Monday, 14 May 2018

Misconceptions About Anxiety Disorders And Facts

May 14, 2018

Misconceptions About Anxiety Disorders


We often hear people say I have anxiety or I'm stressed out this is something hard to deal with. People with anxiety have probably experienced this fact which is something that's quite hard to deal with. Today we are going to talk about the misconception about anxiety disorder. 


When you have anxiety you feel quite a lot of the time that people don't understand and that people think it's something different than actual.

Which is really difficult and quite crippling thing to deal with and I don't think people always understand a big part of who you are.

 The only difference between somebody who is not understanding your anxiety just because they've never been taught about mental illness or they've never had it in their life. 

Also maybe they've never known anybody that has it just because they've never encountered anxiety or depression before.




So let's see what are the misconceptions about anxiety disorders that are taking over people who are dealing with.




Anxiety Facts

Misconceptions-


#1 Anxiety isn't a big deal

It's obvious that we all feel anxious sometimes and that's not an actual anxiety disorder, cause anxiety is something different it actually impairs our ability to work in our daily life.

Many people think that anxiety is not a big deal but in reality, they don't know how anxiety can affect your life and make it worse.




#2 Anxiety is not a real illness


Some anxiety depends on the situation, for example, we often experience it before having exams or job interviews or something when we gonna try something new.

But when the symptoms are real and physical such as dizziness, muscles tension, trouble breathing, heart palpitation, insomnia,  etc and you have the same feeling for more than months or year then you have encountered with real mental illness. (which is treatable though).





#3 Anxiety and Panic attacks are same


Both panic attacks and anxiety are both different to deal with.


Anxiety is a set of future fears in which you are more anxious about the next 5 minute or 5 hours or 5months/ years and it can exist for long if it not get treated on time.

Whereas Panic attack is a sudden uncontrollable fear and sensations that you feel. Panic attacks can be for last few minutes or for an hour.



#4 Anxiety disorders are not very common 



Millions of us live with some form of anxiety disorders and it's not something so unfamiliar that you have to treat yourself as alone who only does.




#5 We all are introverts


Have you ever been called introvert? Or, scared of big crowds?
And this is the misconception that many people think a person who suffers from anxiety is an introvert or doesn't like to get socialize because yes maybe a person having a social anxiety.


But social anxiety is totally different from generalized anxiety in which people actually want a part of the big groups.



#6 Anxiety  disorders are caused by stress


People often talk that anxiety disorders are caused by stress so reducing stress could help you to feel better and that's really what most people do when they feel a lot of anxiety they try to get stress out of their lives.

The causes of all the anxiety disorders are pretty complicated it's usually a combination of genetics or your inheritance.


#7 Switching negative  thoughts with positive thoughts



Maybe you have tried once this technique of fighting negative thoughts with positive ones but you failed because that doesn't actually work and this is something called paradoxical.



Unwanted thoughts tend to get stronger and more repetitive and in the result, your anxiety won't be going down and then you start getting mad at yourself. 


And on and on the inside of your head  it goes round and round and you can't actually make yourself  stop thinking something if you just stop  for a moment


#8  Push yourself

Another misconception is- to fix your anxiety you just have to push yourself a 'lil bit and things won't be the same but this is a  really offensive way to save somebody I guess. So if you have a friend or loved one who is going through anxiety never try to say these stuff  



Though people think that encouraging their friends or their loved ones or family members could help and I also personally support people by encouraging them. The thing you have to understand is, do not put unnecessary pressure on them it could be the worst thing that you ever do.

Pressure also plays a role to make your anxiety worse. People with anxiety can't deal with situations when they are suppressed by many things.




#9  Antidepressants will only make you worse

Hey! Antidepressant works best and nowadays there are many antidepressants available that you can take as prescribed. I will always encourage people who are going through anxiety to try antidepressants and do not listen to people who have never had an anxiety or depression.



#10  You won't get better unless they go through therapy 



You might have been to loads of therapists in the past and many of them were really not helpful but only had made you feel worse. Well, I don't mean that you shouldn't try therapy. In fact, you must try once. 



