If someone has the majority of symptoms from not just one personality disorder but 4, (Antisocial, Borderline, Histrionic, and Narcissistic), what would the diagnosis be? Also, how do you deal with such a person without loosing your mind yourself?
- Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
- Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
- Questions submitted to this column are not guaranteed to receive responses.
- No correspondence takes place.
- No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Dombeck to people submitting questions.
- Dr. Dombeck, Mental Help Net and CenterSite, LLC make no warranties, express or implied, about the information presented in this column. Dr. Dombeck and Mental Help Net disclaim any and all merchantability or warranty of fitness for a particular purpose or liability in connection with the use or misuse of this service.
- Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
To answer your first question, it is appropriate to diagnose each personality disorder type separately if sufficient criteria are met for each of them to support the diagnosis. For instance, if full criteria were met for each personality disorder you’ve listed, you would just diagnose the personality disorders you’ve listed. I’ve also seen some clinicians make a diagnosis of Mixed Personality Disorder with X, Y and Z traits although this is not strictly by the (DSM-IV) book. If some criteria are met in each area, but not enough in any one of them to make a formal and supportable diagnosis in that area, the appropriate diagnosis is Personality Disorder NOS (not otherwise specified) with X, Y, and Z (or whatever) traits).
The answer to your second question is “with great care “. (grin!)