Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T17:28:44.405Z Has data issue: false hasContentIssue false

Drug Treatment of the Personality Disorders

Published online by Cambridge University Press:  02 January 2018

George Stein*
Affiliation:
King's College Hospital, and Farnborough Hospital, Farnborough Common, Orpington, Kent BR6 8ND

Abstract

Many people with well defined borderline and schizotypal personality disorders may benefit considerably from small doses of neuroleptics. Depression that occurs with personality disorders, which is frequent, responds poorly to tricyclics but may respond better to neuroleptics, while the response to ECT is usually short lived. Selected borderline subjects may respond to MAOIs, particularly where there is a history of childhood hyperactivity. Carbamazepine and lithium may help some individuals with episodic behavioural dyscontrol and aggression, even in the absence of epileptic, affective or organic features. Drug treatments can be combined with psychotherapy, but further placebo-controlled trials are needed to clarify which drugs are most useful, and whether there are any useful clinical predictors of drug responsiveness.

Type
Review Articles
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H. S., Rosenthal, T. L., Haykal, R. F., et al (1980) Clinical and sleep EEG findings separating “subaffective dysthymias” from “character spectrum disorders”. Archives of General Psychiatry, 37, 777793.CrossRefGoogle Scholar
American Psychiatric Association (1968) Diagnostic and Statistical Manual of Mental Disorders (2nd edn) (DSM–II). Washington, DC: APA.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Androlunis, P. A., Gluech, B. C., Stroebel, C. F., et al (1982) Borderline personality disorder subcategories. Journal of Nervous and Mental Disease, 170, 670679.CrossRefGoogle Scholar
Ballenger, J. C. & Post, R. M. (1980) Carbamazepine in manic depressive illness: a new treatment. American Journal of Psychiatry, 137, 782790.Google Scholar
Baron, M. (1981) Schedule for Interviewing Borderlines. New York: New York State Psychiatric Institute.Google Scholar
Baxter, L., Edell, W., Gerner, R., et al (1984) Dexamethazone suppression test and axis I diagnosis of inpatients with DSM–III borderline disorder. Journal of Clinical Psychiatry, 45, 150153.Google Scholar
Beecher, H. K. (1955) The powerful placebo. Journal of the American Medical Association, 159, 16021606.CrossRefGoogle ScholarPubMed
Bick, P. A. & Hannah, A. L. (1986) Intramuscular lorazepam to restrain violent patients. Lancet, i, 206.Google Scholar
Black, D. W., Bell, S., Hulbert, J., et al (1988) The importance of Axis II in patients with major depression. Journal of Affective Disorders, 14, 115122.Google Scholar
Brinkley, J. R., Beitman, B. D. & Friedel, R. O. (1979) Low dose neuroleptic regimes in the treatment of borderline patients. Archives of General Psychiatry, 36, 319326.CrossRefGoogle Scholar
Cade, H. F. H. (1949) Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia, 36, 249352.Google Scholar
Cantwell, D. P. (1972) Psychiatric illness in the families of hyperactive children. Archives of General Psychiatry, 27, 414417.Google Scholar
Casey, P. R. (1989) Personality disorder and suicidal intent. Acta Psychiatrica Scandinavica, 79, 290295.Google Scholar
Chessick, R. D. (1969) The borderline patient. In American Handbook of Psychiatry (ed. Arieti, S.). New York: Bask Books.Google Scholar
Chowdrey, N., Hicks, R. C. & Kreitman, N. (1973) Evaluation of an aftercare service for parasuicidal patients. Social Psychiatry, 8, 6781.CrossRefGoogle Scholar
Cole, J. O., Salomon, M., Gunderson, J. G., et al (1984) Drug therapy in borderline patients. Comprehensive Psychiatry, 25, 249262.CrossRefGoogle ScholarPubMed