 But here what I wanna explain is you can help yourself by doing the stuff that makes you feel better with a non-pressure environment and setting a goal in your life and focusing on yourself.




#11  Therapy for anxiety- It's gonna take forever


Many people still have this misconception that therapy for anxiety is going to take them forever but the therapy which is called CBT (Cognitive Behavioral Therapy) and it is the most effective therapy used now to treat anxiety disorder it's not gonna take long or forever. 



#12 Medications are the only cure


As above mentioned CBT is now being most effective and helpful therapy for anxiety disorder, so we can state that medications are not the only way to get rid of anxiety disorders.


       So, those were the 12  misconceptions about anxiety disorders.


So, let me know if you ever had to face any of these misconceptions in your life.


Other helpful online resources do visit.




















Wednesday, 9 May 2018

Eating Disorders: Co-morbidity, Assessment, Management And Treatment

May 09, 2018
Eating Disorder: Assessment, Treatment, and Management


A considerable proportion of patients with Eating Disorders have other psychiatric disorders. Most common co-morbid illness is Depression, followed by Anxiety Disorders and Personality Disorders.


However, Psychosis, OCD, and PTSD are more common in Anorexia Nervosa as compared than in other eating disorders.
Secondly, Alcohol and substance misuse are the more common in Bulimia Nervosa than in other Eating Disorder.

comorbidity, treatment, management of AN,BN and BED


 Assessment For Eating Disorder - General Points

According to a medical report the majority of patients with Eating Disorder especially BN and BED do not receive proper treatment (either patient do not seek treatment or the diagnosis is overlooked). 

Here are the few points that could help for the assessment of Eating Disorder.


  • Take a comprehensive Medical History.

  • Measure the BMI (Body Mass Index).

  • Do a general physical examination, looking for the signs and symptoms of Anorexia Nervosa and Bulimia Nervosa.

  • Do routine blood tests before initiating the treatment.

  • Do a baseline ECG.

Management of Eating Disorders - Overview

  • There are a wide variety of treatments used for Eating disorders.

  • Normalization of nutrition and eating habits is a central goal in the treatment of patients.

  • As eating disorders tend to run  a chronic course, it is important to monitor and address, on an ongoing basis:

    • Psychiatric co-morbidities.

    • Physical health complications.

    • Changes in Social circumstances.

Management of Anorexia Nervosa-
  
Depending on the availability or need patient can be treated in a :

    • Routine Psychiatry Outpatients (Adult or Child and Adolescent Services) clinic.

    • General Psychiatry Inpatient Unit.

    • General Medical Inpatient Unit.

    • Specialist Eating Disorders Inpatients/Outpatients Unit.


Pharmacotherapy for AN

Based on the research, Atypical antipsychotics (Olanzapine) and Zinc supplementation could be beneficial.

 Moreover, it is important to identify and treat any co-morbid depression and anxiety accordingly, with antidepressants.



A rationale for using Atypical Antipsychotics in AN-
  • In order to help promote weight gain(Olanzapine could be beneficial).

  • To reduce hyperactivity (used by patients as a weight losing tactic).

  • According to some evidence from neuroendocrine studies that dopamine neurotransmission is increased in AN.

So, that means Antipsychotics that have dopamine antagonist effect might be helpful.

A rationale for using Zinc in AN-

 There is a zinc deficiency in AN and zinc plays an extreme role in neurotransmitter function, it has an appetite stimulant effect also.
 According to one study, it has been found effective and beneficial that a 14 mg of elemental zinc given daily for two months(as a suggested dose).



Treatment of Bulimia Nervosa-


  • Patients are generally treated as Outpatients.

  • CBT is the treatment of choice- either Individual CBT or Group CBT

  • Other CBT Options: web-based / Telemedicine CBT, Guided Self-help, Bibliotherapy(Self-help books).

  • Interpersonal Therapy may be another helpful option.

  • Education about Healthy dieting can be helpful.


Pharmacotherapy for BN-

 SRRIs (particularly high-dose of Fluoxetine) can be helpful in reducing bingeing urges and other obsessional preoccupation with weight.


