Personality disorders (PD) and interpersonal violence (IV) during COVID-19 pandemic: a systematic review

Abstract

Not only did the ongoing CoronaVIrus Disease-19 (COVID-19) pandemic cause a massive number of casualties, but also there is growing concern that the burden of its psychological aftermaths will only show up years down the road. This systematic review summarises the existing literature reporting the impact of COVID-19 on personality disorders (PDs)-related violence. MEDLINE and APA PsycINFO were independently searched for relevant studies by two authors. Eligible studies had to be identifiable through database searching, published and fully accessible. This systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. An initial pool of 241 studies were found, out of which 69 met the selection criteria and were, therefore, included. The majority reported a worse Mental Health Outcome (MHO) during the pandemic as related to dysfunctional personality and positive personality traits predicting a better outcome. Furthermore, increased levels of interpersonal violence (IV) and self-directed violence were reported. Further research should be conducted on the reciprocal interaction of PDs and IV during the time of pandemic. Nevertheless, the dramatic impact of restrictive measures on PDs has still to be appropriately addressed.

Hospital Admissions for Personality Disorders Increased During the COVID-19 Pandemic

“…Based on the characteristics of these disorders, Preti et al 4 hypothesized that the pandemic would be poorly tolerated in people with personality disorders, but a subsequent systematic review found only a few small clinical studies and low-quality surveys. 5 The analysis presented here suggests that people with personality disorders in Alberta manifested increased rates of hospitalization during early phases of the pandemic. Indeed, the increase was more pronounced than the widely reported increase in admissions for eating disorders.…”

The impact of COVID-19 pandemic on patients with personality disorders

“…4,5 Most studies on the impact of the pandemic on patients with personality pathology have focused on borderline personality disorder (BPD). 6 Social distancing measures during the pandemic and an increased sense of loneliness are serious aggravating factors for patients with BPD and may cause anxieties of abandonment and rejection, social withdrawal, and feelings of emptiness. Consequently, the patient's susceptibility to risky behaviors and substance use increases.…”

“…7 Several papers have studied the number of patients with PD or self-harm visits to hospital emergency departments during the pandemic. 6,9 In the studies that examined self-injury, the psychiatric diagnosis was not recorded, but they are mentioned here because the presence of self-harm is closely associated with PD. 10 The number of emergency department visits of patients with PD or self-harm was found to be increased in some papers, decreased in others, and stable in others, compared to the previous year.…”

“…10 The number of emergency department visits of patients with PD or self-harm was found to be increased in some papers, decreased in others, and stable in others, compared to the previous year. 6,9 During the same period, however, both the distress of patients with PD and rates of self-harm thoughts in the general population increased. 3,[6][7][8] The decreased number of emergency department visits could be the result of reduced access to services or amelioration of symptomatology due to decreased social contact or sufficient remote therapy through telepsychiatry.…”

“…6,9 During the same period, however, both the distress of patients with PD and rates of self-harm thoughts in the general population increased. 3,[6][7][8] The decreased number of emergency department visits could be the result of reduced access to services or amelioration of symptomatology due to decreased social contact or sufficient remote therapy through telepsychiatry. A critical issue that mental health services providing therapy to patients with PD had to encounter was the need to discontinue in-person psychotherapy and continue by telephone or online.…”