In clinical practice, frequently people suffering from other medical conditions, especially endocrine or neurological disorders, have personality disorders as the first symptom. Even in normal physiological states, traits of personality disorders may be seen (especially during the early adult stage or adolescence). People suffering from frontal lobe tumors of the brain can develop personality disorder symptoms and may not have any neurological symptoms. The severity of the personality changes can vary from one individual to another such that it may be a part of normal functioning or a recognizable mental condition (Gunderson, 2008, Reus, 2004, Devens, 2007 & Lloyd, 1996).
Personality disorders need to be closely differentiated from personality traits. The manner in which one perceives the self with relation to the world, coping mechanism from stress from the environment, values derived from various experiences in life, etc, lead to the development of a personality style. The personality development phase usually develops around the period of early adulthood. It is usually during this stage that traits or characteristics similar to the symptoms of personality disorders develop. Personality disorders are something much more than personality disorders. The extent of symptoms is such that the individual finds it difficult to function at home, school, and workplace or in social settings.
They are unable to meet with their roles, responsibilities, functions, occupational demands, etc. A person suffering from a personality trait is usually able to function properly, but in certain realm (such as dependence on others, getting angry easily, etc) may be abnormal. During the phase of certain illnesses, the individual may demonstrate worsening of the personality traits. Such as during illnesses, they may depend excessively on a friend or a close family member. When the traumatic phase is over, the individual may return to normal functioning and the severity of the personality trait usually returns back to normal.
The symptoms of personality disorders are usually present during the early stages of life. By the phase of young adulthood, the personality disorder becomes prominent. Several issues that may be present at the young age such as completing education, seeking a job, developing romantic relationships, etc, are not handled properly by the individual. Individuals with DPD and ASD usually have the symptoms becoming less obvious after the age of 30 or 40 years. However, individuals with other types of personality disorders such as Obsessive-compulsive personality disorder, etc, usually do not have the symptoms becoming less severe with old age (Devens, 2007 & Jacobson, 2001).
As per the guidelines laid down, personality disorders can be classified into three types, namely, Cluster A, Cluster B, and Cluster C. Each of the disorders in each of the clusters has similar symptoms (Reus, 2004, & Lloyd, 1996).
Several medical and psychiatric disorders can occur along with personality disorders. These include:-
The manner in which biological factors, environmental factors and the presence of certain mental disorders can work together resulting in the development is not understood clearly and is found to be highly complex. Mental disorders are said to make the individual more vulnerable to develop personality disorders. Biological and environmental factors are said to interact with one another leading to the development of personality disorders. It is found that in certain Cluster A disorder, the familial relationship is found to be higher. Hereditary also plays a very important role in the development of ASD. Several other symptoms such as depression, anxiety, mood changes, etc, which run in families, are also known to be transmitted along with personality disorders.
In cluster B group of personality disorders, a strong link exists between the environment and the development of the disorder. Child abuse, sexual abuse and physical abuse are often the cause of child stressors which could result in the development of a personality disorder. Besides, inadequate parenting, institutional problems, etc, play a role in the development of several personality disorders.
In borderline personality disorders about three fourths of all patients give a history of child abuse. Childhood abuse is seen on an average in about 50 % of other personality disorders. 20 to 40 % of the psychiatric populations and about 10 to 15 % of the general population give the history of childhood abuse. In patients affected with alcohol disorders, the prevalence of personality disorders is about 28 % and those with drug disorders is about 47% (Devens, 2007 & Jacobson, 2001).
Antisocial Personality Disorder
Antisocial personality disorder (ASD) is a condition in which the individual tries to disregard the law and the rights of other people. Such individuals are always seen disobeying the law and often abuse the rights of other people. The condition is characterized by a more or less long-standing behavior. The individual also tries to manipulate the law and exploits other people. Such individuals are often turned as criminal, as they would pose a hazard to the safety and security of other people. The condition is frequently known as Sociopathic personality, and the individual is known as a sociopath or psychopath. Such individuals are not able to perform their professional, family or parental commitments and are often discarded by others (Fitzgerald, 2007, Devens, 2007, Jacobson, 2001, Feinstein, 2008, Mayo Clinic, 2008 & Ballas, 2006).
