ONSET AND CLINICAL COURSE
Personality disorders are relatively common, occurring in 10% to
13% of the general population. Incidence is even higher for people in lower
socioeconomic groups and unsta-ble or disadvantaged populations. Fifteen
percent of all psy-chiatric inpatients have a primary diagnosis of a
personality disorder. Forty percent to 45% of those with a primary diag-nosis
of major mental illness also have a coexisting person-ality disorder that
significantly complicates treatment. In mental health outpatient settings, the
incidence of personal-ity disorder is 30% to 50% (Svrakic & Cloninger,
2005). Clients with personality disorders have a higher death rate, especially
as a result of suicide; they also have higher rates of suicide attempts,
accidents, and emergency department visits and increased rates of separation,
divorce, and involve-ment in legal proceedings regarding child custody (Svrakic
Cloninger, 2005). Personality disorders have been corre-lated highly with
criminal behavior (70% to 85% of crimi-nals have personality disorders),
alcoholism (60% to 70% of alcoholics have personality disorders), and drug
abuse (70% to 90% of those who abuse drugs have personality disor-ders; Svrakic
& Cloninger, 2005).
People with personality disorders often are described as “treatment
resistant.” This is not surprising, considering that personality
characteristics and behavioral patterns are deeply ingrained. It is difficult
to change one’s personality; if such changes occur, they evolve slowly. The
slow course of treatment can be very frustrating for family, friends, and
health-care providers.
Another barrier to treatment is that many
clients with personality disorders do not perceive their dysfunctional or
maladaptive behaviors as a problem; indeed, sometimes these behaviors are a
source of pride. For example, a bellig-erent or aggressive person may perceive
himself or herself as having a strong personality and being someone who can’t
be taken advantage of or pushed around. Clients with person-ality disorders
frequently fail to understand the need to change their behavior and may view changes
as a threat.
The difficulties associated with personality disorders persist
throughout young and middle adulthood but tend to diminish in the 40s and 50s.
Those with antisocial per-sonality disorder are less likely to engage in
criminal behavior, although problems with substance abuse and disregard for the
feelings of others persist. Clients with borderline
personality disorder tend to demonstrate decreased impulsive behavior, increased adaptive behav-ior, and
more stable relationships by 50 years of age. This increased stability and
improved behavior can occur even without treatment. Some personality disorders,
such as schizoid, schizotypal, paranoid, avoidant, and obsessive– compulsive,
tend to remain consistent throughout life.
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