 Antiepileptic Topiramate may be helpful as it has an appetite reducing the effect.



Management of Binge Eating Disorder

Studies show that it has a high placebo response. Similar treatment approaches as for BN.

  • Psychotherapy options:

    • CBT: Individual / Group/ Online/ Self- Guided Help/ Bibliotherapy.

    • Other psychotherapies: IPT (Inter-Personal Therapy)

  • Medications:

    • SRRIs (esp. Sertraline/ Esciatalopram / Citalopram), Imipramine, Topiramate, (Sibutramine is no longer approved due to risk of MI and stroke).

  • Weight loss treatment programmes / Individual coaching, etc can be helpful with obesity.



Other helpful Treatment Options for Eating Disorders


Exercise programmes (Light resistance training) this might be helpful in changing the patient's attitudes towards exercise and also may increase bone and joint strength.

  • Mindfulness training

  • DBT (Dialectical Behaviour Therapy)

  • EMDR

  • Yoga

  • Body Awareness Therapy

  • Estrogen Supplementation

  • Bright Light Therapy

  • Parenting skills training (parents need to create awareness among their children to reduce the risk of an eating disorder behaviors from an early age.)

Also, read 

          



Saturday, 5 May 2018

5 Helpful Tips To Talk With Your Doctor About Social Anxiety

May 05, 2018
How to talk with your doctor about social anxiety?

This post is about my own personal experience. If I talk about my doctor he is very open to talking about social anxiety but for some other people, it might be in sort of awkward situations to speak up about their insecurities. 


So I hope this post will help people who are experiencing some of these challenges. I believe people with social anxiety have a harder time in communicating than most other people, so going to the doctor can be particularly frightening or unnerving. 

Here are few points that I am gonna share with you and I hope it will help you out.

Helpful Tips To Talk With Your Doctor About Social Anxiety


Firstly, make a complete list of all your queries and doubts related to your anxiety in a handwritten or on your phone before of all the things that you want to talk with your doctor and that would be easier for you to talk with your doctor

 If you have already those questions lists in front of you, so you actually don't forget anything like when you  become nervous or something because I know  what happens to people when they become  nervous they forget to say things that they had planned for discussion, 

So, better you can make a list and then so you won't be getting off from your track when you're in the room with the doctor. Therefore whatever the reason you have you're going to your doctor follow through with that list and talk with your doctor and surely something might help you.



Secondly, whenever you go to your doctor just remember that your doctor is there to help you, well a lot of doctors are there for the money but hopefully, you have a doctor who is there to help you and who wants to see you get better.


Thirdly, explain to your doctor about every symptom that you're experiencing, doesn't really matter if it's a big or little and can tell your doctor like what the most worrisome or bothersome symptoms are for you. 

There are a lot of different medications for social anxiety if you're not on medications yet and you think that it might be helpful just ask your doctor to add some if possible for you(according to your symptoms).



Fourth, if you're on medications and you think you need a dose change so you can explain to the doctor why you think you need to change your medication. 


So do not hesitate to tell your doctor the exact reasons. Maybe you're experiencing too many side effects and you want your dosage to be decreased or changed, tell your doctor that your experiences side effects because maybe a  decrease or change in dosage is what you all need. 



Fifth, now this one is very important that you got to think over it. Never decide at the last minute that you don't actually need to be with your doctor for help because that the most people used to do. 

So you better take a step ahead of your social anxiety to get rid of and remember that the reason you went to the doctor.


Important Note*

At the end of the day, you are paying your doctor or your insurance company to help you or maybe that doctor is being paid by someone to help you, so it's your right that you get a good and proper treatment for your social anxiety. 


Moreover, if you are not satisfied with your doctor in results of not getting a proper response and being not helpful to you anymore, so you have a choice to change your doctor and your medications as well.


Other helpful resources related to Social Anxiety Disorder  you may go through the following links


1

NIMH  Anxiety Disorders







Tuesday, 1 May 2018

Bipolar And Unipolar Disorder: Co-morbidity, Prognosis, Factors And Treatment

May 01, 2018
The Co-morbidity is common for both Polar and Unipolar disorders. Some common co-morbid psychiatric disorders include Anxiety disorder, alcohol/substance misuse, personality disorders, eating disorders, ADHD. 