ASD usually develop during the late childhood, adolescence or the early adulthood period. If the person has grown up in an abusive and neglectful environment, the chances of developing the disorder are relatively higher. Usually, such individuals who would be developing ASD have some amount of behavioral difficulties by the age of 15 years. Usually men are more often affected with ASD compared to women (in the ratio of 3:1). Individuals admitted to prisons are usually having the highest prevalence of ASD. The management and the outcome of ASD are particularly difficult (Devens, 2007, Jacobson, 2001, Feinstein, 2008, Mayo Clinic, 2008 & Ballas, 2006).
The exact cause for ASD has not been really understood, but genetic factors and environmental factors have a major role to play in the development and TEH progression of this disorder. In studies, it has been seen that children who are born from parents with the disorder are at a higher risk of developing it, compared to the average population. As such a family history can play a very important role in the development of the disorder, as the close relative or a family member present would mean a higher risk of developing the disorder. IT is frequently seen that children having an alcoholic parent are at a higher risk of developing ASD. The symptoms of ASD are usually chronic and are seen over a long period of time.
IN identical twin studies, it has been seen that one twin is at a higher than normal risk when the other twin has developed the disorder. The environment present at the family, school, society, etc, in which the child exists, plays a very important role in the development of the disorder. Children who grow up in a chaotic environment, those who are abused or neglected frequently, those who face a lot of family conflict, those who grow up with very little supervision, etc, are at a hier risk of developing ASD. Children who have parents who or drug abusers or alcohol abusers, seldom have emotional bonds with the parents and feel very insecure in life.
This insecurity coupled with certain genetic traits play a very imponit role in the development of the disorder. Children frequently require role models in their life, to help them grow and develop. The absence of such a role-model can result in a lot of confusion and disturbance in mental growth, predisposing them to criminal behavior. Such children consider the world to be a very dangerous place to live in and fear the unknown. They may pick up a violent behavior as a reaction mechanism, often being criminal and aggressive behavior.
Children who developing the disorder in school frequently fight back with a family member, teacher, parents, elder sibling, seniors at school, etc. The child may also be confused a to what behavior is acceptable and what is not. It has been seen that children who enjoy setting fire to objects and who ill-treat animals are at a higher risk of developing the disorder. The other risk factors for the development of this disorder include children suffering from ADHD, children with reading disorders, or children who tend to mix about with other children who demonstrate antisocial behavior (Fitzgerald, 2007, Devens, 2007, Jacobson, 2001, Feinstein, 2008, Mayo Clinic, 2008 & Ballas, 2006).
The main symptoms of this condition is that the child tries to manipulate the law to suit their own needs and often exploits others such that their rights are abused. They do not understand what acceptable behavior is and what is not. They do not distinguish between what is right and what is wrong. They have a lot of trouble at school, college, workplace, home, family or in a social situation.
Other often tries to avoid them due to the unacceptable behavior that may be meted out. They are unable to fulfill their professional, familial, social or parenting commitments. They get angry, aggressive or violent almost immediately, and cannot be approached for anything. Some of the individuals who suffer from antisocial disorder may possess some amount of charm and wit, such that they others are attracted towards them. Some of the problems faced by individuals with ASD include:
Usually the symptoms are chronic in nature.
The diagnosis of antisocial personality disorder is made based on the history, symptoms, signs, mental status examination, surveys and questionnaires, physical examination and other laboratory tests. As there is no confirmatory test for antisocial personality disorder, the psychiatrist would frequently depend on the history and symptoms to arrive at the diagnosis. The history would be taken from the individuals, family members, friends, school teachers, colleagues, etc. A thorough physical examination is conducted to rule out any physical disorder that would result in the production of the symptoms.
Usually antisocial personality disorder is diagnosed above the age of 18 years, and in people below the age of 15 years, the diagnosis of a conduct disorder needs to be made. Some of the conduct disorders that can be identified include vandalism, burning, bullying, stealing, truancy, cruelty to animals, running from home, etc. In certain instances, the physician may find it very difficult to arrive at the diagnosis of antisocial personality disorder, due to the close similarity between other personality disorders. The individual have at least three of the following features, to arrive at the diagnosis of antisocial personality disorder:-
It would also be advisable for the healthcare authorities to study the criminal records of the individual. Substance abuse also needs to be ruled out through history, urine tests and blood tests (Ballas, 2006).
