therapy of DSM-IV-TR personality disorders: Highly effective interventions for the most common personality disorders (2nd ed.). New York, NY: Routledge/Taylor & Francis Group.
Thuo, J., Ndetei, D. M., Maru, H., & Kuria, M. (2008). The prevalence of personality disorders in a Kenyan inpatient sample. Journal of Personality Disorders, 22(2), pp. 217-220.
Volkan, K. (1994). Dancing among the Maenads: The psychology of compulsive drug use. New York, NY: Peter Lang.
Wilson, S. T., Stanley, B., Oquendo, M. A., Goldberg, P., Zalsman, G., & Mann, J. J. (2007). Comparing impulsiveness, hostility, and depression in borderline personality disorder and bipolar II disorder. Journal of Clinical Psychiatry, 68(10), pp. 1533-1539.
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients. American Journal of Psychiatry, 162(10), pp.1911-1918.
1. Interestingly enough it seems that being a victim of domestic violence rather than the perpetrator is not related to having a personality disorder. In fact, some personality disorders may be inversely related to being the victim of domestic violence (Manelski, 2005).
2. DBT combines Cognitive Behavior Therapy with mindfulness techniques from Buddhist psychology.