Whereas, Physical co-morbidities include: Thyroid dysfunction, migraine, metabolic syndrome (induced by antipsychotics).
Bipolar and unipolar depression :Signs and Symptoms and treatment


Prognosis Of Mood Disorders- Poor Prognostic Factors

  •  Earlier age of onset(childhood-onset Bipolar).

  • Longer duration/increased severity of episodes.

  • Poor initial response to treatment.

  • Suicidal behavior.

  • Alcohol and substance misuse.

  • Low level of social support/ social integration.

Additionally increased frequency of episodes, Psychotic symptoms, mixed episodes, family factors such as high expressed emotions, and the first episode of depression rather than Mania are some poor prognostic factors for the Bipolar disorder.



Treatment of Depression (Bipolar And Unipolar Disorder)-



There are two main treatment approaches for depression, which is  used either on their own or in combination:
  1. Anti-depressants

  1. Psychotherapy (usually CBT-Cognitive Behaviour Therapy)

Rationale For Anti- Depressants-

Monoamine Hypothesis of Depression: This states that depression is due to a deficiency of Monoamines(Serotonin or Noradrenaline) in the brain so, by increasing the levels of one or both of these monoamines, depression can be treated.


Newer Antidepressant :

1) Agomelatine:
  • Agonist at MT1/MT2 melatonin receptors.
  • Melatonin, secreted by the pineal gland (which is important to sleep).
  • MT1 and MT2 receptors are located in the suprachiasmatic nucleus of the hypothalamus(the sleep center).
  • Common side effects include diarrhea, headache, and nausea.


General Principles When using Antidepressants.

  • Start Low, Go Slow

    •          Start at a low dose.

    •          Increase dose gradually(if needed).

    • Review mental state regularly.

    • Monitor for side effects.

    • Avoid 'poly-pharmacy'(using more than one antidepressant, except for treatment-resistant Depression)

NOTE- It usually takes at least 2 to 3 weeks for an anti-depressant effect to manifest. If the patient improves, continue medication for several months after recovery. 


If the patient doesn't improve, gradually change to the other anti-depressant. If repeated relapses, consider long-term maintenance treatment.


COGNITIVE BEHAVIOR THEORY (CBT)

The aim of CBT is to help the patient'to correct the negative cognitions and other unhelpful behaviors that maintain the depression because of negative cognitions and maladaptive behaviors can cause one to feel low in mood and which leads to depression.


Management Of Bipolar Depression-
  • Among atypicals: Quetiapine may be the drug of choice.

  • Among anti-epileptics: Lamotrigine may be the drug of choice.

  • For severe, treatment-resistant depression: ECT may be an option.

General Management Principles

  • Assess suicidal risk during depressive/mixed episodes.

  • Assess safety issues(to the patient and others as well) during manic episodes.

  • Identify and try to address contributory factors such as work stressors, physical health issues, alcohol misuse, etc.

  • Educate the patient about the illness and rationale of treatment.

  • Advice patients about Sleep Hygiene as disturbed sleep is a prominent risk factor for relapse and also for switching from Depression to Mania.

Long-term course of Bipolar Disorder-
    
  • The average duration of a Depressive episode is (months) is more than that of Manic episodes.

  • Women with the Bipolar disorder may experience more Depressive episodes than men with Bipolar disorder.

  • Patients with Bipolar disorder tends to have more and longer Depressive episodes in the course of their lifetime than patients with the Unipolar disorder.

  • On an average, a Bipolar patient will experience about 10 episodes in their lifetime with a roughly equal number of depressive/manic episodes.




Monday, 30 April 2018

Eating Dark Chocolate Can Improves Mental Health : 5 Incredible Benefits of Dark Chocolates

April 30, 2018

Can Dark Chocolates Really Help In Improving Stress?


