FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Personality & other

Personality disorder

Overview

Enduring, pervasive, inflexible patterns of inner experience and behaviour deviating markedly from cultural expectation, beginning by adolescence/early adulthood and causing distress/impairment. Clusters A (odd), B (dramatic), C (anxious).

Recognise

  • Cluster A: paranoid, schizoid, schizotypal
  • Cluster B: borderline (EUPD), antisocial, histrionic, narcissistic
  • Cluster C: avoidant, dependent, obsessive-compulsive (OCPD)
  • EUPD: affective instability, impulsivity, self-harm, fear of abandonment, unstable relationships, splitting

Red flags

  • Recurrent self-harm and suicide attempts (esp. EUPD) — assess each episode on its merits

Differentials & how to tell them apart

Bipolar disorderdiscrete sustained mood episodes vs minute-to-hour affective instability of EUPD
Complex PTSDtrauma-driven; overlapping features
Depressionepisodic vs lifelong pattern

Investigations

Longitudinal clinical assessment; exclude mood disorder, psychosis and substance misuse driving the picture.

Management

  1. 1Structured psychological therapy is the mainstay — DBT or MBT for EUPD; therapeutic community for some.
  2. 2Crisis: brief problem-solving, safety planning; avoid initiating long-term medication in a crisis.
No drug is licensed to treat PD itself — avoid routine/long-term drugs; treat comorbid depression/anxiety; short-term sedation only in crisis

Key points

Drugs do not treat PD — guard against polypharmacy. Continuity and a clear care plan reduce crises.

Monitor & prognosis

Self-harm/suicide risk, comorbidities, engagement with therapy.

EUPD often improves over years with therapy.

Source: NICE CG78 (borderline)/CG77; StatPearls