Collard, J. (1976) Pimozide in the treatment of some “social maladjustments” in “personality disorders”. Acta Belgica Psychiatrica, 79, 686703.Google Scholar
Connell, P. H. (1958) Amphetamine Psychosis. Maudsley Monograph, No. 5. London: Chapman and Hall.Google Scholar
Conte, H. R., Plutchik, R., Karasu, T. B., et al (1980) A self-report borderline scale: discriminative validity and preliminary norms. Journal of Nervous and Mental Disease, 168, 428435.Google Scholar
Cowdrey, R. (1987) Round table discussion. Treatment of outpatients with borderline personality disorder. Journal of Clinical Psychiatry, 48 (suppl. 8), 3637.Google Scholar
Cowdrey, R., Pickar, D. & Davies, R. (1985) Symptoms and EEG findings in the borderline syndrome. International Journal of Psychiatry and Medicine, 15, 201211.Google Scholar
Cowdrey, R. & Gardner, D. L. (1988) Pharmacotherapy of borderline personality disorder. Archives of General Psychiatry, 45, 111119.Google Scholar
Craft, M., Ismail, I. A., Krishnamurthi, D., et al (1987) Lithium in the treatment of aggression in mentally handicapped patients: a double blind trial. British Journal of Psychiatry, 158, 685689.Google Scholar
Deitch, J. T. & Jennings, R. K. (1988) Aggressive dyscontrol in patients treated with benzodiazepines. Journal of Clinical Psychiatry, 49, 184188.Google Scholar
Delay, J., Deniker, P. & Haul, J. M. (1954) Traitement des etats d'excitation et d'agitation par une methode medicamenteuse derivee de l'hibernotherapie. Annals Medicale et Psychologique, 110, 267273.Google Scholar
Department of Health and Social Security (1985) Mental Illness Hospitals and Units in England. Results from the Mental Health Enquiry. Statistical Bulletin. Government Statistical Service. London: HMSO.Google Scholar
Deykin, E. Y. & Dimascio, A. (1972) The relationship of patient background characteristics to efficacy of pharmacotherapy in depression. Journal of Nervous and Mental Disease, 155, 209215.Google Scholar
Dostal, T. & Zvolsky, P. (1970) Anti-aggressive effects of lithium salts in severely retarded adolescents. International Pharmacopsychiatry, 5, 203207.Google Scholar
Dryud, J. E. (1972) The treatment of the borderline syndrome. In Modern Psychiatry and Clinical Research (eds Offer, E. & Freedman, D. X.), pp. 159193. New York: Basic Books.Google Scholar
Eichelmann, B. (1988) Towards a rational pharmacotherapy for aggressive and violent behaviour. Hospital & Community Psychiatry, 39, 3139.Google Scholar
Ellison, J. M. & Adler, D. A. (1984) Psychopharmacologic approaches to borderline syndromes. Comprehensive Psychiatry, 25, 255262.Google Scholar
Faltus, F. J. (1984) The use of alprazolam in the treatment of three patients with borderline personality disorder. American Journal of Psychiatry, 141, 802803.Google ScholarPubMed
Fawcett, J. & Siomopouloo, J. (1971) Dextroamphetamine response as a possible predictor of improvement with tricyclic therapy in depression. Archives of General Psychiatry, 25, 244247.Google Scholar
Fawcett, J., Clark, D. C., Aagesen, C. A., et al (1987) A double blind placebo controlled trial of lithium carbonate therapy for alcoholism. Archives of General Psychiatry, 44, 248256.Google Scholar
Gardner, D. L. & Cowdrey, R. W. (1985) Alprazolam-induced dyscontrol in borderline personality disorder. American Journal of Psychiatry, 142, 98100.Google Scholar
Gardner, D. L. & Cowdrey, R. W. (1986) Positive effects of carbamazepine on behavioural dyscontrol in borderline personality disorder. American Journal of Psychiatry, 143, 519522.Google ScholarPubMed
Gelder, M., Gath, D. & Mayou, R. (1989) Oxford Textbook of Psychiatry (2nd edn). Oxford: Oxford University Press.Google Scholar
Gelenberg, A. J. (1987) Round table discussion. Psychopharmacology of borderline personality disorder: a review. Journal of Clinical Psychiatry, 48 (suppl. 8), 2325.Google Scholar
