Dr. Gabriele Massei, Dirigente Medico di Psichiatria, Servizio Psichiatrico di Diagnosi e Cura, presso Ospedali Riuniti della Versilia, Lucca, Italy
Although true prevalence rates can be difﬁcult to ascertain due to diagnostic challenges, surveys have found 4% to 15% of the population are affected by at least 1 personality disorder. (Grant et al.; 2004) The prevalence is thought to be even higher among those seeking healthcare services, with researchers suggesting that 1 in 4 primary care patients meet criteria for a personality disorder (Grant et al., 2004; Tyrer et al.2015) Personality disorders are a common occurrence in psychiatric wards (Comtois et al., 2016), with prevalence rates estimanted between 80% and 19%. According to some studies (Evans et al, 2017), having a PD is associated to a greater number of hospital admission; among others, the patients with Borderline Personality disorder are more likely in comparison to others to represent to emergency rooms or to be readmitted to an inpatient mental health unit.
Taken together, these data show an important phenomenon both in terms of sheer numbers and in terms of burden (economic and human). More specifically, given the deeply interpersonal nature of the disturbances in Personality Disorders, interpersonal schemas will most probably affect the relationship between the patient and the caring staff, leading to the same kind of troubled relation as manifested in the history of the disease (Riddle 2015). Different personality disorders tend to determine different, though characteristic, ways of framing a caring relationship, eventually leading to perpetuate the circles of interpersonal schemas, interpersonal misinterpretation and personal failures (DiMaggio et al, 2015).
The context of presentation and hospitalisation in personality disorders may vary greatly, ranging from psychopathological symptoms to other comorbid psychiatric illnesses to problematic behaviours, and from the suffering of others/disruption of personal relationships to phisical symptoms and disorders.
In order to foster the best therapeutic alliance it is paramount to 1) conduct a rapid yet thorough assessment to evaluate the key areas of functioning in the mind of the patient 2) frame the evaluation and share it among the staff 3) provide a simple but coherent framework of care aimed to respond coherently to the challenges poised by the patient and avoid the reinstatement of disfunctional dynamics.
Different kind of critical issues in different personality disorders
Note: Schizoid and Schizotypal personality disorder have been left apart from the discussion, due to the intrinsecally different nature of their simptoms.