Individuals affected with antisocial personality disorder at a risk of facing various problem in life:-
The criteria laid down under DSM-IV-TR for antisocial personality disorder include:-
Dependent Personality Disorder
Dependent personality disorder (DPD) is a mental condition in which the individual over depends on other individuals in order to meet their physical and mental needs. It belongs to a group of disorders in which the individuals develops marked fear and anxiety (anxiety personality disorders). The individual is always helpless and is very submissive in nature. They have to be taken care of by somebody else, usually a close friend, relative or a family member.
They find it very difficult to make decisions by themselves. When the individual is separated from his protector, he becomes very anxious and fears for the worst. The condition causes a significant impairment of activities such that the individual is unable to function at the home, school, workplace or in social settings. DPD usually starts in early adulthood. According to DSM-IV-TR, the individual needs to meet with certain criteria laid down in order to be classified as suffering from DPD (The Cleveland Clinic, 2008 & Ballas, 2006). These include (5 or more of the below):-
About 0.5 % of the general population is affected with DPD. In a greater segment of the population, a trait of DPD exists. However, on very rare occasions is the trait reported in clinical practice. DPD usually affects females more often compared to males in the ratio of 2:1. Overall, DPD is one of the most frequently reported clinical personality disorder (Devens, 2007 & Young, 2008).
The exact cause for DPD has not been understood clearly, however, biological factors and environmental factors have a major role to play in the development of the disorder. It has been seen that neglect and abuse of children can lead to several personality disorders, especially antisocial personality disorder. On the other hand, DPD may be caused due to over parenting, provided the child has a trait or tendency towards the disorder. The condition usually begins in childhood, continues through adolescence, teenage stages and progresses into early adulthood. Children with certain physical illnesses or with certain mental conditions (such as separation anxiety disorder) are at a high risk of developing DPD (Young, 2008, The Cleveland Clinic, 2008 & Ballas, 2006).
The symptoms and signs of DPD may vary from one individual to another. A physician who would be treating a patient suffering from DPD, would feel depleted and annoyed on the patients dependence on others. They may also not consider meeting with the reasonable needs of the patient. The individual constantly feels insecure and helpless without others. They are unable to make a decision and need constant reassurance from a close friend or a relative that the decision that they are making is positive. One of the most constant fears that the individual would be having is that of losing the relationship with their close friends and relatives. These thoughts of separation create a lot of insecurity in their mind and may also make them angry or aggressive.
The individual may constantly demonstrate childlike behavior. They are unusually submissive to their close ones and constantly explain their problems and worries to them. They also depend excessively on the physician for medical supervision. When left to themselves, they only feel the need of a friend or relative and are not interested in using medical services. The patient needs the direction provided by somebody else. They always have the fear that they are not able to make decisions by themselves. One of the vital fears that they would be having is regarding independence. They fear that independence should not be provided to them. In certain ways, DPD and borderline personality disorders are similar to one another, in the sense that the individual would depend on another person.
However, in case of threat of separation from their protector, individuals suffering from either of these disorders would react in a different way. An individual suffering from borderline personality disorder is more likely to get agitated and angry, and on the other hand, a person suffering from DPD would become submissive, emotional and obsequious. DPD individuals tend to function in an abnormal manner in the school, home, and workplace or in social settings.
The defence they could be producing include regression, reaction-formation and passive-aggression. The patient may use alcohol, food, drugs, or other means in order to satisfy their dependency needs. Individuals suffering from DPD always make an effort to please other people. They always give priority over fulfilling their needs compared to the needs of their protectors. They always demonstrate the ability to trust and have confidence in other people. DPD individuals are constantly sensitive to any criticism from others (Feinstein, 2007, Ballas, 2006 & Cleveland Clinic, 2008).
