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[Personality disorders in psychiatry].

J F Denis1

  • 1Département de psychiatrie, Cité de la Santé de Laval, Québec.

Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie
|April 1, 1990
PubMed
Summary

Personality disorders are social illness syndromes, not diseases, stemming from relational systems. Clinicians should foster patient responsibility rather than overindulgence or rejection.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Systems Theory

Background:

  • Personality disorders present significant challenges in clinical practice due to counter-transferential strain and limited specific treatments.
  • These disorders are often viewed simplistically as individual diseases, overlooking their systemic and relational components.

Purpose of the Study:

  • To reframe personality disorders as social illness syndromes rooted in interpersonal patterns and relational systems.
  • To highlight the systemic entrapment clinicians can experience and propose an alternative management approach.

Main Methods:

  • Conceptual analysis from a systems perspective, differentiating personality disorders from Axis I disorders.
  • Examination of clinician-patient dynamics, including manipulative interpersonal devices and common pitfalls like overindulgence or rejection.

Main Results:

  • Personality disorders are characterized by reciprocal, reinforcing interpersonal patterns within a 'disordering system' rather than isolated individual pathology.
  • Clinicians can become entangled in these cycles by failing to recognize manipulative behaviors and by adopting inappropriate management strategies.

Conclusions:

  • Treating personality disorders requires a shift from a disease model to a systems approach, recognizing them as social illness syndromes.
  • Effective management involves actively resisting the urge to assume patient responsibility, employing firm guidance to encourage accountability and differentiate from Axis I symptom control.

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