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PubMed2001

The impact of personality disorder in UK primary care: a 1-year follow-up of attenders.

BACKGROUND: The usefulness of the concept of personality disorder has not been properly tested outside psychiatric services. We set out to examine this in primary care, by examining the ability of the diagnosis to predict health status and patterns of service use. METHOD: A cohort of consecutive attenders, who had previously been rated for the presence of personality disorder using a standardized assessment, was followed-up at 1 year. The participating general practitioners also rated the personalities of, and their attitudes towards, a proportion of this sample of attenders. RESULTS: After adjusting for the effects of all covariates, a rating of personality disorder (generated by the standardized assessment) was associated with frequent attendance to general practice and fewer referrals to secondary care. A GP rating of personality disorder was associated with the prescription of psychotropic medication. The level of agreement between a GP rating of personality disorder and the standardized assessment was poor. GPs rated personality disorder more frequently in participants who were perceived to be less compliant, less likeable and more stressful to deal with. Participants with a psychiatric rating of personality disorder did not attract these negative perceptions. CONCLUSIONS: Personality disorder, as rated by a research interview, is a predictor of health service usage. There is a significant disparity between a research rating of personality disorder and the diagnostic ratings made by GPs. The GP ratings of personality disorder were strongly associated with adverse perceptions of the patient's consulting behaviour.

Adult↗

PubMed2003

Abuse and neglect in childhood: relationship to personality disorder diagnoses.

BACKGROUND: Childhood history of abuse and neglect has been associated with personality disorders and has been observed in subjects with lifetime histories of suicidality and self-injury. Most of these findings have been generated from inpatient clinical samples. METHODS: This study evaluated self-rated indices of sustained childhood abuse and neglect in an outpatient sample of well-characterized personality disorder subjects (n=182) to determine the relative associations of childhood trauma indices to specific personality disorder diagnoses or clusters and to lifetime history of suicide attempts or gestures. Subjects met criteria for ~2.5 Axis II diagnoses and 24% reported past suicide attempts. The Childhood Trauma Questionnaire was administered to assess five dimensions of childhood trauma exposure (emotional, physical, and sexual abuse, and emotional and physical neglect). Logistic regression was employed to evaluate salient predictors among the trauma measures for each cluster, personality disorder, and history of attempted suicide and self-harm. All analyses controlled for gender distribution. RESULTS: Seventy-eight percent of subjects met dichotomous criteria for some form of childhood trauma; a majority reported emotional abuse and neglect. The dichotomized criterion for global trauma severity was predictive of cluster B, borderline, and antisocial personality disorder diagnoses. Trauma scores were positively associated with cluster A, negatively with cluster C, but were not significantly associated with cluster B diagnoses. Among the specific diagnoses comprising cluster A, paranoid disorder alone was predicted by sexual, physical, and emotional abuse. Within cluster B, only antisocial personality disorder showed significant associations with trauma scores, with specific prediction by sexual and physical abuse. For borderline personality disorder, there were gender interactions for individual predictors, with emotional abuse being the only significant trauma predictor, and only in men. History of suicide gestures was associated with emotional abuse in the entire sample and in women only; self-mutilatory behavior was associated with emotional abuse in men. CONCLUSION: These results suggest that childhood emotional abuse and neglect are broadly represented among personality disorders, and associated with indices of clinical severity among patients with borderline personality disorder. Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. These results help qualify prior observations of the association of childhood sexual abuse with borderline personality disorder.

Adult↗

PubMed2006

Personality characteristics in obesity and relationship with successful weight loss.