The diagnosis of DPD is made based on the history, symptoms, signs, physical examination, mental status examination, laboratory tests, etc. Several laboratory tests such as blood tests and urine tests are performed to rule out other physical disorders
Ultimately, the DSM-IV_TR criteria help to classify the personality disorders carefully and differentiate it from conditions having similar symptoms. Some of the characteristic features that the physician would be looking for to help in the diagnosis of DPD include:-
It is very important that any physical symptom that is present be actually noted by the physician who could help establish or rule out a physical disorder. The presence of a physical disorder can be the cause for symptoms of DPD. The physician should also try avoiding being a protective figure for the patient. During an interview, the patient would be giving excessive importance to a close friend or a relative. The physician would also have to rule out other disorders that belong to cluster one personality disorders. Medical causes for personality changes need to be ruled out through laboratory tests, imaging studies, etc. Several assessment tools are frequently utilized to help evaluate a patient suffering from DPD (Devens, 2007, Jacobson, 2001, Feinstein, 2008, Mayo Clinic, 2008 & Ballas, 2006).
It is frequently seen that insidious suffering from certain mental disorders are at a higher than normal risk to develop personality disorders. Through several research studies conducted the world over, it has been found that personality disorders affect about 10 to 13 % of the worlds population. One of the most common personality disorders is Schizotypal personality disorder. The most common cluster of the personality disorder is cluster A personality disorder.
In cluster B disorders, borderline personality disorder is the most common, and in cluster C personality disorders, DPD is the most common. In the psychiatric inpatient groups, personality disorders can occur in about 30 to 60 % of the population. In the psychiatric inpatient populations, borderline personality disorder was the most common type. Axis 2 disorders were the most common in psychiatric inpatients. In the psychiatric outpatient group, the prev lance of personality disorders was about 20 to 40 %. Amongst this group, the most common types included avoidant, borderline and the dependent types (Devens, 2007, Feinstein, 2007, Jacobson, 2001).
Treatment of Personality disorders
The treatment of personality disorders is particularly difficult as the characteristics of such disorders are long-term and are relatively fixed. Psychotherapy seems to be the main stay of any treatment plan of personality disorders. One of the short-term approaches that could be useful includes adaptational approaches treatment. In this treatment strategy, the individual would be taught methods to solve their current problems. Other methods that also seem to be useful in the management of personality disorders include supportive psychotherapy, crisis intervention (to manage any sudden problems), environmental manipulation (steps to alter the environment), and management of substance abuse.
Some individuals suffering from certain personality disorders may have associated mental conditions, and these conditions need to be further managed in an appropriate manner to ensure that the outcome would be satisfactory. Coping mechanisms can be influenced by long-term psychotherapy treatment schedules. The best people who can provide psychotherapy for those suffering from personality disorders include psychiatrists and psychologists, as the treatment schedule seems to be very complex and intense. People who do not have a significant crisis arising due to their condition should be administered long-term psychotherapy. These include some amount of stability and reducing all problems that may arise out of substance abuse and other mental disorders (Devens, 2008 & Jacobson, 2001).
One of the evidence-based treatment frequently utilized in the treatment of personality disorders is psychodynamic psychotherapy. In this form of therapy, the psychiatrist would try to help the patient relieve him of his/her problems by gaining an insight into them and developing a method of solving them. In this form of therapy, the psychiatrist would analyze the various unconscious psychological process that are going on and would be acting as a defense mechanism.
The individual would utilize these psychological processes to handle various issues in life such as conflicts, dangers, problems, situations demanding an adaptation, etc. These defense mechanisms may not function in a normal manner and it is through clarification, confrontation and interpretation that the psychiatrist would ensure that the defense mechanisms begin to function normally. The psychiatrist would have to assert to the patient their beliefs are distorted and need to be resolved (Feinstein, 2008, Devent, 2008 & Jacobson, 2001).
Medications have a limited application in the sector of treatment of personality disorders. Individuals suffering from axis one group of disorders (clinical syndromes that are mainly mental disturbances that involve altering one mental dimension) usually respond the best to drug therapy. It is ideal that all the characteristics such as major depression and anxiety present in the personality disorder be treated appropriately. Studies have demonstrated following the treatment of such characteristics, the personality disorder itself would remit.
