Should you tell your patient they have a personality disorder?

Is it a good practice to tell your patient they have a personality disorder? And if so, when should you tell them?

These are questions that US healthcare professionals frequently grapple with regarding these often stigmatized—but highly prevalent—disorders.

Historically, the popular answer was “no”—that it’s best to not disclose this diagnosis to patients. But that consensus has shifted in recent years. Here’s why.

How big is the problem?

According to an article published by Cleveland Clinic, approximately 9% of the US population suffers from personality disorders.^[] While this percentage may seem low, it translates to roughly 29,610,000 people affected by these disorders, making them an extremely prevalent healthcare concern.

Should patients be told their diagnosis?

In past years, stigma regarding personality disorders has led to controversy in the medical world on whether clinicians should disclose personality disorder diagnoses to patients.

"To this day, there are different psychiatrists and some medical school curricula that continue to teach that personality disorders are long-term, fixed, and nontreatable—and that it's kind of disparaging to give this kind of diagnosis to a patient," Kaz Nelson, MD, a professor of psychiatry and behavioral sciences at the University of Minnesota Medical School, Minneapolis, said in a 2021 article published by Medscape.^[]

However, many healthcare professionals (HCPs) have begun to move away from that thinking. More are finding it significantly beneficial to share this diagnosis with patients in order to facilitate and encourage their proper care.

"I think practice has changed to the point where the general practice is to discuss patient diagnoses with [patients] openly," Paul Appelbaum, MD, a professor of psychiatry, medicine, and law at Columbia University Vagelos College, said in the Medscape article.

Classification of personality disorders

To properly diagnose a patient with a personality disorder, HCPs refer to the criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Based on these criteria, there are three categories of personality disorder—clusters A, B, and C.^[]

Cluster A disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. This cluster is typically characterized by eccentric thinking and odd behaviors including paranoia and mistrust, as well a lack of personal connections.

Cluster B includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. These disorders are characterized by dramatic and erratic behavior such as causing mental and physical harm to self and others, as well as mood swings and lack of empathy.

Cluster C includes avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. These disorders are characterized by significant anxiety and fear.

Treatment plan management

According to an article from Cambridge University Press, treatment is dependent on each patient and their specific personality disorder.^[]

Based on the patient's own habits, the patient and clinician can come up with a realistic management plan to achieve the greatest outcome in treating the disorder. For example, if a patient exercises regularly, it would make sense to include physical activity in their treatment plan.

Treatment for personality disorders is not one-size-fits-all, but there are some common principles spanning across diagnoses that can be incorporated into each treatment plan. Common principles of a such a plan could include:

• Tailoring to an individual’s needs

• Having explicit and realistic goals—and prioritizing those goals

• A long-term time frame

• Shared expectations between patient and physician

• Consistency and tolerance

Note that just because there is a treatment plan in place doesn’t mean that there won’t be lapses or setbacks. This is where tolerance and patience play key roles.

Research also supports the use of pharmacological treatments to reduce some symptoms of personality disorders. For example, anticonvulsants, anti-psychotics, and selective-serotonin reuptake inhibitors have been shown to be useful in treating mood-related issues such as irritability, as well as fear and anxiety.

However, the use of pharmacological interventions seems to be the most beneficial for personality disorders when there is a specific behavior being targeted. Furthermore, therapy is also considered a mainstay of management, though the therapy types and goals will vary based on the particular patient and their specific personality disorder diagnosis.