OBJECTIVE: Personality influences lifestyle behaviors. Therefore, certain personality traits could contribute to obesity and the response to behaviorally based weight loss therapy. PURPOSE: The aims of this study were to test the hypothesis that personality characteristics differ between lean and obese persons in the community, obese persons in the community and obese persons seeking weight loss therapy by enrolling in a comprehensive weight loss program, and in obese persons who were successful and unsuccessful in achieving behavioral therapy-induced weight loss. METHODS: The Temperament and Character Inventory was administered to 264 lean (body mass index (BMI) <25 kg/m(2)) and 56 obese (BMI> or =35 kg/m(2)) subjects from the St Louis community and 183 obese patients (BMI=44+/-10 kg/m(2)) enrolled in the Washington University Weight Management Program (WUWMP), which involved weekly group behavioral therapy and diet education sessions for 22 weeks. RESULTS: Compared with lean subjects, obese subjects in the community scored higher in novelty seeking (19.7+/-5.9 vs 16.2+/-6.0, P<0.05), lower in Persistence (4.1+/-1.8 vs 4.8+/-1.7, P<0.05) and lower in self-directedness (32.1+/-7.6 vs 34.3+/-6.6, P<0.05.) Patients enrolled in the WUWMP scored higher than obese persons in the general population in both Reward Dependence (17.1+/-4.2 vs 15.7+/-4.3, P<0.05) and cooperativeness (36.9+/-5.4 vs 34.5+/-6.2, P<0.05). Patients who were successful in losing weight (>10% weight loss) after 22 weeks of behavioral therapy scored lower in novelty seeking than those who were unsuccessful in losing weight (<5% weight loss) (17.6+/-5.9 vs 20.2+/-5.9, P<0.05). DISCUSSION: These results suggest that personality traits differ between lean and obese persons, and between obese persons who enroll and who do not enroll in a comprehensive weight management program. Moreover, high scores in novelty seeking are associated with decreased success in achieving behavioral therapy-induced weight loss.

Attitude to Health↗

PubMed1998

Personality disorder comorbidity with major depression and response to treatment with sertraline or citalopram.

The purpose of this study was to investigate the frequency of DSM-III-R personality disorders in depressed patients treated in primary care, and to examine the effect of sertraline or citalopram on the diagnosis of personality disorders. A total of 308 patients with a major depressive disorder were assessed with the Swedish version of the Structured Clinical Interview for Personality Disorders (SCID) screen questionnaire, before and after 24 weeks double-blind treatment with sertraline (50-150 mg/day) or citalopram (20-60 mg/day). Following treatment, significant reductions in the frequency of paranoid, borderline, avoidant and dependent personality disorder diagnoses were seen in both treatment groups. When the personality disorders were analysed as continuous, dimensional personality traits significant reductions were seen for most personality categories. To elucidate if the observed reductions in personality disorder criteria could be explained by the improvement in depressive symptomatology, a series of multiple regressions were made. Reduction of depression scores was of some importance for the changes in most personality disorders. However, the multiple R never exceeded 0.24 (cluster C). Type of drug was of importance only as concerns obsessive-compulsive personality disorder. Overall, the results suggest that sertraline and citalopram may be beneficial in the treatment of certain personality disorder traits in patients with major depressive disorders.

Adult↗

PubMed1993

Personality disorder in patients infected with HIV: a controlled study with implications for clinical care.

OBJECTIVE: Previous studies of psychiatric illness in populations infected with or at risk for HIV have not included systematic evaluation for personality disorders. The authors present the first controlled study of 1) personality disorders in HIV-positive and HIV-negative homosexual men and 2) the impact of personality disorder on coping, social support, and mood in asymptomatic HIV-positive homosexual men. METHOD: The authors studied 58 asymptomatic HIV-positive and 53 HIV-negative homosexual men living outside the high-prevalence epicenters of the AIDS epidemic. Personality disorder was assessed with a clinician-administered interview, the Structured Clinical Interview for DSM-III-R. RESULTS: There was a significantly higher prevalence of personality disorder in the HIV-positive (33%) than in the HIV-negative (15%) subjects. In the HIV-positive subjects, those with a personality disorder (compared to those without a personality disorder) showed 1) significantly greater mood disturbance, with higher scores on the Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, Profile of Mood States Total Mood Dysfunction, and the Beck Hopelessness Scale, 2) greater use of denial and helplessness when coping with the threat of AIDS, and 3) greater social conflict. CONCLUSIONS: These findings suggest that personality disorder is common in the HIV-positive population. Compared with HIV-infected patients without a personality disorder, patients with a personality disorder may experience greater dysphoria and be more likely to cope with the threat of AIDS in a dysfunctional way. Recognition of the impact of personality disorder on coping with HIV infection is important for comprehensive, sensitive, and effective clinical care.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Adverse outcomes associated with personality disorder not otherwise specified in a community sample.

