[The current status of personality disorders in psychiatry]

A growing body of research has elucidated the bio-psycho-social backgrounds and clinical facts of personality disorders defined in DSM-III-IV Axis II, and has endorsed the clinical value of the diagnoses. However, the concept of personality disorder still remains diaphanous, and requires further clarification. One complication is that personality disorder can be seen from either the perspective that is a milder variant of other Axis I disorders, or that it is an abnormally exaggerated form of normal personality traits. That the disorders can be grouped according to these viewpoints indicates that there may be heterogeneity within them, while they have common characteristics: a long duration, extended areas of affected functioning, subtle and marginal severity of symptoms, and "person-near" nature. These features may also account for the difficulty in defining and assessing the disorder. Treatment is another important focus for discussion. Patient-therapist cooperation is essential and of itself is a difficult goal. Most failures of the therapeutic relationship lead to a variety of problems, including legal or ethical ones. Prerequisites for involuntary treatment, remedies for the risk of treatment disruption by violent acting-out and preventing malpractice are issues to be discussed. Inexorably we must return to the principle that our task is to help our patients take ultimate responsibility for decisions about their personality.