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Treatment of Personality Disorders

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Most personality disorders are considered treatable. Learn about the treatments for personality disorders; including medications and therapy.

While people with personality disorders can possess very different personality disturbances, they have at least one thing in common: chances are their mental illness will not remit without professional intervention. However, exactly what that intervention should consist of remains a subject for debate. This, along with the disorders' notoriety for being problematic to treat, has posed challenges to their successful resolution, or at least management.

"People with personality disorders exhibit chronic, pervasive problems getting along with people in all kinds of different contexts," says Thomas R. Lynch, PhD, assistant professor of psychology at Duke University and the Duke University Medical Center. "And this includes therapists."

As a result, people with the disorders often don't seek treatment, and those who do often drop out, he says. For example, people with borderline personality disorder (BPD)--the most commonly treated personality disorder--quit treatment programs about 70 percent of the time.

At one time, psychiatrists thought that personality disorders did not respond very well to treatment. This opinion was derived from the notion that human personality is fixed for life once it has been molded in childhood, and from the belief among people with personality disorders that their own views and behaviors are correct, and that others are the ones at fault. More recently, however, doctors have recognized that humans can continue to grow and change throughout life. So, although most personality disorder patients don't seek treatment, most patients with personality disorders are now considered to be treatable, although the degree of improvement may vary. The type of treatment recommended depends on the personality characteristics associated with the specific disorder.

How are personality disorders treated?

Most personality disorders are considered treatable. Learn about the treatments for personality disorders; including medications and therapy.The first goal of treatment is the relief of anxiety, depression, and other distressing symptoms (if present). Drug therapy can help.Drugs such as selective serotonin reuptake inhibitors (SSRIs) can help both depression and impulsivity. Anticonvulsant drugs can help reduce impulsive, angry outbursts. Other drugs such as risperidone (Risperidal) have been helpful with both depression and feelings of depersonalization in people with borderline personality. Reducing environmental stress can also quickly relieve symptoms.

However, drug therapy does not generally affect the personality traits themselves. Because these traits take many years to develop, treatment of the maladaptive traits may take many years as well. No short-term treatment can cure a personality disorder, although some changes may be accomplished faster than others. Behavioral changes can occur within a year; interpersonal changes take longer. For example, for people with a dependent personality, a behavioral change might be to stop stating that they cannot make decisions; the interpersonal change might be to interact with coworkers or family members in such a way that they actually seek out or at least accept some decision-making responsibilities.

Although treatments differ according to the type of personality disorder, some general principles apply to all treatments. Because people with a personality disorder usually do not see a problem with their own behavior, they must be confronted with the harmful consequences of their maladaptive thoughts and behaviors. Thus, a therapist needs to repeatedly point out the undesirable consequences of their thought and behavior patterns. Sometimes the therapist finds it necessary to set limits on behavior (for example, people might be told that they cannot raise their voice in anger). The involvement of family members is helpful and often essential because they can act in ways that either reinforce or diminish the problematic behavior or thoughts. Group and family therapy, group living in designated residential settings, and participation in therapeutic social clubs or self-help groups can all be valuable in helping to change socially undesirable behaviors.

Because personality disorders are particularly difficult to treat, choosing a therapist with experience, enthusiasm, and an understanding of the person's areas of emotional sensitivity and usual ways of coping is important. Kindness and direction alone do not change personality disorders. Psychotherapy is the cornerstone of most treatments and usually must continue for more than a year to change a person's maladaptive behavior or interpersonal patterns.

In the context of an intimate, cooperative doctor-patient relationship, people can begin to understand the sources of their distress and recognize their maladaptive behavior. Psychotherapy can help them more clearly recognize the attitudes and behaviors that lead to interpersonal problems, such as dependency, distrust, arrogance, and manipulativeness.

For maladaptive behaviors, such as recklessness, social isolation, lack of assertiveness, or temper outbursts, group therapy and behavior modification, sometimes within a day hospital or residential setting, are effective. These behaviors can be changed in months. Participation in self-help groups or family therapy can also help change maladaptive behaviors. Dialectical behavioral therapy is effective for borderline personality disorder. This therapy involves weekly individual psychotherapy and group therapy as well as telephone contact with therapists between scheduled sessions. It aims to help people understand their behaviors and teach them problem solving and adaptive behaviors. Psychodynamic therapy is also effective for people with borderline or avoidant personality disorder. These therapies help people with a personality disorder think about the effects their behaviors have on others. For some people with personality disorders, primarily those that involve maladaptive attitudes, expectations, and beliefs (such as narcissistic or obsessive-compulsive personality), psychoanalysis is recommended and is usually continued for at least 3 years.