Chapter Twelve
Summary
Historically, psychotherapy has been the mainstay in the treatment of personality disorders. More recently
medications are getting another look as personality disorders are not simply viewed as “behavioral” conditions caused
by poor parenting, but in fact, many believe that personality disorders may have more of a biological basis then once
believed. Current research suggests that personality disorders may have as much as a 60% biologically determined
cause. Consistently about 10-15% of the general population has a bona fide personality disorder.
To date, there are no FDA approved medications for use with personality disorders. Medications are only
used to help reduce the symptoms often present with these types of patients that worsen a patient’s condition or
interfere with the treatment process. Essentially, the three main types of symptoms addressed correspond to the three
clusters presented in the DSM 5; namely, the eccentric or odd cluster; the dramatic, emotional or erratic cluster, and
the anxious or fearful cluster.
For rather “eccentric” type patients, the use of low dose atypical antipsychotics is often used, as these have
minimal tardive dyskinesia risks. Typically the dose is ¼ to ½ of the dose used to treat schizophrenia or another
psychotic spectrum conditions.
Specific Discussion Questions:
1. Explain how we are not treating the personality disorder per se, but rather the troublesome behavioral
symptoms of the disorder.
2. Explain how the three distinct clusters may require different medications.
3. Explain why MAOIs are no longer used in reducing isolative behaviors in this diagnostic group.
Possible True/False Questions:
1. Approximately 7% of the general population has a personality disorder.
2. Experts once believed that the use of medications in the treatment of personality disorders interfered with
psychotherapy.
3. Current research and evidence suggests that personality disorders are a biopsychosocial entity caused by
complex interactions of psychosocial and biological factors.
4. Current research suggests that biological factors may account for about 40-60% of all cases.
5. There are currently eight medications that are FDA approved for treating personality disorders.
6. In patients demonstrating the “dramatic” cluster symptoms, the use of antidepressants like the SSRIs or even
mood stabilizers are often helpful.
7. Antipsychotic medications may be needed to treat the symptoms of patients in the first cluster.
8. Neuroimaging studies have demonstrated differences in the frontal lobe functioning of patients with
schizotypal personality disorder.
Multiple Choice Questions
1. What percentage of the general population have personality disorders?
a. 3-5%
b. 7-9%
c. 10–15%
d. 24-27%
2. What percentage of Borderline Personality Disorder patients are taking at least one medication?
a. 5-10%
b. 34%
c. 50-60%
d. 90-99%
3. Which of the following was found in the literature to be contributing factors in impulsive and violent
behaviors?
a. head trauma
b. toxic substances
c. low serotonin levels
d. All of the above
4. What percentage of personality disorders may have a genetic factor?
a. 40-60%
b. 50-70%
c. 60-80%
d. None of these
5. Cluster “dramatic” symptoms include:
a. Impulsive, depressive, angry and labile symptoms.
b. Paranoid, eccentric, thought disordered, dissociative.
c. Anxious, inhibited, and avoidant.
d. Fussy or neurotic symptoms.
6. Typically, SSRIs are used for which of the following cluster(s) or groups?
a. Cluster “a” only
b. Cluster “b” only
c. Clusters “a” and “b”
d. Clusters “b” and “c”
7. Historically, ________ has been used to calm anxious, impulsive patients:
a. Buspar
b. Wellbutrin
c. Neurontin
d. All of these
8. While medications like Depakote and Tegretol have been used to calm a labile and anxious patient, a newer
medication called ___________ has been used with success.
a. Valium
b. valbenazine
c. buspirone
d. Trileptal
Alternative Class Assignments and Essay Questions:
1. Divide your class into two groups. Have one group make a rational argument for using medications to help
control the behavioral symptoms of patients with Axis II conditions. The other group with argue for more
traditional “talk therapies.”
2. Explain how the depletion of serotonin has been implicated in lability, impulsivity, and aggression.
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in each case?
2. Is there another disorder that may apply or should be ruled-out?
Answer Key to Possible True/False and Multiple Choice Questions
Chapter Twelve
Possible True/False Questions:
Multiple Choice Questions