Clinical Features and Clusters of 10 DSM-IV-TR Personality Disorders

Gambaran Klinik dan Jenis-Jenis Gangguan Kepribadian 

Personality disorders (PDs) are a heterogeneous group of deeply ingrained and enduring behavioral patterns characterized by inflexible and extreme responses to a broad range of situations, manifesting in cognition (ways of perceiving and interpreting self, others, and events), affectivity (range, intensity, lability, and appropriateness of response), interpersonal functioning, and impulse control. PDs impinge on medical practice in multiple ways, including self-destructive behaviors, interpersonal disturbances, and nonadherence. Appropriate physician responses and effective treatments exist for many PDs. Borderline personality disorder (BPD) is an extremely debilitating and notoriously difficult to treat disorder. BPD may be misattributed to other PDs, and behaviors of patients in crises may also misleadingly suggest BPD. Correct diagnosis of PDs and proper intervention will help to improve patient outcomes. 

Ten PDs are currently distinguished clinically. They are often grouped into three clusters: odd or eccentric (cluster A); dramatic, emotional, or erratic (cluster B); and anxious or fearful (cluster C). These groupings are helpful in broadly categorizing PD difficulties but are limited in their usefulness because they do not signify similarities in etiologies and treatment response.

Clinical Features and Clusters of 10 DSM-IV-TR Personality Disorders

Cluster Personality Disorder Clinical Features Cluster A: odd, eccentric Paranoid Suspicious; overly sensitive; misinterpretations Schizotypal Detached; perceptual and cognitive distortions; eccentric behavior Schizoid Detached; introverted, constricted affect Cluster B: dramatic, emotional, erratic Antisocial Manipulative; selfish, lacks empathy; explosive anger; legal problems since adolescence Borderline Dependent and demanding; unstable interpersonal relationships, self-image, and affects; impulsivity; micropsychotic symptoms Histrionic Dramatic; attention seeking and emotionality; superficial, ie, vague and focused on appearances Narcissistic Self-important; arrogance and grandiosity; need for admiration; lacks empathy; rages Cluster C: anxious, fearful Avoidant Anxiously detached; feels inadequate; hypersensitive to negative evaluation Dependent Clinging, submissive, and self-sacrificing; needs to be taken care of; hypersensitive to negative evaluation Obsessive-compulsive Preoccupied with orderliness, perfectionism, and control

PDs are relatively common, with a prevalence of 10–18% in the general population. Patients with PDs may seek help from family physicians for physical complaints, rather than psychiatric help. Higher rates for all types of PDs are found in medical settings. Prevalence of BPD in the general community is 1.2%. 

PDs have a pervasive impact because they are central to who the person is. They are major sources of long-term disability and are associated with greatly increased mortality. Patients with PDs have fewer coping skills and during stressful situations may have greater difficulties, which are worsened by poor social competency, impulse control, and social support. Patients with BPD are frequently maltreated in the forms of sexual, physical, and emotional abuse; physical neglect; and witnessing violence. PDs are identified in 70–85% of persons identified as criminal, 60–70% of persons with alcohol dependence, and 70–90% of persons who are drug dependent. 

Borderline, schizoid, schizotypal, and dependent PDs are associated with high degrees of functional impairments and greater risk for depression and alcohol abuse. Obsessive-compulsive and narcissistic PDs may not result in appreciable degrees of impairment. Dependent PD is associated with a marked increase in health care utilization. 

Referensi:
Current Diagnosis & Treatment Family Medicine 2nd Edition (McGraw-Hill) 2007

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