Goddard, P. & Lokare, V. G. (1970) Diazepam in the management of epilepsy. British Journal of Psychiatry, 117, 213214.Google Scholar
Goetzl, V. (1977) Lithium carbonate in the management of hyperactive aggressive behaviour of the mentally retarded. Comprehensive Psychiatry, 18, 599606.CrossRefGoogle ScholarPubMed
Goldberg, S. C., Schulz, S. C., Schulz, P. M., et al (1986) Borderline and schizotypal personality disorders treated with low-dose thiothixene vs placebo. Archives of General Psychiatry, 43, 680686.Google Scholar
Griffiths, J. L. (1985) Treatment of episodic behavioural disorders with rapidly acting benzodiazepines. Journal of Nervous and Mental Disease, 173, 312315.Google Scholar
Gunderson, J. G. (1984) Borderline Personality Disorder. Washington, DC: American Psychiatric Press.Google Scholar
Gunderson, J. G. (1986) Pharmacotherapy for patients with borderline personality disorder. Archives of General Psychiatry, 48, 698700 Google Scholar
Gunderson, J. G. (1987) Round table discussion. Treatment of outpatients with borderline personality disorder. Journal of Clinical Psychiatry, 48 (suppl. 8), 3637.Google Scholar
Gunderson, J. G., Kolb, J. E. & Austin, V. (1981) The diagnostic interview for borderline patients. American Journal of Psychiatry, 138, 896903.Google Scholar
Gunderson, J. G., Frank, A. F., Ronningstam, E. F., et al (1989) Early discontinuance of borderline patients from psychotherapy. Journal of Nervous and Mental Disease, 171, 3842.Google Scholar
Hakola, H. P. A. & Laulumaa, V. A. O. (1982) Carbamazepine in the treatment of violent schizophrenics. Lancet, i, 1358.Google Scholar
Hedberg, D. L., Hauch, J. H. & Gleuch, B. C. (1971) Tranylcypromine–trifluoperazine combination in the treatment of schizophrenia. American Journal of Psychiatry, 127, 11411146.Google Scholar
Hill, D. (1944) Amphetamine in psychopathic states. British Journal of Addiction, 44, 5054.Google Scholar
Hill, P., Murray, R. M. & Thorley, A. (1986) Essentials of Post Graduate Psychiatry. London: Grune and Stratton.Google Scholar
Jacobson, S. & Tribe, P. (1972) Deliberate self injury (attempted suicide) in patients admitted to hospital in mid Sussex. British Journal of Psychiatry, 121, 379386.Google Scholar
Kalina, R. K. (1964) Diazepam: its role in a prison setting. Diseases of the Nervous System, 25, 101107.Google Scholar
Kaplan, H. I. & Sadock, B. I. (1989) Comprehensive Textbook of Psychiatry (5th edn). Baltimore: Williams & Wilkins.Google Scholar
Kendell, R. E. & Zealley, A. K. (1988) Companion to Psychiatric Studies (4th edn). Edinburgh: Churchill Livingstone.Google Scholar
Kernberg, O. (1968) The treatment of patients with borderline personality organisation. International Journal of Psychoanalysis, 49, 600619.Google Scholar
Kernberg, O. (1986) The suicidal patient. In Severe Personality Disorders: Psychotherapeutic Strategies, pp. 254263. New Haven: Yale University Press.Google Scholar
Kiloh, L. G., Ball, J. R. B. & Garside, R. F. (1962) Prognostic factors in treatment of depressive states with imipramine. British Medical Journal, i, 12251227.Google Scholar
Klein, D. F. & Fink, M. (1962) Psychiatric reaction patterns to imipramine. American Journal of Psychiatry, 119, 432438.Google Scholar
Klein, D. F., Gittleman, R., Quitkin, F., et al (1980) Diagnosis and Drug Treatment of Psychiatric Disorders. Baltimore: Williams and Wilkins.Google Scholar
Klein, E., Bental, E., Lerer, B., et al (1983) Carbamazepine and haloperidol vs. placebo haloperidol in excited psychoses. Archives of General Psychiatry, 41, 165170.Google Scholar
Klein, N. S., Wren, R. C., Cooper, T. B., et al (1974) Evaluation of lithium therapy in chronic and periodic alcoholism. American Journal of Medical Science, 268, 1520.Google Scholar