OBJECTIVE: The authors investigated 1) whether adolescents and adults in the community diagnosed with personality disorder not otherwise specified are at elevated risk for adverse outcomes, and 2) whether this elevation in risk is comparable with that associated with the DSM-IV cluster A, B, and C personality disorders. METHOD: A community-based sample of 693 mothers and their offspring were interviewed during the offspring's childhood, adolescence, and early adulthood. Offspring psychopathology, aggressive behavior, educational and interpersonal difficulties, and suicidal behavior were assessed. RESULTS: Individuals who met DSM-IV criteria for personality disorder not otherwise specified were significantly more likely than those without personality disorders to have concurrent axis I disorders and behavioral, educational, or interpersonal problems during adolescence and early adulthood. In addition, adolescents with personality disorder not otherwise specified were at significantly elevated risk for subsequent educational failure, numerous interpersonal difficulties, psychiatric disorders, and serious acts of physical aggression by early adulthood. Adolescents with personality disorder not otherwise specified were as likely to have these adverse outcomes as those with cluster A, B, or C personality disorders or those with axis I disorders. CONCLUSIONS: Adolescents and young adults in the general population diagnosed with personality disorder not otherwise specified may be as likely as those with DSM-IV cluster A, B, or C personality disorders to have axis I psychopathology and to have behavioral, educational, or interpersonal problems that are not attributable to co-occurring psychiatric disorders. Individuals with personality disorder not otherwise specified and individuals with DSM-IV cluster A, B, or C personality disorders are likely to be at substantially elevated risk for a wide range of adverse outcomes.

Achievement↗

PubMed2000

Dimensions and categories: the "big five" factors and the DSM personality disorders.

The five-factor model of personality, which has been widely studied in personality psychology, has been hypothesized to have specific relevance for DSM-defined personality disorders. To evaluate hypothesized relationships of the five-factor model of personality to personality disorders, 144 patients with personality disorders (diagnosed via a structured interview) completed an inventory to assess the five-factor model. Results indicated that the majority of the personality disorders can be differentiated in theoretically predictable ways using the five-factor model of personality. However, while the personality disorders as a whole appear to be differentiable from normal personality functioning on the five factors, the patterns are quite similar across the disorders, a finding that may provide some insight into the general nature of personality pathology but may also suggest problems with discriminant validity. Third, it does not appear that considering disorders as special combinations of features (as might be expected in some categorical models) is more informative than considering them as the sum of certain features (as might be expected in a dimensional model).

Adolescent↗

PubMed1999

Personality factors and disorders in chronic pain.

It has long been recognized that there is a relationship between certain personality types and personality disorders (PD) and chronic nonmalignant pain (CP). The relationship, however, is far from understood and the physiological and psychological mechanisms that underlie it are unclear. Those who treat chronic pain face many challenges when dealing with individuals who have personality disorders and they often become frustrated when interacting with these patients. Patients with certain traits and personality disorders may continue to worry and ruminate about their symptoms long after the tissue pathology has resolved. Other individuals may overly rely on the clinician and assume a passive role in their treatment, thereby decreasing the likelihood for a positive outcome. Moreover, patients with personality disorders may be demanding (eg, borderline), self-absorbed (eg, narcissistic), or substance seeking (eg, antisocial, borderline). In an attempt to improve management of such patients, pain specialists have attempted to better understand the complex relationship between personality and chronic pain. In this article, we will review the predominant historical and current theories of pain and personality, discuss aspects of the gate-control theory of pain that may relate to personality, and discuss the diathesis-stress model of personality disorders in pain. Last, we will review studies of personality and personality disorders in chronic pain and their treatment implications. We conclude that, based on the underlying neurochemistry, there may be a direct or indirect link between PD and CP, but further prospective research, both on the biological and psychological relationship, should be conducted.

Chronic Disease↗

PubMed2002

Relationships of personality disorders with MMPI-2 malingering, defensiveness, and inconsistent response scales among forensic examinees.

