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Clinical considerations for evidence-based treatment of borderline personality disorder (BPD) are outlined in the context of the best available evidence, discussed with reference to BPD traits currently identified in the upcoming Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) revision. The DSM-5 will highlight refractory affective, interpersonal, and identity symptoms in BPD as potential treatment targets. In addition to providing a framework for clinical decision-making, future research strategies will also focus on neurotransmitter systems of greater relevance to understanding overall personality functioning.Although only a few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, several meta-analyses and systematic reviews converge on the consensus effectiveness of lamotrigine, topiramate, valproate, aripiprazole, olanzapine, and omega-3 fatty acid supplementation. Stronger evidence exists for treating disinhibition and antagonism than negative affectivity, particularly interpersonal facets of such traits. In addition, basic research suggests a future role for modifying glutamatergic, opioid, and oxytocinergic neurotransmitter systems to treat BPD.Clinicians should utilize omega-3, anticonvulsants, and atypical antipsychotic agents in treating specific DSM-5 BPD traits, notably disinhibition, antagonism, and some aspects of negative affectivity. Future research will focus on normalizing opioid and oxytocin dysregulation, as an adjunct to evidence-based psychotherapy, in an effort to improve interpersonal functioning.

Borderline personality disorder is the most widely researched single personality disorder, and much research activity continues. This review covers empirical literature on diagnosis, classification and treatment of borderline personality disorder published during 2006 and 2007. Several of the issues that concern borderline personality disorder also concern personality disorders in general, and so the review is broadened in the diagnostic section to include the latter.Integration of categorical and dimensional approaches to personality disorders is actively being sought for inclusion in the next revision of the psychiatric classifications. Although there are few new studies on pharmacotherapy for borderline personality disorder, many new findings on psychotherapy have been reported. They indicate that a variety of treatment modalities can influence borderline personality disorder, but the role of spontaneous improvement over time and established prognostic factors have not received sufficient attention. New modalities of psychotherapy have been tested by less stringent designs.Research into classification, diagnosis and psychotherapy of borderline personality disorder is flourishing, but research activity in pharmacotherapy is limited.

Purpose of review To describe the prevalence and specific management of severe and complex personality disorders in community mental health services and similar settings. Recent findings Conflicting reports exist in the literature but the consensus of evidence suggests that more complex personality disorder (more so than simple personality disorder) impairs response to treatment of most psychiatric disorders and complicates their management. Poor adherence to treatment may be one of the mechanisms underlying this. Summary Increasing evidence now suggests that more complex and severe personality disorders have a negative impact on the outcome of most psychiatric disorders. Some indications, however, are there to show that pharmacological treatments may not handicap the outcome of pharmacological treatment as much as other types of intervention and may be selectively chosen in this group. Severe personality disorder needs to be identified early in community services as by anticipating and adjusting to its effects it is likely to improve treatment plans and prognosis.

In recent years a considerable number of publications has appeared on various aspects of Internet interventions for mental health care. The purpose of the present article is to review the current scientific status of Internet interventions for the treatment of mental disorders.Randomized controlled studies on the use Internet interventions for the treatment of mental disorders are still scarce. Most studies in the field have been on Internet interventions for the treatment of depressive disorders and anxiety disorders, using cognitive behavioural therapy. In addition, a few studies have been published on the use of Internet interventions in the treatment of substance use disorders (smoking, problem drinking), insomnia and tinnitus.Recent studies provide provisional evidence that Internet interventions may be a promising tool for the treatment of some mental disorders.

Purpose of reviewThis article reviews the problem of ‘boundaries’ in psychopathology and its conceptualization in the diagnostic classification of psychiatric disorders.Recent findingsA modest number of publications in 2004–2005 contribute concepts, methods and data relevant to several aspects of th

Interest in the possibility of successful interventions for personality disorders has increased during the past 2 years, mainly because of heightened awareness of the diagnosis. In particular, efficacy of treatments for borderline personality disorder has improved, with good evidence for the superiority of focused day hospital psychotherapy compared with standard care, and somewhat less convincing evidence for the value of sodium valproate in this condition. Other reports also suggest that both psychosocial and pharmacological treatments are both likely to have a significant role to play in the treatment of all personality disorders, and for the first time these modalities are being properly evaluated in good research studies. The view that personality disorders are untreatable can now be challenged with serious evidence.

