Abstract
Personality disorders are characterized by ‘ego-syntonic’ maladaptive behaviors that
impair functioning. This contribution outlines the relevant characteristics and approach
to patients with personality disorders pertaining to the dermatology setting. For
patients with Cluster A personality disorders (paranoid, schizoid, and schizotypal),
it is crucial to avoid being overly contradictory of eccentric beliefs and to take
a straightforward, unemotional approach. Cluster B includes antisocial, borderline,
histrionic, and narcissistic personality disorders. Promoting safety and boundaries
is paramount when interacting with patients with an antisocial personality disorder.
Patients with borderline personality disorder have higher rates of various psychodermatologic
conditions and benefit from an empathetic approach and frequent follow-up. Patients
with borderline, histrionic, and narcissistic personality disorders all have higher
rates of body dysmorphia, and the cosmetic dermatologist needs to avoid unnecessary
cosmetic procedures. Patients with Cluster C personality disorders (avoidant, dependent,
and obsessive-compulsive) often have significant anxiety associated with their illness
and may benefit from extensive and clear explanations of their condition and management
plan. Due to the challenges posed by these patients’ personality disorders, they are
often undertreated or receive poorer quality care. While it is essential to acknowledge
and address challenging behaviors, their dermatologic concerns should not be dismissed.
Keywords
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