Personality Disorders in Indian Psychiatric Clinics

Volume 7 Issue 3 March, 2017

Couple of decades back, the emphasis on personality disorders assessment and management in the psychiatric clinics across India was not much, compared to the psychotic and mood disorders. Personality disorders are often observed as comorbidities, affecting outcome of associated psychiatric disorders and as such, these disorder have negative impact of various aspects of one’s life. However many times these disorders are missed, not diagnosed; or even if identified, there seems to have little effort to manage them; probably because of lack of resources like time, expertise, or even the clinicians’ interest. The psychiatrist-to-population ratio is low in India and most psychiatrists are still busy in dealing with severe mental illnesses, on day to day basis; and there is little chance for personality disorders to be picked up as a management target. Other possible reasons for under diagnosis could be inadequate training of clinicians and associated stigma amongst the patients. Besides, as most patients have to pay for their treatment, engagement may be an issue for a prolonged treatment period usually indicated for personality disorders. My experience in many multidisciplinary teams suggested that a considerable proportion of patients attending psychiatric clinics had personality disorder. Many of these patients could be supported through therapeutic interventions.

It is important to explore whether the scenario has changed over the years. Obviously these patients should be appropriately identified and treated. There are a variety of intervention approaches for the personality disorders; psychotherapeutic interventions being the mainstay. Although no drugs are licensed for the treatment of personality disorder, there is scope for short term use of some medications to manage associated symptomatic presentations. And there is a definite role for medications for any comorbid mood or other disorders.

There is a need for greater resource, clinicians, and importantly, public education. The literature and clinical experience suggest that many people with personality disorder improve to a great extent in the long term and enjoy a productive life. Clinicians should get over any therapeutic nihilism they might have, which is precluding them even looking at it. It is true that lack of personnel and expertise are major stumbling blocks which need to be addressed as well; and that’s a task for training centers. Clinicians and media should work together imparting public education about these disorders and emphasize the availability of support.