 5 Incredible Benefits of Dark Chocolates

According to the recent study at Loma Linda University in Southern California, it has been suggested that eating a dark chocolate could be helpful for you to lower down your mental stress.


The researchers have found that dark chocolate contains a higher amount of cacao (70%) that actually helps in reducing the inflammation and stress level.

 Studies have also found that consuming dark chocolate gradually also helps in improving your mood and memory.

 So next time whenever you are feeling low or having bad mood do grab a dark chocolate bar one or two.

Same as in another study, the researchers had the healthy participants who took the equivalent of a chocolate bar --- 48 grams of dark chocolate which contains 30% of organic cane sugar and 70%  cacao. 

Later on, their brains were scanned with ECG which measures brain waves,30 minutes and 60 minutes after eating the chocolate. And guess what the gamma waves increased across the cortex which is mainly related to memory and cognition.


From child to adult chocolate has been a longtime favorite of all age, we do love to eat. As above studies already claim that eating dark chocolate is helpful to reduce stress, but there are so much more good about eating dark chocolates such as: 


1) Dark chocolate improves mood, stress, memory, and immunity.


2) Dark chocolate contains anti-oxidants which have a capacity to prevent aging by free radicals. 


3) It also helps to keep your skin healthy and glowing.


4) Dark chocolate helps to boost our brain power, cocoa is rich in antioxidants called flavanols which dilates blood vessels allowing more oxygen and blood to the brain. 

The antioxidant reduces inflammation throughout the body which can eventually lead to heart disease, cancer, aging.


5)Dark chocolate contains a large amount of Amin (amino acid) and acts as an effective natural sex enhancer by increasing nitric oxide and blood flow to sex organ which increases sensation, satisfaction, and desires.

 It also contains a chemical called P (Phenylethylamine) which promotes the production of neurotransmitter dopamine which enhances feelings of well-being, joy, and pleasure.


Also, read- :)

10 Effective Foods To Eat Daily To Beat Your Depression And Anxiety

Personality Disorder: Types, Causes And Symptoms :Cluster A, Cluster B and Subtypes

April 30, 2018

What is a Personality Disorder?

Personality Disorder: Types, Causes And Symptoms :

A Personality Disorder is a type of mental disorder in which a person has the unhealthy pattern of thinking, behaving and functioning. 


According to the ICD-10 the Personality disorder is defined as 

"Characteristic and enduring pattern of inner experience and behavior, that, as a whole, deviates markedly from the culturally, expected and accepted range.


 Usually, Personality Disorder started in teenage or in early adulthood.




Major Symptoms Of  Personality Disorder:

   Persistent, maladaptive, inflexible patterns:
  • Of thinking(about self, other and the world)

  • Feeling(intensity of emotions)

  • Behavior

  • Relationship with others

  • Cause significant distress to self and to others.


                    Types Of Personality Disorder:


1) Cluster A (Odd or Eccentric disorder)

     Cluster A personality disorder includes- Paranoid Personality Disorder, Schizoid Personality Disorder and Schizotypal Disorder.
  
a) Paranoid Personality Disorder
  • Pervasive mistrust/suspiciousness - misinterpreting friendly or neutral actions of others as hostile.
  • Self- referential attitude.

  • A tendency to bear grudges.

  • A combative sense of personal rights.

  • Excessive sensitivity to criticism and setbacks.

  • Preoccupation with conspiratorial explanations for personal or universal events.


b) Schizoid Personality Disorder
  • Inability to express both positive tenders feelings as well as negative feelings like anger.

  • No desire for relationships or close friends.

  • Emotional coldness/ detachment.

  • Indifference to criticism or praise.

  • Unintentional disregard for social norms.


c) Schizotypal Disorder

  • Appearance and behavior are odd and eccentric.

  • The tendency to social withdrawal.

  • Old Belief.

  • Paranoid Ideas.

  • Ruminations involving violent or sexual themes.

  • Depersonalization / Derealization / illusions.

  • Transient quasi-psychotic episodes.


2) Cluster B Personality Disorder


Cluster B Personality disorders are characterized by dramatic, erratic and emotional behavior. 