Kramer, B. A. (1982) Poor response to ECT in patients with a combined diagnosis of major depression and personality disorder. Lancet, i, 1048.Google Scholar
Kroll, J., Carley, K., Sines, L., et al (1982) Are there borderlines in Britain? A cross-validation of US findings. Archives of General Psychiatry, 39, 6063.Google Scholar
Lancet (1986) Management of borderline personality disorders. Lancet, ii, 846847.Google Scholar
Lefkowitz, M. (1969) Effects of diphenylhydantoin in disruptive behaviour: study of male delinquents. Archives of General Psychiatry, 20, 643651.CrossRefGoogle Scholar
Leone, N. F. (1982) Response of borderline patients to loxapine and chlorpromazine. Journal of Clinical Psychiatry, 43, 148150.Google Scholar
Liebowitz, M. R. & Klein, D. G. (1981) Inter-relationship of hysteroid dysphoria and borderline personality disorder. Psychiatric Clinics of North America, 4, 6787.CrossRefGoogle Scholar
Lion, J. R. (1979) Benzodiazepine in the treatment of aggressive patients. Journal of Clinical Psychiatry, 40, 7071.Google Scholar
Luchens, D. J. (1984) Carbamazepine in violent non-epileptic schizophrenics. Psychopharmacological Bulletin, 20, 569571.Google Scholar
Mandell, A. J. (1976) Dr. Hunter S. Thompson and the new psychiatry. Psychiatry Digest, 37, 1217.Google Scholar
Mattes, J. A. (1984) Carbamazepine for uncontrolled rage outburst. Lancet, ii, 11641165.Google Scholar
Merry, J., Reynolds, C. M., Baily, J., et al (1976) Prophylactic treatment of alcoholism by lithium carbonate. Lancet, ii, 481482.Google Scholar
Monroe, R. R. (1970) Episodic Disorders. Cambridge: Harvard University Press.Google Scholar
Monroe, R. R. (1982) DSM–III style diagnoses for the episodic disorders. Journal of Nervous and Mental Disease, 170, 664669.Google Scholar
Montgomery, S. A. & Montgomery, D. (1982) Pharmacological prevention of suicidal behaviour. Journal of Affective Disorders, 4, 291298.Google Scholar
Morrison, J. R. & Stewart, M. A. (1971) A family study of the hyperactive child syndrome. Biological Psychiatry, 3, 189195.Google Scholar
Neppe, V. W. (1983) Carbamazepine as an adjunctive treatment in non-epileptic chronic inpatients with EEG temporal lobe abnormalities. Journal of Clinical Psychiatry, 44, 326331.Google Scholar
Oast, S. P. & Zitrin, A. (1975) A public health approach to suicide prevention. American Journal of Public Health, 65, 144147.Google Scholar
Okuma, T., Inanaga, K., Otsuki, S., et al (1981) A preliminary double-blind study of the efficacy of carbamazepine in the prophylaxis of manic depressive illness. Psychopharmacology (Berlin), 73, 9596.CrossRefGoogle ScholarPubMed
Ovenstone, I. K. (1973) Spectrum of suicidal behaviours in Edinburgh. British Journal of Prevention and Social Medicine, 27, 2735.Google Scholar
Overall, J. E., Hollister, L. E., Johnson, M., et al (1966) Nosology of depression and differential response to drugs. Journal of the American Medical Association, 195, 946948.Google Scholar
Paykel, E. S. (1972) Depressive typologies and response to amitriptyline. British Journal of Psychiatry, 120, 147156.Google Scholar
Paykel, E. S. (1989) Treatment of depression, the relevance of research for clinical practice. British Journal of Psychiatry, 155, 754763.Google Scholar
Perinpanayagam, M. S. & Haig, R. A. (1977) Use of depot tranquillisers in disturbed adolescent girls. British Medical Journal, i, 835836.CrossRefGoogle Scholar
Perry, C. J. (1985) Depression in borderline personality disorder. Lifetime prevalence at interview and longitudinal course of symptoms. American Journal of Psychiatry, 142, 1521.Google ScholarPubMed
Pfohl, B., Staugh, D. & Zimmerman, M. (1984) The implication of DSM–III personality disorders for patients with major depression. Journal of Affective Disorders, 7, 309318.Google Scholar