Purpose of review The development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and- of the 11th edition of the International Classification of Disease (ICD-11) have led to renewed attention to the conceptual controversies surrounding the nosology of mental disorder. This article reviews recent work in this area, and suggests potential ways forward for psychiatric nosology, focusing in particular on the need for improved classification approaches for public and global mental health. Recent findings DSM-5 and ICD-11 have taken somewhat different approaches, but both appropriately emphasize the importance of clinical utility and diagnosic validity in psychiatric nosology. The Research Domain Criteria framework provides a useful focus on the individual-level causal mechanisms that are relevant to vulnerability to mental disorder. An analogous approach to societal-level causal mechanisms would be useful from a public and global mental health perspective. Summary In their day-to-day work, clinicians will continue to use the fuzzy constructs operationally defined and narratively depicted in DSM-5 and ICD-11. Advances in our understanding of the individual-level and society-level causal mechanisms that contribute to vulnerability to mental disorder may ultimately lead to improved classification systems, and in turn to better individualized care as well as improved global mental health.

Liaison psychiatrists treat patients who present with self-harm, with medically unexplained symptoms (MUSs) and physical illnesses with psychological comorbidity. We sought to explore recent studies into the impact of personality disorder in liaison psychiatry.One in five patients presenting to most liaison psychiatry services suffers from a personality disorder. Patients who have self-harmed have a high rate of personality disorder, but there is little research on how liaison psychiatrists can engage these patients in appropriate treatments. Most patients with MUSs or a functional somatic syndrome do not have a personality disorder, but the prevalence is probably higher than in the general population. Little is known about how a personality disorder might affect the efficacy of treatment in these conditions. Patients with personality disorders have higher rates of physical illness. Personality disorders may complicate the treatment of patients with long-term physical conditions, and talking therapies have recently been described in primary and secondary care.Liaison psychiatrists have an ideal therapeutic opportunity to engage patients with a personality disorder in treatment when these patients present with self-harm. There is a need to understand and research how personality disorders might affect the prognosis and treatment of patients with MUSs or a functional somatic syndrome. Personality disorders may complicate the treatment of patients with long-term physical conditions, and talking therapies recently described in primary and secondary care may help their physical and psychological health.

PURPOSE OF REVIEW The present review examines the decision of the DSM-5 Personality and Personality Disorders Working Group to retain or to remove specific personality disorders included in DSM-IV-TR and presents the reactions elicited by the decision and published between 10 February 2010 and 30 September 2012. RECENT FINDINGS In the first draft of Chapter P (Personality disorders), posted on the DSM-5 Internet site on 10 February 2010, the DSM-5 Personality and Personality Disorders Working Group proposed to remove paranoid, schizoid, histrionic, dependent and narcissistic personality disorders from the classification. A revised version of the draft, posted on the Internet in June 2011, reinstated narcissistic personality disorder but not the four remaining types that had been slated for removal. Underlying the decision of the Work Group for retaining versus removing specific personality disorder types are arguments concerning the clinical utility and validity of each type. The arguments provided by the Work Group have not been accepted unanimously by other personality disorder experts. SUMMARY DSM-5 will retain six out of the 10 personality disorder types listed in DSM-IV-TR while removing the remaining four types. Reactions to the decision and to the arguments presented for doing so have been mixed.

Purpose of review: To review recent literature around the controversial diagnosis of personality disorder, and to assess the ethical aspects of its status as a medical disorder. Recent findings: The diagnostic currency of personality disorder as a psychiatric/medical disorder has a longstanding history of ethical and social challenges through critiques of the medicalization of deviance. More recently controversies by reflexive physicians around the inclusion of the category in the forthcoming revisions of International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders classifications reflect the problems of value-laden criteria, with the diagnostic category being severely challenged from within psychiatry as well as from without. Summary: The clinical diagnostic criteria for extremely value-laden psychiatric conditions such as personality disorder need to be analyzed through the lens of values-based medicine, as well as through clinical evidence, as the propensity for political and sociolegal appropriation of the categories can render their clinical and diagnostic value meaningless.