MMPI-2 validity scales were correlated with MCMI-II personality disorder scales to examine relationships between response styles and personality disorders in a sample of 84 criminal defendants. 14 MMPI-2 validity scales were significantly correlated with 13 personality disorders. All of the personality disorder scales were significantly correlated with at least one validity measure and 11 of 13 personality disorder scales were significantly correlated with two or more MMPI-2 validity scales. While a personality disorder diagnosis may have a general effect on validity scales, relationships theoretically consistent with a given personality disorder were also found. This means that response set appears to be a manifestation of personality, and as such, examiners should expect symptom amplification or minimization or inconsistent responses, based on an individual's personality. Subsequently, forensic examiners are encouraged to evaluate the relationships between MCMI-II personality disorders and MMPI-2 validity scales to avoid misjudging MMPI-2 profiles as invalid when they accurately reflect manifestations of personality.

Adolescent↗

PubMed2003

The relationship of personality disorders to treatment outcome in depressed outpatients.

BACKGROUND: Many clinicians believe that depressed patients with comorbid personality disorder(s) may respond differently to standard treatments than patients with depression alone. Personality disorders appear to be common among patients with depression, suggesting potentially significant treatment implications for a large group of patients. METHOD: Subjects with DSM-III-R major depression were recruited for a study looking at prediction of antidepressant response. All patients were assessed using the Structured Clinical Interviews for DSM-III-R Axis I and Axis II, as well as rated on the Hamilton Rating Scale for Depression and the Montgomery-Asberg Depression Rating Scale (MADRS). Patients were then randomly assigned to treatment with fluoxetine or nortriptyline and reassessed at 6 weeks. The major outcome measure was percentage reduction in MADRS scores. RESULTS: Of the 183 patients who completed the personality disorder assessment, 45% had at least 1 comorbid personality disorder. Subjects with comorbid personality disorders were slightly younger, more depressed at baseline, had poorer social adjustment, more general psychopathology, and more chronic depression. Despite these differences, the presence of a comorbid personality disorder did not adversely affect overall outcome at 6 weeks, but there was an interaction between having a comorbid personality disorder and drug type. The major effect was that patients with a cluster B personality disorder did relatively poorly on nortriptyline compared with fluoxetine treatment. CONCLUSION: The finding that the presence of a comorbid personality disorder does not affect overall treatment response is similar to that reported by some recent studies. The finding that patients with cluster B personality disorders respond poorly to nortriptyline is also consistent with a small literature on borderline personality disorder.

Adult↗

PubMedDate not supplied

[Pharmacotherapy in personality disorders: methodological issues and results].

The pharmacotherapy of personality disorders is less developed than are psychological treatments in this area, but they are a logical prolongation of psychobiological models of personality and temperament, and respond to the need of many clinicians in front of difficult patients. The assessment of drugs effects in personality disorders includes some important conceptual and methodological issues. Categorical or dimensional instruments evaluating baseline personality and under-treatment changes are now available. Such studies are necessary of long duration, with difficult patients, and use specific outcome criteria. The results obtained in the field of pharmacotherapy of personality disorders can be classified according to DSM IV axis-II categorization. In anxious personalities (cluster C), some isolated studies suggest a favourable effect of antidepressants on obsessive-compulsive dimension, on avoidant personality disorder, and on inhibition and trait-anxiety, especially when serotoninergic agents are used. Few studies have been conducted in cluster A personality disorders, and some are in favour of the interest of low doses of antipsychotic drugs in this group. Most studies have been conducted in cluster B, and especially in antisocial and borderline personality disorders. Partial positive results have been obtained using various classes of drugs for dealing with aggression and impulsive behaviors, including lithium, beta-blockers, carbamazepine, valproate, antipsychotic drugs, and also SSRIs. Self-harm and suicidal behaviors seem to be partially but significantly improved by antidepressants and low doses of antipsychotics. Opioid antagonisms may be helpful for these indications in the future. Other symptom-oriented strategies for psychopharmacology have been conceptualized, focused on depressive personality, emotional lability, cognitive and perceptual disturbances, or interpersonal sensitivity. Overall, the pharmacotherapy of personality disorder remains to date one of the less explored in psychiatry research. Nevertheless, it may lead in the future to the development of effective treatments, in complement to psychotherapy, for actually severe, chronic, and disabling disorder.