They include- 

Antisocial Personality Disorder,

Borderline Personality Disorder, 

Histrionic Personality Disorder, 

Avoidant Personality Disorder, 

Dependent Personality Disorder, 

Obsessive-Compulsive(Anankastic) Personality Disorder, 

Passive-aggressive Personality Disorder



a) Antisocial Personality Disorder: This disorder is also known as Dissocial Personality Disorder in ICD-10. Other related terms include Psychopathic Personality, Sociopathic Personality, Dangerous and Severe Personality disorder.

  • Low threshold for aggression/impulsivity resulting in fights, assaults.

  • Incapacity to experience remorse and to learn from punishments.

  • Can easily establish relationships, but ain't maintain them.

  • Callous unconcern for feelings of others.

  • Disregard for social rules as evidenced by repeatedly breaking the law.

b) Borderline Personality Disorder:

A borderline personality disorder is generally characterized by unstable effects of intense anxiety, irritability that last usually for only a few hours at a time.


  • Involvement in intense, unstable relationships in which the other person is alternately idealized and devalued.

  • Recurrent threats or acts of self-harm, especially self-mutilation.

  • Chronic feelings of emptiness.

  • The patient makes frantic efforts to avoid abandonment.

  • A tendency to quarrelsome behaviors.

  • A tendency to act impulsively without consideration of results such as alcohol, drugs, sex, driving, etc.

  • Frequent outbursts of anger or violence, physical fights.

  • A patient may expierence dissociative symptoms, paranoid ideas, etc.



c) Histrionic Personality Disorder
  
   Histrionic Personality Disorder is characterized by wanting to be the center of attention in events that one participates.

  • Usually, the patient feels uncomfortable in situations where one cannot be the center of attention.

  • Exaggerated expression of emotions.

  • Shallow and labile affect.

  • Theatrical speech that lacks specific details.

  • Inappropriate seductiveness in behavior.

  • Over-concern with physical attractiveness, in an attempt to draw the attention of others.

  • Easily suggestible and influenced by others.

  •  Histrionic Personality Disorder is associated with Somatization Disorder.



d) Narcissistic Personality Disorder
Named after Narcissus, a hunter in Greek mythology, who fell in love with his own reflection in a pool of water.

  • A belief that one is special.

  • Lack of empathy: inability/unwillingness to identify with the feelings of others.

  • Envious of others, but also feels that others are envious of her/him.

  • Arrogant attitude or behavior.

  • Need for an excessive admiration or attention seeking.

  • Preoccupation with fantasies of success, power, beauty, ideal love, etc.

  • Exploitation of others in relationships and taking advantages of others to achieve one's goal.


e) Avoidant Personality Disorder
  • Avoidance of activities that involve interpersonal contact for fear of criticism or rejection.

  • A belief that one is inept, unappealing or inferior to others.

  • Preoccupied with the fear of being criticised or rejected in social situations.

  • General feelings of tension.

  • Restrictions on lifestyle because of the need for physical security.

  • Unwillingness to get involved unless certain of being accepted and liked.



f) Dependent Personality Disorder

 In Dependent Personality disorder the person excessively depending on others for an emotional support.

  • Inability to make even everyday decisions without advice or reassurance from others.

  • Allowing others or wanting others to make important life decisions.

  • Subordinating one's own needs to the needs of those that one depends on.

  • Difficulty in doing things due to lack of self-confidence.

  • Fear of losing support.

  • Feeling helpless when alone.

  • Preoccupied with exaggerated fears of being unable to care for oneself if alone.


g) Obsessive-Compulsive(Anankastic) Personality Disorder

  • Preoccupied with Perfectionism.

  • Excessive doubting.

  • Preoccupied with details, lists, rules, etc that interferes with the main objective of the task being done.

  • Excessive conscientiousness and inflexibility with morals, ethics, and values.

  • General Stubbornness.

  • Rigid adherence to social conventions


h) Passive-aggressive Personality Disorder

  • Procrastination.

  • Failing to do one's share of teamwork.

  • Avoids obligations by claiming to have forgotten.

  • Protesting that others make unreasonable demands.

