Personality Disorders and Treatment Outcome
In the last 15 years, a number of studies have found that personality disorders complicate, delay, or obstruct somatic or psychological treatment of Axis I affective and anxiety disorders in adults (Pfohl, Stangl, & Zimmerman, 1984; Pilkonis & Frank, 1988; Shea et al., 1990). Reviewing the DSM-IV definition of personality disorder sheds light on probable reasons (American Psychiatric Association, 1994). Long-term maladaptive interpersonal strategies, misinterpretation of situations and people, disturbed emotional reactions, and poor impulse control clearly complicate treatment of more circumscribed conditions such as Major Depression or Panic Disorder. Earlier onset of depressive and anxious symptoms, as well as greater symptom severity, duration, and relapse, have been found for these personality disordered individuals (Abrams, Rosendahl, Card, & Alexopoulos, 1994; Black, Bell, Hulbert, 8c Nasrallah, 1988; Devanand et al., 1994; Fava et al., 1996; Loebel, 1990). Personality disordered patients report more social discomfort, loneliness, reticence, friction, and fewer social contacts, as measured on the Social Adjustment Scale (Shea et al., 1990). Psychotherapy and pharmacotherapy rely on interpersonal collaboration and persuasion to achieve results. It is no wonder that personality disordered individuals have difficulty developing a good working therapy alliance, and exhibit greater attrition and poorer compliance with both somatic and psychological treatments (Krupnick et al., 1996; Zweig 3C Hinrichsen, 1992). When they do stay in therapy, a longer treatment period has generally been required (Shea, Widiger, & Klein, 1992).