Antidepressive Agents↗

PubMed2002

Characteristics of assaultive patients with schizophrenia versus personality disorder: six year analysis of the Assaulted Staff Action Program (ASAP).

Literature reviews of individual assaultive patients, repetitively violent patients, and restrained assaultive patients document that persons diagnosed with schizophrenia or personality disorder are at the highest risk to become assaultive. While there has been some initial research of possible predictor variables across diagnostic groups, this six-year retrospective study is the first to compare only persons with schizophrenia or personality disorder on basic demographic and the selected clinical variables of history of violence, personal victimization, and substance use disorder. In this study, the variance suggested that persons with schizophrenia and personality disorder were both likely to be assaultive. Assaults by persons with schizophrenia were somewhat proportional to their presence in the population studied. However, personality disordered patients represented a disproportional increase from the population studied. Younger females with a diagnosis of personality disorder and with histories of violence toward others and personal victimization appeared at increased risk to be assaultive and to require restraints. The findings and their implications for safety and clinical care are discussed.

Adolescent↗

PubMed1992

Personality and clinical characteristics in patients with trichotillomania.

BACKGROUND: Trichotillomania, a disorder of self-directed hair pulling, has been the subject of few systematic studies. Although personality characteristics and disorders are often noted to coexist with trichotillomania, no thorough assessment of comorbidity with DSM-III-R Axis II disorders has been published. The present study was conducted to evaluate personality disorders and other personality characteristics in a large outpatient population of trichotillomanics and to compare these findings with those in a nontrichotillomanic comparison group. METHOD: Forty-eight outpatient female trichotillomanics were evaluated with the Structured Interview for DSM-III-R Personality Disorders (SIDP-R) and the revised version of the Minnesota Multiphasic Personality Inventory (MMPI-2). Personality disorders and personality cluster symptom scores from the SIDP-R and MMPI-2 scales were compared with those derived from a comparison group of 48 age-matched female outpatient psychiatric patients. RESULTS: Forty-two percent of the trichotillomanic group met criteria for a personality disorder. The only statistically significant difference in frequency of diagnoses between the trichotillomanic and comparison groups was a greater frequency of borderline personality disorder in the comparison group. Trichotillomanics demonstrated significantly less SIDP-R cluster A personality symptoms as well as less depression and better psychological adjustment on the MMPI-2. CONCLUSION: Our study suggests that no particular personality disorder or trait characterizes female trichotillomanics. Female trichotillomanics seeking psychiatric intervention appear to have better psychological adjustment and less psychopathology in general than other psychiatric outpatients.

Adolescent↗

PubMed2005

[Depression and personality].

In the current research concerning the relation between depression and personality a phenomenological, anthropological method and an empirical, statistical method coexist. Each of these methods has its own limitations. The latter is abandoning the classical endogenous-neurotic dichotomy without full considerations. It also tries to treat the personality as an objectively defined entity and it lacks insight into the fact that the "pre"-morbid personality is sometimes revealed "after" onset of the illness. Although the former has succeeded in establishing the concept of "Typus melancholicus," which is still of a clinical significance today, it is not sufficiently well developed to deal with patients having endogenous symptoms who show other types of personality. It also lacks the profound description on the domain of neurotic depression or depression with personality disorder. Typus melancholicus personality includes two components, not only as found in its original phenomenological arguments but also as suggested by the recent empirical research. The first component consists of the tendency to seek for a symbiotic relation with others and the intolerance of ambiguity. The excessive narcissistic cathexis to the "private self," rather than the "official self" (Matussek), can also be included here. The second component consists of the "orderliness" and the "hypernomic" identification with role identities. Typus melancholicus is brought about only when these two components are integrated into one personal structure and the contradiction between them remains not overt. In contrast, it can be considered that in such marginal types as the dependent anaclytic type, avoidant type and soft bipolar type, this contradiction is already overt. Although these marginal types show neurotic or personality disorder-like manifestations, it can be considered that the authentic domain of neurotic depression and the depression of personality disorder spreads outside of these marginal types. In this domain the depression in which the problems of object relations play a dominant role is important. It is worth taking into consideration the contrast between endogenous depression and depression associated with the problems of object relations when we decide therapeutic strategies. This contrast can be pointed out from the following three perspectives; the relation between subject and society, ambivalence, and the status of somatic symptoms. In the former, social elements play a limited role, constituting only the background conditions of patients, while in the latter patients' personal conflicts are closely intermingled with social elements. In the former the patients are almost unable to maintain ambivalent feelings so as to deal with reality and they rather adjust themselves to reality utilizing their syntonic personalities. The latter patients, on the other hand, have intense ambivalent feelings and are impacted when the negative side of the ambivalence predominates. In the former, pathological phenomena are located where somatic and psychological spheres are not yet divided, while in the latter metaphorical interpretations of somatic symptoms from the psychological contents are sometimes possible to a certain degree.

