Personality disorders

A respectful and empathetic approach to communication is key, especially given that many patients with personality disorders have had prior experiences with stigma or bias in healthcare settings.[14]Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with borderline personality disorder Am J Psychiatry. 2024 Nov 1;181(11):1024-8. http://www.ncbi.nlm.nih.gov/pubmed/39482953?tool=bestpractice.com [56]National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management. Jan 2009 [internet publication]. https://www.nice.org.uk/guidance/CG78 When assessing a person with a possible personality disorder, consider offering post-assessment support, particularly if sensitive issues (such as childhood trauma) have been discussed.[56]National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management. Jan 2009 [internet publication]. https://www.nice.org.uk/guidance/CG78

Local treatment plans and protocols may vary between regions and healthcare settings. A suggested strategy is to help the patient to develop and maintain an effective treatment relationship with his or her healthcare provider. Where possible, patients should be advised to select one primary care physician, who will be identified as their primary care physician in a facility that is considered the medical 'home-base' for their treatment. The parameters of the medical practice, such as hours of operation of the clinic site, contact information, and after-hours availability of their physician or his/her designated substitute, and protocol with regard to use of types of communication (e.g., e-mail, telephone) should be specified at the onset of the relationship. Regarding their health care, patients should be encouraged to be involved as active participants in establishing and achieving treatment goals, including those related to lifestyle modification and chronic disease management. Patients and families should be assisted to locate support organisations within their communities. National Alliance on Mental Illness (US) Opens in new window Poor social functioning is a complication of personality disorder, and the establishment of positive social supports is a desirable goal, particularly for patients with children and those who have chronic medical conditions.

Referral to a mental health provider should be made with great care and presented to the patient as a consultation for a symptom that he/she agrees is troubling, such as anxiety, depression, a lifestyle modification concern, or a functional impairment. The physician should emphasise that the patient will continue to follow up with him or her after the consultation, and that referral to the specialist does not suggest termination of care or abandonment.

The possibility of teratogenicity should be considered for any of the drugs used in the treatment of personality disorders, and the risks and benefits discussed with the patient. Of particular note, valproic acid and its derivatives may cause major congenital malformations, including neurodevelopmental disorders and neural tube defects, after in utero exposure.

• These agents must not be used in female patients of childbearing potential unless other options are unsuitable, there is a pregnancy prevention programme in place, and certain conditions are met.

• Precautionary measures may also be required in male patients owing to a potential risk that use in the 3 months leading up to conception may increase the likelihood of neurodevelopmental disorders in their children.

• Regulations and precautionary measures for female and male patients may vary between countries, with some countries taking a more heightened precautionary stance, and you should consult your local guidance for more information.

In some countries, it is also recommended that topiramate should only be used in women of childbearing potential if there is a pregnancy prevention programme in place.