Psychiatria Danubina, Vol. 31 No. 1, 2019.
Review article
https://doi.org/10.24869/psyd.2019.2
AN INTEGRATIVE MODEL AND DYNAMIC NOSOLOGY OF PERSONALITY DISORDER: PART 2: SYMPTOM-BASED PHARMACOTHERAPY
Dragan Svrakic
; Department of Psychiatry, VA medical center St Louis, Washington University School of Medicine, St Louis, MO, USA
Mirjana Divac-Jovanovic
; Department of Psychology, Faculty for Media and Communication, Singidunum University, Belgrade, Serbia
Naazia Azhar
; Department of Psychiatry, VA medical center St Louis, Washington University School of Medicine, St Louis, MO, USA
Abstract
This paper presents an integrative model of personality and personality disorder which incorporates psychoanalytic concepts with modern neuroscience. In addition, a dynamic, personalized, and context - and time-sensitive diagnosis of personality disorder is introduced. The authors cogently argue that all clinical variants of personality disorder share the same common deficit: fragmented basic units of experience at the nonconscious core of the mind (aka “partial object relations”). The fragmentation propagates through mental faculties (thought, motivation, emotion), as they self-organize into subsystems of personality, e.g., one’s sense of self, identity, character, moral values, rendering them polarized into extreme and thus adaptively suboptimal. The syndrome of personality disorder arises as a nonconscious compensatory maneuver of the fragmented mind to organize itself through a defensive but unrealistic self-image (e.g., narcissistic, schizoid, antisocial, etc.), giving rise to a host of unique symptoms. Symptomatic pharmacotherapy of personality disorder is best organized around four empirically derived domains of symptoms, shared by all variants to a variable degree: i) mood and anxiety dysregulation; ii) impulsivity, aggression, and behavior dyscontrol; iii) emotional disinterest and detachment; and iv) cognitive distortions and brief reactive psychoses. Pharmacotherapy targeting the above domains is
nonspecific, as medications affect multiple domains simultaneously. Modest empirical evidence and considerable clinical benefits continue to support the use of medications in the overall symptomatic treatment of personality disorder.
Keywords
personality disorder; pharmacotherapy; integrative model; temperament; character
Hrčak ID:
222254
URI
Publication date:
4.4.2019.
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