Depression↗

PubMed1997

Physical activity among persons with disabilities--a public health perspective.

Regular physical activity, sports participation, and active recreation are essential behaviors for the prevention of disease, promotion of health, and maintenance of functional independence. This health behavior is essential for persons with and without disabilities. Population-based surveys have consistently demonstrated that persons with disabilities are less likely to be physically active, compared to persons without such limitations. However, these observations are based on relatively few surveys and are dependent on physical activity assessment methods that may not be sensitive and specific enough for persons with disabilities. Studies clearly demonstrate that many persons, representing a variety of selected disabilities, can adapt to increased levels of physical activity, as evidenced by alterations in various components of physical fitness. More importantly, other studies consistently provide evidence that participation in regular physical activity among persons with selected impairments and disabilities results in improved functional status and quality of life. Further efforts are critically needed in the area of the development of physical activity assessment methodology for persons with disabilities. Methods need to be developed that will provide survey researchers and those in public health the capacity to measure and monitor activity patterns of persons with disabilities. This information is important not only for public health officials but also health policy analysts, service providers, and disability advocacy groups. Further understanding of the role of physical activity in the maintenance of function and independence among persons with disabilities is needed. The understanding of environmental and social barriers to physical activity among persons with disabilities needs further exploration. Finally, physical activity determinants research among persons with disabilities, including the role of assistive technology as well as maximizing the intrinsic capacity of functional anatomy and physiology, needs to be addressed.

Adolescent↗

PubMed1993

Comorbidity of DSM-III-R eating disorders and personality disorders.

The purpose of this study was to assess the relationship of eating disorders to personality disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. One hundred forty-six also completed the Personality Diagnostic Questionnaire-Revised (PDQ-R). Rates of personality disorder among patients with and without eating disorders were determined by each of the three instruments. Comorbidity between bulimia nervosa and anorexia nervosa and a conservative estimate of individual Axis II disorders was examined. Eating disorders with and without personality disorders were compared on age at onset and two measures of illness severity. Results indicate that the association, in general, between personality disorders and eating disorders varies by diagnostic method. Bulimia nervosa, however, is associated with borderline personality disorder and anorexia nervosa with avoidant personality disorder. Eating disorders with personality disorders are characterized by chronicity and low levels of functioning compared with eating disorders without personality disorders.

Adolescent↗

PubMed2006

The role of personality disorder in 'difficult to reach' patients with depression: findings from the ODIN study.

Individuals with personality disorders (especially paranoid personality disorder) tend to be reluctant to engage in treatment. This paper aimed to elucidate the role of personality disorder in predicting engagement with psychological treatment for depression. The Outcomes of Depression International Network (ODIN) involves six urban and three rural study sites throughout Europe at which cases of depression were identified through a two-stage community survey. One patient in seven who was offered psychological treatment for depression had a comorbid diagnosis of personality disorder (most commonly paranoid personality disorder). Forty-five percent of patients who were offered psychological treatment for depression did not complete treatment. The odds of completion were higher for patients with a comorbid diagnosis of personality disorder, especially paranoid, anxious or dependent personality disorder. The relatively low number of cases with some specific personality disorders (e.g. schizoid personality disorder) limited the study's power to reach conclusions about these specific disorders. This study focused on a community-based sample which may lead to apparently lower rates of engagement when compared to studies based on treatment-seeking populations. Episodes of depression in the context of personality disorder may represent a valuable opportunity to engage with patients who might otherwise resist engagement.

Adolescent↗

PubMed2007

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing.

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

Adaptation, Psychological↗