Skip to main content
SpringerLink
Log in

Complex Cases of Comorbid Depression and Personality Disorder (PD)

  • Chapter
  • First Online:
Complex Clinical Conundrums in Psychiatry

Abstract

Personality disorders complicated by affective disorders represent clinical complexities deserving of careful attention. It can present a challenge to psychiatrists where pharmacological, cognitive, and behavioural interventions require careful balance to achieve optimal patient outcomes. Here we present two cases relevant to the topic where the intersection of these treatments is discussed in detail. In consideration of their unique cognitive behavioural formulations, caveats are discussed to demonstrate myriad manifestations of the comorbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barber JP, Muenz LR. The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program. J Consult Clin Psychol. 1996;64(5):951–8.

    Article  CAS  PubMed  Google Scholar 

  2. Bateman AW, Gunderson J, Mulder R. Treatment of personality disorder. Lancet. 2015;385(9969):735–43.

    Article  PubMed  Google Scholar 

  3. Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H, Jüni P, Cuijpers P. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10(5):e1001454.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Beck AT, Butler AC, Brown GK, Dahlsgaard KK, Newman CF, Beck JS. Dysfunctional beliefs discriminate personality disorders. Behav Res Ther. 2001;39(10):1213–25.

    Article  CAS  PubMed  Google Scholar 

  5. Beck AT, Davis DD, Freeman A. Cognitive therapy of personality disorders. 3rd ed. New York: The Guilford Press; 2015.

    Google Scholar 

  6. Beckwith H, Moran PF, Reilly J. Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personal Ment Health. 2014;8(2):91–101.

    Article  PubMed  Google Scholar 

  7. Cooper AA, Conklin LR. Dropout from individual psychotherapy for major depression: a meta-analysis of randomized clinical trials. Clin Psychol Rev. 2015;40:57–65.

    Article  PubMed  Google Scholar 

  8. Dimaggio G. Integrated treatment for personality disorders: an introduction. J Psychother Integr. 2015;25(1):1–2. https://doi.org/10.1037/a0038765.

  9. Dixon-Gordon KL, Whalen DJ, Layden BK, Chapman ALA. Systematic review of personality disorders and health outcomes. Can Psychol. 2015;56(2):168–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fournier JC, Derubeis RJ, Beck AT. Dysfunctional cognitions in personality pathology: the structure and validity of the personality belief questionnaire. Psychol Med. 2012;42(4):795–805.

    Article  CAS  PubMed  Google Scholar 

  11. Havik OE, VandenBos GR. Limitations of manualized psychotherapy for everyday clinical practice. Clin Psychol Sci Prac. 1996;3:264–7.

    Article  Google Scholar 

  12. Hardy GE, Barkham M, Shapiro DA, Stiles WB, Rees A, Reynolds S. Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression. J Consult Clin Psychol. 1995;63(6):997–1004.

    Article  CAS  PubMed  Google Scholar 

  13. Joyce PR, McKenzie JM, Carter JD, Rae AM, Luty SE, Frampton CM, Mulder RT. Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive-behavioural therapy for depression. Br J Psychiatry. 2007;190:503–8.

    Article  PubMed  Google Scholar 

  14. Keefe JR, Webb CA, DeRubeis RJ. In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders. J Consult Clin Psychol. 2016;84(4):353–64.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kikkert MJ, Driessen E, Peen J, Barber JP, Bockting C, Schalkwijk F, Dekker J, Dekker JJM. The role of avoidant and obsessive-compulsive personality disorder traits in matching patients with major depression to cognitive behavioral and psychodynamic therapy: a replication study. J Affect Disord. 2016;205:400–5.

    Article  PubMed  Google Scholar 

  16. Kuyken W, Kurzer N, DeRubeis RJ, Beck AT, Brown GK. Response to cognitive therapy in depression: the role of maladaptive beliefs and personality disorders. J Consult Clin Psychol. 2001;69(3):560–6.

    Article  CAS  PubMed  Google Scholar 

  17. Levy KN, Johnson BN, Clouthier TL, Scala JW, Temes CM. An attachment theoretical framework for personality disorders. Can Psychol. 2015;56(2):197–207.

    Article  Google Scholar 

  18. Linehan MM. Skills training manual for treating borderline personality disorder. New York: Guilford Press; 1993.

    Google Scholar 

  19. Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am. 2010;33(3):657–85.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nathan PE, Corman JM. A guide to treatments that work. New York: Oxford University Press; 2015. Chapters 27 and 28. p. 851–94.

    Google Scholar 

  21. Samuels J. Personality disorders: epidemiology and public health issues. Int Rev Psychiatry. 2011;23(3):223–33.

    Article  PubMed  Google Scholar 

  22. Seivewright H, Tyrer P, Johnson T. Change in personality status in neurotic disorders. Lancet. 2002;359(9325):f2253–4.

    Article  Google Scholar 

  23. Shea MT, Widiger TA, Klein MH. Comorbidity of personality disorders and depression: implications for treatment. J Consult Clin Psychol. 1992;60(6):857–68.

    Article  CAS  PubMed  Google Scholar 

  24. Tarrier N, editor. Case formulation in cognitive behaviour therapy: the treatment of challenging and complex cases. London/New York: Routledge, Taylor & Francis Group; 2006.

    Google Scholar 

  25. Tyrer P, Crawford M, Mulder R. ICD-11 working group for the revision of classification of personality disorders. Reclassifying personality disorders. Lancet. 2011;377(9780):1814–5.

    Article  PubMed  Google Scholar 

  26. Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet. 2015;385(9969):717–26.

    Article  PubMed  Google Scholar 

  27. Weissman MM, Markowitz JC, Klerman GL. Clinician’s quick guide to interpersonal psychotherapy. Oxford/New York: Oxford University Press; 2007.

    Book  Google Scholar 

Download references

Disclosure Statement

No grants received for this work. There was no conflict of interest with any person or organization.

Author information

Authors and Affiliations

  1. Northern Ontario School of Medicine, Sudbury, ON, Canada

    Ramamohan Veluri MD, DPM, MRCPsych, FRCPC

  2. Psychiatry Resident, Northern Ontario School of Medicine, Sudbury, ON, Canada

    Vicky P. K. H. Nguyen MD, PhD

Authors
  1. Ramamohan Veluri MD, DPM, MRCPsych, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vicky P. K. H. Nguyen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry, Northern Ontario School of Medicine Psychiatry Department, Sudbury, Ontario, Canada

    Kuppuswami Shivakumar

  2. Woodstock General Hospital, Woodstock Ontario, University of Western Ontario, London, Ontario, Canada

    Shabbir Amanullah

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Veluri, R., Nguyen, V.P.K.H. (2018). Complex Cases of Comorbid Depression and Personality Disorder (PD). In: Shivakumar, K., Amanullah, S. (eds) Complex Clinical Conundrums in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-70311-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-70311-4_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70310-7

  • Online ISBN: 978-3-319-70311-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation