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% 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; namely, the paranoid, eccentric, dissociative cluster; the impulsive, angry labile
cluster, and the anxious inhibited, avoidant cluster.
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 “clusters” require different medication goals.
3. Explain why MAOIs are no longer used in reducing isolative behaviors in this diagnostic group.
4. What role do anticonvulsants or mood stabilizers play in the treatment of personality disorders?
5. What types of medical tests/evaluations should be used to rule-out other underlying physical causes of
behavioral disorders or personality change?
Possible True/False Questions:
1. Approximately 7% of the general population have 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 “cluster B” symptoms, the use of antidepressants like the SSRIs are often
helpful.
7. Antipsychotic medications may be needed to treat the symptoms of patients in “cluster A.”
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. 10-23%
d. 24-27%
2. Which of the following is not a typical therapeutic approach used in the treatment of personality disorders:
a. psychodynamic
b. cognitive
c. dialectical
d. REBT
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 “a” symptoms include:
a. Impulsive, depressive, angry and labile symptoms.
b. Paranoid, eccentric, thought disordered, dissociative.
c. Anxious, inhibited, and avoidant.
d. Fussy, demanding, neurotic symptoms.
6. Typically, SSRIs are used for which of the following cluster(s)?
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
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.
3. The research appears to suggest that personality disorders may have as much as a 60% genetic cause/link.
Explain the ramifications for current therapies and the argument for using psychotropics.
4. Discuss the pros and cons of using medications for chronic, long-term management of serious personality
disorders.
5. Explain how anticonvulsants and other mood regulators are used to control various types of problematic
behaviors.
Read the Case Vignette in this chapter and answer the following questions:
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Chapter Twelve
Answer Key
True/False Questions:
Multiple Choice Questions