Philips, A. E. (1970) Traits, attitudes and symptoms in a group of attempted suicides. British Journal of Psychiatry, 116, 475482.CrossRefGoogle Scholar
Rampling, D. (1978) Aggression – a paradoxical response to tricyclic antidepressants. American Journal of Psychiatry, 135, 117118.Google Scholar
Resnick, O. (1967) The psychoactive properties of diphenylhydantoin experiences with prisoners and juvenile delinquents. International Journal of Neuropsychiatry, 3 (suppl. 2), 3036.Google Scholar
Reyntjens, A. M. (1972) A series of multicentre trials with pimozide in psychiatric practice. Acta Psychiatrica Belgica, 72, 653661.Google Scholar
Richmond, J. S., Young, J. R. & Groves, J. E. (1978) Violent dyscontrol responsive to D-amphetamine. American Journal of Psychiatry, 135, 365366.Google Scholar
Rifkin, A., Quitkin, F., Carrillo, C., et al (1972) Lithium carbonate in emotionally unstable character disorders. Archives of General Psychiatry, 27, 519523.Google Scholar
Robertson, M. M. & Trimble, M. R. (1982) Major tranquillisers used as antidepressants, a review. Journal of Affective Disorders, 4, 173193.Google Scholar
Rosenblatt, S., Schaiffer, D. & Rosenthal, J. S. (1976) Effects of diphenylhydantoin on child-abusing parents: a preliminary report. Current Therapeutic Research, 19, 332336.Google Scholar
Schmideberg, M. (1959) The borderline patient, in American Handbook of Psychiatry (ed. Arieti, S.), vol. 1, pp. 398416. New York: Basic Books.Google Scholar
Serban, G. & Siegel, S. (1984) Response of borderline and schizotypal patients to small doses of thiothixene and haloperidol. American Journal of Psychiatry, 141, 14551458.Google Scholar
Shawcross, C. R. & Tyrer, P. (1985) The influence of personality on response to monoamine oxidase inhibitors and tricyclic antidepressants. Journal of Psychiatric Research, 19, 557562.Google Scholar
Sheard, M. H. (1971) Effect of lithium on human aggression. Nature, 230, 113114.Google Scholar
Sheard, M. H., Marini, J. L., Bridges, C. I., et al (1976) The effect of lithium on unipolar aggressive behaviour in man. American Journal of Psychiatry, 133, 14091413.Google Scholar
Shekim, W. O., Masterson, A., Cantwell, O. P., et al (1989) Nomifensine maleate in adult attention deficit disorder. Journal of Nervous and Mental Disease, 177, 296299.Google Scholar
Soloff, P. H. (1981) Pharmacotherapy of borderline disorders. Comprehensive Psychiatry, 22, 535543.Google Scholar
Soloff, P. H. (1987) Round table discussion. Treatment of outpatients with borderline personality disorder. Journal of Clinical Psychiatry, 48 (suppl. 8), 3637.Google Scholar
Soloff, P. H., George, A., Nathan, R. S., et al (1986a) Progress in pharmacotherapy of borderline disorders: a double-blind study of amitriptyline, haloperidol and placebo. Archives of General Psychiatry, 43, 691697.Google Scholar
Soloff, P. H., Anselm, G., Nathan, S., et al (1986b) Paradoxical effects of amitriptyline on borderline patients. American Journal of Psychiatry, 143, 16031605.Google Scholar
Steiner, M., Elizur, A. & Davidson, S. (1979) Behavioural toxicity: neuroleptic induced paradoxical behavioural toxicity in young borderline schizophrenics. Confinia Psychiatrica, 2, 226233.Google Scholar
Stern, A. (1938) Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychiatric Quarterly, 7, 467489.Google Scholar
Stone, M. H. (1985) Analytically orientated psychotherapy in schizotypal and borderline patients: at the border of treatability. Yale Journal of Biology and Medicine, 58, 275288.Google Scholar
Stone, M. H. (1990) The Fate of Borderline Patients. New York: Guilford Press.Google Scholar
Sweeney, D. R. (1987) Treatment of outpatients with borderline personality. Journal of Clinical Psychiatry, 48 (suppl. 8), 3235.Google Scholar
