Personality Disorders

Personality disorders are enduring patterns of inner experience and behaviour that differ markedly from cultural expectations and become clinically significant through their persistence, inflexibility, or effect on functioning and relationships. A single crisis, mood episode, substance exposure, or traumatic reaction does not establish the diagnosis; the NP looks for a longitudinal pattern across settings and considers medical, substance-related, mood, psychotic, trauma-related, and neurodevelopmental explanations. Borderline personality disorder (BPD) deserves particular attention because rapid interpersonal crises may coexist with self-harm and suicidal behaviour. The DSM-5 diagnosis requires at least five of nine features: abandonment fears, unstable relationships, identity disturbance, impulsivity, recurrent suicidal behaviour or self-injury, affective instability, chronic emptiness, intense anger, and transient stress-related paranoid ideation. A patient’s suicidal thoughts must never be dismissed as merely chronic; current intent, plan, access to means, preparatory actions, and protective factors determine immediate risk. For BPD, structured psychotherapy—especially dialectical behaviour therapy (DBT)—is the treatment foundation. Medication does not correct the core personality pattern. In a Canadian NP practice, prescribing remains subject to provincial or territorial authority, the current Health Canada product monograph, and local...