  • General disdain for people in authority.

  • Sulkiness/irritability when asked to do something that one doesn't want. 



Sunday, 29 April 2018

Personality Disorders :Assessment, Management and Treatment

April 29, 2018

        Assessment of Personality Disorders



Personality Disorders :Assessment, Management and Treatment
  • Personality Disorder shares many common features with functional Mental Disorder. The main differentiating feature is that in Personality Disorder, the one set is early and the features have been persistent and stable, while in functional Mental Disorder, the onset is usually later and the symptoms tend to be episodic. However, this distinction is not clear.

  • Knowing the background personality in a patient with a Mental Disorder helps the Clinician be more realistic with respect to the treatment outcome expectations.

  • So, it is very important to access the patient's Personality as a part of the initial assessment(usually with extra information from another source such as Parents, Siblings, Spouse, Family, Physician, etc) who has known the patient for many years.


  •   It is generally not appropriate to make a diagnosis of a Personality Disorder after just one Assessment session. Usually, a  patient would need to be seen at least a few times.

  • Previous Medical/Psychiatric records, if available, should also be studied.

  • while the exception of Borderline Personality Disorder, most other Personality Disorders are diagnosed the only incidentally in routine psychiatric services in patients presenting with other problems like Psychosis, Depression, Anxiety, etc.

  • Patients with a Personality disorder are at higher risk of developing Mental Disorder.


Management Of Personality Disorder


Apart from the Borderline PD, the vast majority of patients with Personality Disorders(with no co-morbid Mental Disorder) do not to the attention of mental health services. Hence, most of the studies of treatment have been on Borderline PD.


The other Personality Disorders are usually incidentally diagnosed in patients presenting with the other disorders like Depression, Anxiety, Psychosis or Addiction.


 Antisocial PD is, as expected, very common in the prison/criminal justice settings. It is usually diagnosed formally only after the person has committed a crime.


Management Of Borderline Personality Disorder:

 The goals of treatment include:

  • Better management of one's emotion.

  • Avoidance of / reduction of self-harm behavior.

  • Having more clarity about one's purpose in life.

  • Building better quality relationships with others.

  • Improvement in functioning.

  • Addressing the co-morbid Psychiatric/substance misuse issues.

Psychotherapy for Borderline PD-

    • Psychodynamic Psychotherapy

    • Dialectical Behaviour Therapy (DBT)

    • Transference-Focused Psychotherapy (TFT)

    • Mentalisation -Based Therapy (MBT)

    • Emotion Regulation Training (ERT)

    • Cognitive Behaviour Therapy (CBT)

    • Schema-Focused Therapy (SFT)

    • Interpersonal Psychotherapy (IPT)

 Pharmacotherapy for Borderline PD


  • Not used as a primary treatment as it is unlikely to alter the natural course of the disorder.

  • Mainly used for symptoms management.

  • Risk of overdose needs to be borne in mind while prescribing psychotropics.

  • Drugs that may have some benefits include:
              a) Antidepressants: usually SSRIs.

              b)Antipsychotics: usually low/dose atypicals.

              c)  Mood stabilizers: e.g. Valproate, Lithium.

                     d) Others e.g. Clonidine, Omega-3 fatty acids.



Management Of Paranoid Personality Disorder-

Patient with Paranoid Personality Disorder is very difficult to treat as they are mistrustful of most people, including Psychiatrists. A patient with Paranoid PD is unlikely to present for treatment unless there are significant immediate problems. 


For examples, a patient may be at risk of losing a job because of complaints from colleagues or a wife is deciding to leave unable to tolerate suspicious nature of the husband.


Low dose Antipsychotics may be helpful.



Treatment for Personality Disorders


If the patient is willing and motivated to change, and depending on the PD, and the availability of services the following treatments may help.


  • Psychotherapies: ranging from Supportive, through CBT, to Exploratory therapies like Psychodynamic Psychotherapy.

  • Self-help: books and online support groups.

  • Treatment of any co-morbid disorders such as Depression, Anxiety, etc with Medication or Psychotherapy to optimize functioning.