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Personality disorder — Clinical Guidelines

Overview

Personality disorders are enduring patterns of maladaptive behavior, cognition, and emotional regulation affecting approximately 1 in 10 older adults, often complicating geriatric care due to challenges in symptom expression and interaction 1 10.

Diagnosis

Characterized by enduring maladaptive patterns impacting functioning 1.

No specific diagnostic tests; clinical assessment is key 1.

DSM criteria guide diagnosis, though specific tests or scales may aid in evaluation 1 16.

Management

First-line treatments: Psychotherapy (e.g., Dialectical Behavior Therapy, Cognitive Behavioral Therapy) 1 5.

Pharmacological interventions: Often used adjunctively; trends show increasing polypharmacy but alignment with guidelines varies 2 3.

Specific drug classes: Not detailed in abstracts; general use of antipsychotics, mood stabilizers, and antidepressants noted 2 3.

Special Populations

Elderly: Higher risk of adverse drug reactions; focus on minimizing polypharmacy and enhancing quality of life 3 10.

Comorbidities: Common multimorbidity necessitates integrated care approaches 1.

Key Recommendations

Prioritize psychotherapy as the cornerstone of treatment for personality disorders (Evidence: Strong 1 5).

Monitor and minimize polypharmacy in older adults with personality disorders to reduce adverse drug reactions (Evidence: Moderate 3).

Tailor management strategies in dermatology settings considering the specific challenges posed by different clusters of personality disorders (Evidence: Expert opinion 4 5).

References

1 Oude Voshaar RC, van Dijk SDM. New horizons in personality disorders-from neglect to necessity in geriatric care. Age and ageing 2025. link 2 Di Leone F, Steingrimsson S, Carlsen HK, Liljedahl SI, Sand P. Trends in pharmacological prescriptions and polypharmacy for personality disorders: a 10-year cross-sectional analysis of naturalistic data. BMC psychiatry 2025. link 3 Schulkens JEM, van Alphen SPJ, Stas L, Louter MA, Verhey FRJ, Sobczak S. Medication Use and Quality of Life in Older Adults with Personality Disorders. Drugs & aging 2025. link 4 Reynolds KA, Rew J, Nakamura M. Personality disorders in dermatology: A review of patient characteristics, associated dermatologic conditions, and pearls for management. Clinics in dermatology 2023. link 5 Reddy V, Myers B, Chan S, Brownstone N, Thibodeaux Q, Koo J. Management strategies for borderline and narcissistic personality disorders in dermatology practice: a review. The Journal of dermatological treatment 2022. link 6 Widiger TA. PDTRT Special Section: Methodological issues in personality disorder research. Personality disorders 2017. link 7 Nakamura M, Koo J. Personality disorders and the "difficult" dermatology patient: Maximizing patient satisfaction. Clinics in dermatology 2017. link 8 Chung PH, Cheng Y. Prevalence of Self-Reported Work-Related Injuries and Their Association with Psychological Symptoms in General Working Population of Taiwan. Journal of occupational rehabilitation 2017. link 9 Meunier GF. MBTI and historical data. Psychological reports 2011. link 10 Supiano KP, Carroll AM. Personality disorders in older clients and their families: a challenge for geriatric care managers. Care management journals : Journal of case management ; The journal of long term home health care 2009. link 11 Lester D. Association between neuroticism and introversion. Psychological reports 2004. link 12 Caralis D, Haslam N. Relational tendencies associated with broad personality dimensions. Psychology and psychotherapy 2004. link 13 Diorio JA, Fallon LF. Fundamentals of compensation and benefits. Occupational medicine (Philadelphia, Pa.) 2001. link 14 Marlowe MJ. Biological aspects of personality disorder. British journal of hospital medicine 1993. link 15 Eysenck HJ, Furnham A. Personality and the Barron-Welsh Art Scale. Perceptual and motor skills 1993. link 16 van Leeuwen AM. Personality disorders and criminal responsibility. Medicine and law 1990. link 17 Lester D, Ecker C, Kimchick M. Autonomic reactivity and personality. Psychological reports 1990. link 18 Keltikangas-Järvinen L. Alexithymia and Type A behaviour compared in psychodynamic terms of personality. The British journal of medical psychology 1990. link 19 von Broembsen F. Transformations of identity: referent location, agency, and levels of integration in the progress from potential self to existential identity. American journal of psychoanalysis 1989. link 20 Page RC. Social change in a therapeutic community. The International journal of the addictions 1983. link 21 De Julio S, Duffy K. Neuroticism and proxemic behavior. Perceptual and motor skills 1977. link 22 Lester D, McLaughlin S, Nosal G. Graphological signs for extraversion. Perceptual and motor skills 1977. link 23 Corbin CB. The reliability and internal consistency of the motivation rating scale and the general trait rating scale. Medicine and science in sports 1977. link

Personality disorder