Tobin, J. M., Bird, I. F. & Boyle, D. F. (1960) Preliminary evaluation of librium in the treatment of anxiety reactions. Diseases of the Nervous System, 21 (March suppl.), 1119.Google Scholar
Tunks, E. R. & Dermer, S. W. (1977) Carbamazepine in the dyscontrol syndrome associated with limbic dysfunction. Journal of Nervous and Mental Disease, 164, 5663.Google Scholar
Tupin, J. P., Smith, D. B., Clanon, T. L., et al (1973) The long-term use of lithium in aggressive prisoners. Comprehensive Psychiatry, 14, 311317.Google Scholar
Tyrer, P. (1988) The management of personality disorder. In Personality Disorders (ed. Tyrer, P.), pp. 112118. London: Wright.Google Scholar
Tyrer, P., Casey, P. & Ferguson, B. (1988) Personality disorder and mental illness. In Personality Disorders (ed. Tyrer, P.), pp. 93104. London: Wright.Google Scholar
Tyrer, S. P., Walsh, A., Edwards, D. E., et al (1984) Factors associated with a good response to lithium in aggressive mentally handicapped subjects. Progress in Neuropsychopharmacology & Biological Psychiatry, 8, 751755.Google Scholar
Valgum, S. & Valgum, P. (1989) Co-morbidity for borderline and schizotypal personality disorders. A study of alcoholic women. Progress in neuro-psychopharmacology and biological psychiatry. Journal of Nervous and Mental Disease, 177, 279284.Google Scholar
Van Kammen, D. P. & Murphy, D. L. (1979) Prediction of antidepressant response to lithium carbonate by a one day administration of d-amphetamine in unipolar depressed women. Neuropsychobiology, 5, 266273.Google Scholar
Van Kammen, D. P., Docherty, J. P., Marder, S. R., et al (1982) Antipsychotic effects of pimozide in schizophrenia. Treatment response prediction with acute dextro-amphetamine response. Archives of General Psychiatry, 39, 261266.Google Scholar
Waldinger, R. J. & Gunderson, J. G. (1984) Completed psycho-therapies with borderline patients. American Journal of Psychotherapy, 38, 190202.Google Scholar
Weischer, M. L. (1969) Uber die antiagressive wirkung von Lithium. Psychopharmacologia, 15, 245254.Google Scholar
Weiss, G., Hechtman, L., Periman, T., et al (1979) Hyperactives as young adults: a controlled prospective ten-year follow-up of 75 children. Archives of General Psychiatry, 36, 675681.Google Scholar
Wender, P. H., Reimherr, F. W. & Wood, D. R. (1981) Attention deficit disorder (minimal brain dysfunction) in adults. Archives of General Psychiatry, 38, 449456.Google Scholar
Wickham, E. A. & Reed, J. V. (1987) Lithium in the control of aggression and self-mutilating behaviour. International Clinical Psychopharmacology, 2, 181190.Google Scholar
Winkleman, N. W. (1955) Chlorpromazine in the treatment of neuropsychiatric disorders. Journal of The American Medical Association, 155, 1821.Google Scholar
Winkleman, N. W. (1975) The use of neuroleptic drugs in the treatment of non-psychotic patients. In Rational Psychopharmacotherapy and the Right to Treatment (ed. Ayd, F.), p. 161. Baltimore: Ayd Medical Communications.Google Scholar
Wood, R. D., Reimherr, F. W., Wender, P. H., et al (1976) Diagnosis and treatment of minimal brain dysfunction in adults. Archives of General Psychiatry, 33, 14531460.Google Scholar
Worrall, E. P., Moody, J. P. & Naylor, G. J. (1975) Lithium in non-manic-depressives: anti-aggressive effect and red blood cell lithium values. British Journal of Psychiatry, 126, 464468.Google Scholar
Zilber, N., Schufman, N. & Lerner, Y. (1989) Mortality among psychiatric patients, the groups at risk. Acta Psychiatrica Scandinavica, 79, 248256.Google Scholar
Zimmerman, M., Coryell, W., Pfohl, B., et al (1986) ECT response in depressed patients with and without a DSM–III personality disorder. American Journal of Psychiatry, 143, 10301032.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.