Studies have also demonstrated that even if Axis one disorders was not diagnosed, but the symptoms were identified and treated appropriable, the condition reduced to a valuable extent. Carbamazepine and beta-blockers seem to be useful in treating certain behavioral problems that develops in antisocial personality disorder. Each group of symptoms that are present in personality disorders can be addressed separately through appropriate group of medications (Dvens, 2008 & Jacobson, 2001). Some of the medications that are used for the symptoms include:-
However, it is important to note that otherwise medications are not effective in treating personality disorders and carries a certain amount of risks. A patient suffering from personality disorder would try to distress them through drug use. When several drugs are utilized in the treatment, the chances of toxicity are higher, leading to suicidal tendencies, drug dependence, etc. The chances of such problems are even higher is comorbid drug abuse is present. Hence, psychotherapy plays a major role in the treatment of this group of disorders (Feinstein, 2008, Devens, 2008 & Jacobson, 2001).
Another manner of benefiting the patient suffering from personality disorders is to reduce the environmental stressors that would be worsening the symptoms of the disorder.
Treatment of Antisocial Personality disorder
A person suffering from antisocial personality disorder would be functioning at the borderline organization at the medical care level. Their ability for reality testing appears to be intact, and they may present with a cheerful, charming, friendly, slick, and superficial behavior. The physician may also be captivated with such behavior. Their may require a lot of special treatment, but devalue or attack the physician in case they are caught doing any dishonest act. Several manipulative methods such as keying, cheating, stealing, etc may be resorted and the physician needs to ensure that he does not fall a victim to their methods. Usually, during stressful situations, their true personality and behavior can be identified. When the individual is receiving care at a similar level for a legitimate disorder, they may be appearing to be suffering from narcissistic personality disorder.
At all levels, the physician has to anticipate the worst and be alert of patients suffering from ASD. They may try to seek to gain cash illegally or escape from legal problems. They may also try to absent themselves from work by providing inappropriate excuses. Suppose, the patient makes an inappropriate request to the physician, he/she needs to consider the patient for father evaluations in order to rule out or confirm the presence of such a condition. For example, some patients suffering from ASD may try to escape work due to disability. The physician should try to verify the same through reliable sources.
The physician should not attempt to alter the patient in case it is evident that the patient is lying or being deceptive. The physician should continue to provide the patient with an environment with is required for them to fool others. One of the ways the patient can be stopped from being deceptive is to inform that the medical decision-making and the outcome of treatment would be poor. The patient would receive inappropriate care and the final outcome would be poor (Grohol, 2006, Mayo Clinic, 2008, Devens, 2008, & Ballas, 2006).
On the other hand, a person suffering from DPD would exhibit another dimension of human behavior in the healthcare setting. They are usually submissive and tend to cling on to any person who they would identity as potential help or protection. The physician would often become depleted, drained or annoyed when in contact with such individuals. They may go to such an extent that the reasonable demands of the patients would not be met. The physician should be label to meet with the reasonable demands of the patient, but at the same time foster independent thinking and taking actions by oneself.
A person suffering from DPD would try to gain secondarily from treatment. Frequently such patients would be using medications, along with several other substances including food and alcohol. They would be having the tendency of misusing medications and alcohol, and hence the physician needs to be extra-cautious during treatment. The physician should be ready to handle any unreasonable demands from such patients (Feinstein, 2008 & Devens, 2008).
In the treatment of antisocial personality disorder and dependent personality disorder, several modes may be utilized. Some of the interventions that may be required for the treatment of the conditions include:-
For the treatment of antisocial personality disorder, psychotherapy seems to be one of the most frequently used intervention. Medications are only utilized to help improve the mood or to handle situations in which the individual may go out of control. Fewer studies have shown that medications are of much use in treating antisocial personality disorder (Grohol, 2006).
Individuals suffering from ASD seem to respond more frequently to psychotherapy compared to any other intervention. The patient usually would not be seeking treatment by himself, and instead would be referred by a court or taken to the hospital by family members. It is important that the physician ensures that in case of referrals by the law enforcement agencies, a differentiation is made from simple criminal behavior. Assessment through various psychological tests has demonstrated the ability to differentiate between these states. Studies have shown that it may be very difficult for psychotherapy to be effective in case the treatment is provided in a jail or forensic setting, as the individual would try to focus on alternative life issues, achieving goals, improving relationships with other at the home, school, workplace, and in social settings.
Psychotherapy should try to concentrate on these life issues, which could serve as a motivational tool. Studies have demonstrated that the outcome of treatment is usually better when psychotherapy is provided on an outpatient basis. The patient may often find it very difficult to establish a link between the feelings and behavior, and it is important for the physician to provide certain means by which this link could be established. Several other studies have shown that in jails or forensic setting, the patient is often threatened into changing through studies. This is another reason as to why psychotherapy administered in jails is often as not effective as that provided on an outpatient basis.
