By Wendy Sarubbi | February 20, 2012 3:59 pm

The cartoon from “The New Yorker” magazine summed up the topic of personality for Dr. John Oldham:  A woman turns to her male companion and asks: “Why are you the way you are?”

As he showed that cartoon to the UCF College of Medicine, Dr. Oldham, president of the American Psychiatric Association (APA), said, “We all have personality. How do you decide if someone has a personality disorder?”

Dr. Oldham, whose visit on February 8 was sponsored by the college’s Student Interest Group in Neurology (SIGN) talked about the future for the field of personality disorders, with a focus on borderline personality disorder (BPD).

According to the APA, personality disorders represent “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.” For patients with borderline personality disorder, life is shaped by difficulties with relationships, poor self-image, and difficulty controlling moods and emotions.

“They are like a car in overdrive, and the brakes don’t work,” Dr. Oldham said.

The National Institute of Mental Health said BPD affects about 1 in 50 adults, making it more common than schizophrenia or bipolar disorder.

But how BPD is diagnosed is changing, he said. The 2013 edition of the APA’s “Diagnostic and Statistical Manual of Mental Disorders” will redraw the roadmap for assessing personality disorders.  Among the likely changes will be a reduction from 10 behavior-based categories to six personality disorder types and a focus on dimensional assessments. Instead of present/absent symptom checklists, the new edition will include severity scales for symptoms such as anxiety that appear in varying degrees in different mental illnesses. Proponents say those quantitative assessments will allow clinicians to better tailor treatment to needs of individual patients.

Dr. Oldham warned that with any mental health issue, patients are often “shamed” by their conditions. For example, soldiers may not seek treatment for post-traumatic stress disorder because they don’t want to appear weak.

“The problem of stigma is best attacked with knowledge,” Dr. Oldham said. “Mental illness isn’t any different from other disabling disorders.”





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