Home Medizin Flexibilität für Patienten mit Persönlichkeitsstörungen empfohlen

Flexibilität für Patienten mit Persönlichkeitsstörungen empfohlen

von NFI Redaktion

SAN DIEGO – Mio Nakamura, MD, MS, Clinical Assistant Professor of Dermatology at the University of Michigan, Ann Arbor, emphasized the need for flexibility and adaptability in providing dermatological care to patients with personality disorders.

„Recognizing the personality disorder, understanding underlying conflicts and needs, and adjusting accordingly is important,“ Nakamura said at the Annual Meeting of the American Academy of Dermatology.

Personality disorders, defined as enduring patterns of maladaptive thinking and behavior deviating from cultural norms, affect up to 15% of the population and can be challenging, if not impossible, to treat, leading to frustration. Nakamura shared her approach to dermatological care for individuals with three specific disorders:

Borderline Personality Disorder (BPD). This condition is characterized by instability in interpersonal relationships, self-image, and emotions. Individuals with BPD are typically impulsive and often engage in self-harming behaviors such as risky sexual activities, cutting, or suicide attempts. „They often express feelings of emptiness, fear of abandonment, and are emotionally labile and sensitive to environmental cues,“ Nakamura explained. „They can be needy and exhibit inappropriate, intense anger.“

According to her clinical experience, a patient’s dermatological complaint is often a „shield“ to hide a real, internal psychological issue, a „need to fill the void,“ she stated. „They are somehow lonely and afraid of abandonment. Rejection is often perceived as abandonment, leading to intense anger and other negative emotions like splitting.“

She advised against conducting tests, treatments, or procedures for individuals with BPD that are not clinically indicated. „If the test results come back negative, such patients may demand further tests,“ she said. „Especially in cosmetic procedures, the patient may end up more dissatisfied with the outcome than before. Do not let the patient’s emotions cloud your judgment. Attempting to argue with the patient is often ineffective.“

To avoid saying „no“ to such patients, Nakamura recommended discussing alternative treatment options to ensure they do not feel abandoned. „Show that you care,“ she said. „Address the patient’s emotional needs, which may be the actual agenda, and schedule regular follow-ups.“

Obsessive-Compulsive Personality Disorder (OCPD). This condition is characterized by a preoccupation with order, perfectionism, and control. „OCPD individuals are so focused on details, rules, and organization that the core of the activity is often lost,“ Nakamura explained. „They can be overly conscientious and place excessive value on morals and ethics.“

Such patients often fear losing control, which can lead to anxiety, depression, and sometimes anger, she continued. When visiting patients with OCD, she recommends dermatologists „focus on facts and knowledge to replace or suppress emotions. Knowledge and information provide a sense of control over the illness.“ Her approach involves professional, structured encounters with detailed explanations and plans. „Provide step-by-step written instructions and provide specific reasons for the prescribed treatment,“ Nakamura suggested. „Schedule regular follow-up appointments.“

Narcissistic Personality Disorder (NPD). This condition is characterized by an inflated sense of self-worth, where the individual believes they are special, unique, and superior to others. These individuals exhibit entitlement, dream of unlimited success or power, lack empathy towards others, and have a constant need for admiration. „The patient’s personality traits are often a ’shield‘ to hide a real, internal psychological problem such as unrecognized low self-esteem or insecurity,“ Nakamura stated. „These patients need praise and a sense of power.“

To convey a „sense of uniqueness“ to patients with NPD, she recommended engaging with them on a medical level, as one would with a colleague. „Such patients often respond better to respect and care than warmth and affection,“ she said. Asking them to make decisions about their care can also give them a sense of power: for example, asking which type of topical steroid they prefer among the options, whether they prefer creams or ointments, and whether they can choose between a follow-up in 4 weeks or 6 weeks.

„Do not let the patient dictate the encounter or ‚get under your skin,'“ Nakamura stressed. „Be cautious in turning the patient away from your practice. Even though it is entirely within your rights, it could result in a ’narcissistic injury,‘ where the patient becomes very angry and seeks revenge.“

Nakamura disclosed that she is an investigator for Amgen, Argentx, Boehringer Ingelheim, Bristo-Meyers Squibb, Pfizer and Regeneron. She is also a member of the advisory boards of argenx, Boehringer Ingelheim, and Bristol-Myers Squibb.

Related Posts

Adblock Detected

Please support us by disabling your AdBlocker extension from your browsers for our website.