The physician should keep in mind that threats do not serve as a motivating factor, helping the patient to change. The physician should try to find out ways of motivating the patient to change, and utilize these as means in order to administer psychotherapy to the patient. Studies have shown that approaches that repetitively reinforce behavior seem too valuable in ASD. The individual should be thought to make a link between the inner feeling and expression of these feeling which can be felt by others. This can often be done by going down to the emotional level of the patient. Such patients are usually not emotional as they do not find it important to be emotional.
They physician needs to get a good and a close rapport with the patient. The physician should ensure that certain amount of trust is obtained through confidentiality. However, the law-enforcement agencies would constantly require information of the patients progress, and in such issues the physician would have to provide information. The patient may initially be very suspicious and distrustful of the physician. They may not be able to consider the physician a different party from that of the law-enforcement agencies. The client would slowly learn from the various sessions with the physician.
However, it is also important that all the doubts regarding treatment are clarified early in order to prevent any misunderstanding from arising later. It is important that the therapy concentrates on bringing about certain emotions in the patient. One of the first emotions that the patient would be experiencing is depression. Once the patient gets depressed, the physician should enure that supportive treatment is immediately provided. Basically, when any emotion other than aggressiveness or agitation has been expressed, the chances of having a positive outcome are higher.
The person suffering from ASD would usually attack and authoritative figure, and hence, should avoid demonstrating himself as such a figure. Any issues regarding authority should be avoided in front of the patient. The patient should also be made to face the changes that occur as a result of their behavior. One way of doing this is to enforce punishment for several crimes that are performed. To some individuals it could act as a motivating factor.
Some individuals suffering from ASD may benefit from family therapy and group therapy. Group therapy helps the individuals open up to others and often can be one of the only means of treating this condition. However, an adversity that could develop in patient suffering from ASD is that the group may contain individuals suffering from other disorders and this could have an negative impact. Besides, if the individual does not go down to the emotional level and express himself, there are all chances that the treatment could fail (Grohol, 2006, Mayo Clinic, 2008, Devens, 2008, & Ballas, 2006).
Frequently, people affected with ASD need to get administered to an inpatient hospital. A person imprisoned and suffering from ASD would be asking a lot of queries related to crime and problems with the law. Once an individuals freedom has been lost, then they would be motivated to change and express a more satisfactory behavior. Besides, hospitalization, admission in a clinical set-up may also be necessary. Some of the hospitals are quite strict with their inpatient programs offering behavioral modifications programs.
Studies have demonstrated that on a long-term basis behavioral approaches are not only effective but also safe in the treatment of ASD compared to other disorders. Usually a patient suffering from ASD not seeks inpatient treatment as they would find such treatment very costly. Frequently, the law-enforcement agencies need to find appropriate sponsors in order to ensure that all the treatment needs of such population are addressed (Grohol, 2006, Mayo Clinic, 2008, Devens, 2008, & Ballas, 2006).
The role of medications in the treatment of ASD is clearly not understood. Medications cannot be utilized per se to treat this disorder. However, medications can be utilized to treat clear, serious and acute forms of the disorder. Several disorders that belong to Axis I group of personality disorders can be treated with medications. Studies conducted have demonstrated that medications can be utilized to manage several associated symptoms of ASD including anxiety, depression, mood disorders, substance abuse, etc. To certain extends, antidepressants such as SSRIs, antipsychotic medications especially the atypical antipsychotics, etc, could help alleviate the associated symptoms. However, studies have demonstrated that these medications should only be utilized for a short duration of time, as they could improve the effectiveness of psychotherapy. (Grohol, 2006).
Group therapy is often not given importance by the medical profession in the treatment of ASD. However, it is important to note that highly customized group-therapy program can be particularly useful in the treatment of ASD. An individual suffering from ASD is feels comfortable to discuss the symptoms and problems their facing to other people suffering from the same disorder.
