Linking treatment to diagnosis in personality disorder

As indicated above, the current classification of personality disorder is controversial and generally unhelpful to the clinician. In particular, the extent of apparent comorbidity between groups of disorders is an illusion of multiple diagnosis, varying from complete independence in some disorders to such close interdependence in others that they could be given the same name. (58>

This explains why in this chapter discussion of treatment has generally followed the simple classification based on the three clusters of personality disorder that have persistently been identified in factor analytical studies and cluster analysis. kM.0,,61. and62)

• The flamboyant or dramatic group, comprising antisocial (dissocial), borderline, impulsive, histrionic, and narcissistic personality disorders (cluster B in DSM).

• The odd or eccentric group, comprising paranoid, schizoid, and schizotypal personality disorders (cluster A).

• The anxious or fearful group, comprising the dependent, anxious (avoidant), and obsessive-compulsive (anankastic) personality disorders (cluster C). Sometimes the obsessive-compulsive group is assigned to a separate cluster, as it can be effectively separated from cluster C.

Although it has been argued that, as personality disorder is primarily manifested by difficulties in interpersonal relationships, it should be classified in these terms rather than as separate categories/63) there are sufficient differences between the main clusters to justify separate examination. In particular, in the United Kingdom there is a medicolegal requirement to identify those with 'psychopathic disorder' who, under successive Mental Health Acts since 1979, may be compulsorily admitted for treatment if they have 'a persistent disorder or disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment'. (39> There is an urgent need to modernize this definition.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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