Personality Disorders and Their Treatment

1. Overview & Epidemiology

A personality disorder (PD) is "an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress and impairment" (Gajdos lecture; DSM definition). Personality features obey a normal distribution — PDs are the extremes of normal traits, not separate "diseases."

• Prevalence: up to ~20% of the general population (Gajdos); at least 15% of psychiatric outpatients and 10% of psychiatric inpatients. ~10% of public-hospital psychiatric inpatients have a PD as their primary disorder.
• Service use: frequent attenders at Emergency Departments — after social crises, fights, alcohol/drug intoxication, self-injury, overdoses.
• Comorbidity burden: co-morbid PD makes managing schizophrenia, bipolar disorder and other illnesses substantially more difficult.

The four defining features (Gajdos) — examiner loves these

• Ego-syntonic — the patient finds their traits acceptable and not in need of change (contrast anxiety disorders, which are ego-dystonic).
• Maladaptive behaviour — uses alloplastic defences: reacts to stress by trying to change the external environment rather than the self (anxiety patients use autoplastic defences → change themselves).
• Inflexible traits — a limited repertoire of responses (e.g. only seduction or aggression), applied in all situations and repeated even when they have already failed.
• Long-standing & pervasive, present across a broad range of personal and social situations.
• → Difficult to treat.

Hungary/Europe note: the oral exam uses ICD alongside DSM. ICD-10 places PDs in F60–F69 ("Disorders of adult personality and behaviour"); F60 = specific PDs. ICD calls borderline PD "emotionally unstable personality disorder" (impulsive + borderline types) and OCPD "anankastic personality disorder" — know both labels.

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