Studies have shown that they are less likely to deceive each other. However, the leaders of the support groups should do something constructive and not misuse the group for any other purpose. An individual suffering from ASD may initially not want to join a support group. However, the initial fears and hesitation would subside when the individual is able to discuss their problems and get them solved in front of the group. These individuals should be very open with each other in helping to discuss their problems, issues, feelings, emotions and experiences (Hare, 2006 & Grohol, 2006).
Treatment of Dependent Personality Disorder
It is very important for the psychiatrist to determine the treatment needs of the patient rather than asking the patient what they would want from the treatment. A patient may plead with the psychiatrist having utopic expectations. However, this may not be reality and the physician may have difficult to meet with such needs of the patient. The physician may often be frustrated and irritated with the patient to such an extent that they may not fulfill their reasonable needs. The psychiatrist should closely monitor and avoid excessive dependence, but also ensure that the reasonable needs of the patient are constantly met.
The patient may often request the physician for certain medications, but these needs to be closely monitored due to potential abuse chances. It is also important to minimize any physical discomfort the patient is having through appropriate means. It is imponit to note that the client would most often adhere to the treatment instructions and is likely to benefit from it. Studies have demonstrated that the burnout rate of psychiatrists treating DPD is high. Some of the treatment methods that are applicable for use in DPD include psychotherapy, medications and group therapy (Hare, 2006, & Grohol, 2006).
Psychotherapy has been the mainstay of treating DPD. An individual seeking treatment for DPD would usually have problems with the symptoms or the complications. The ability to function at home, school, workplace or social settings is also affected. Studies have shown that psychotherapy would produce its results only following a few therapy sessions. One of the surprising things of this disorder is that long-term psychotherapy should not be provided as the patient would begin to depend on the psychiatrist. The psychiatrist should try to means of solving problems of the patient. Usually the shorter the period of administration of psychotherapy, the better would be the outcome of the disorder.
One of the effective means of determining the effectiveness of treatment is the termination test. In this method, the psychiatrist should talk about stopping psychotherapy for the patient and determine the result of such a move. However, if the individual does not want to end treatment, it does not mean that the treatment sessions have been a failure. The individual should be taught a more solution-focussed manner of looking at the world. The psychiatrist should closely study the patients methods of thinking and the various emotions that could be developing. The Patient should be trained in being assertive and should also be provided with behavior methods. To a certain extent, group therapy is also useful in treating the disorder.
However, the individual should not utilize these groups to develop a dependent relationship with other people. The patient needs to be taught the manner in which a dependent relationship on other has to be challenged. The patient should be convinced that such dependent relationships would be unhealthy and in the future should not be initiated in the first place. The patient should also be informed about recognizing the means by which such relationships are existing. Termination of the relationship between the patient and the psychiatrist plays a very important role in the management of DPD.
This should be a joint decision. During this period, the individual may experience several symptoms such as insecurity, anxiety, low-confidence levels, etc. The physician needs to handle these symptoms through medications and psychotherapy. The psychiatrist should not permit the patient to use these new symptoms to continue with treatment further. Cognitive behavior therapy and psychodynamic therapy seem to be the most effective in treating DPD (Hare, 2006 & Grohol, 2006).
In the treatment of DPD, medications can often be abused, to the extent that the patient would depend of them for providing relief of the symptoms. Hence, the physician needs to be extra cautious. Some of the drugs which may be required in treating DPD include sedatives, anti-anxiety drugs, antidepressants (such as SSRIs and SNRIs), etc. In acute management of the disorder, benzodiazepines can be utilized. For treatment comorbid disorders, the psychiatrist can utilize SSRIs.
Studies have shown that in certain situations, a placebo itself would seem to be effective in reducing the symptoms as the patient would feel that he/she is getting the right medication. However, the need to prescribe placebos may be ethically questionable. A patient suffering from DPD would be having multiple symptoms and hence the physician needs to keep the number of drugs administered to a minimum.
Drugs need to be prescribed, if the psychiatrist considers that psychotherapy would be unable to control the symptoms of DPD effectively. In all situations, the physician should clearly mention the exact reason for prescribing the drug. The psychiatrist should clearly mention to the patient that the drug would not decrease the intensity of the insecurity, inadequacy, etc, that the patient is currently experiencing. Such magical effects would be help the patient overcome the symptoms, but would not help in the treatment of the disorder as a whole (Grohol, 2006).
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