Purpose of review After the initial enthusiasm, the study of personality disorder seems to be at a crossroad, without clear direction. This is mainly due to overlapping categorical diagnostic criteria of personality disorders. Study samples based on these criteria are inadequate and their results questionable. Recent findings The literature is unanimously advocating a dimensional concept of personality disorders. Four dimensions are consistently reported to underlie personality disorder symptoms. We put forward an argument that personality disorders are disorders of adaptation, not of personality per se, as extreme personality traits are not ipso facto dysfunctional. Available methods to assess maladaptation are reviewed. Summary The diagnosis 'personality disorder' should be replaced by the diagnosis 'adaptation disorders'. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research - we discuss these aspects in some detail.

We describe several dimensional models of personality disorders and highlight future directions for the integration of dimensional approaches in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This review is timely and relevant, given the upcoming revision of DSM (DSM-V).Research has identified four common higher order factors that could be used to characterize personality pathology. Evidence supports the inclusion of this dimensional representation of personality disorders in DSM-V, possibly as an adjunct to the traditional categorical classification scheme. A dimensional approach would ameliorate many of the problems associated with the categorical approach. Issues that still need to be addressed are on how to integrate these dimensions into the current classification system in a way that they will be accepted by clinicians and psychopathologists. The clinical utility of the dimensional models must be demonstrated, and the development of a method that combines trait elevations and impairment associated with personality pathology is needed in order to define personality disorder from a dimensional perspective.Although there may be some initial resistance to the incorporation of the dimensional models in the future diagnostic manuals, researchers and clinicians are expected to benefit from the more reliable and valid portrayal of personality pathology.

PURPOSE OF REVIEW Individuals with personality disorders have difficulties in finding specific institutions or services that are designated to bind this kind of problem. These are people who are required to go through many diagnoses and consult many professionals before someone produces the correct diagnosis for their condition. This article reviews the new evidence in the management of personality disorders and incorporates reliable data to determine global clinical recommendations for treatment. RECENT FINDINGS This review suggests that, although pharmacotherapy forms the cornerstone of the management, utilization of adjunctive psychosocial treatments and incorporation of a model that involves a healthcare team are required to provide optimal management for patients with personality disorders. SUMMARY The authors related the experience obtained in the Personality Disorder Ambulatory of the Department of Psychiatry of Sao Paulo University Medical School in the handling of the people with personality disorders and proposed the use of gabapentin as a coactuator in the treatment of persons with these conditions.

Personality disorders are not usually thought of as being associated with medical comorbidity. Research shows that medical comorbidity in personality disorders is clinically important.In general those with personality disorders do not feel as fit as others do. Also, those with personality disorders in addition to other psychiatric disorders, such as depression and antisocial personality disorder, are likely to have more health problems than those without personality disorders. People with active borderline personality disorder have been shown to have more medical problems than those with remitted borderline personality disorder. Personality disorders can complicate the course of chronic medical illnesses. Finally, the use of psychotropic medications is not unusual in personality disorders and in itself can be associated with medical illnesses.Clinicians caring for people with personality disorders need to be aware of possible medical comorbidity. More research is needed.

PURPOSE OF REVIEW The purpose of this paper is to review the most recent literature on personality disorders. RECENT FINDINGS Recent data suggest that individual personality disorder criteria and full diagnosis may remit within 1-2 years. The same line of evidence disputes the separation of axis I and axis II disorders and suggests the presence of a continuum. Neuropsychological, neurobiological and genetic studies favor the presence of cognitive disorders and a non-specific mode of hereditability concerning all externalizing disorders. How to best treat personality disorders remains elusive. The most impressive news in the forensic field concerns the introduction of a new concept, dangerous and severe personality disorder by the UK government, for prevention and treatment purposes. SUMMARY The most recent data do not adequately support a separate axis II. Future classification may need to move personality disorders to axis I, each under a suitable group of diseases and eliminate the very term 'personality' from the nomenclature, since it constitutes an empirically unsupported theoretical invasion in a system supposed to be 'atheoretical'.