Treatment of Personality Disorders

Types of Treatment for Personality Disorders

Hospitalization

Inpatient treatment is rarely required for patients with personality disorders, with two major exceptions: borderline patients who are threatening suicide or suffering from drug or alcohol withdrawal; and patients with paranoid personality disorder who are having psychotic symptoms.

Psychotherapy for Treating Personality Disorders

Psychoanalytic psychotherapy is suggested for patients who can benefit from insight-oriented treatment. These patients typically include those with dependent, obsessive-compulsive, and avoidant personality disorders. Doctors usually recommend individual psychotherapy for narcissistic and borderline patients, but often refer these patients to therapists with specialized training in these disorders. Psychotherapeutic treatment for personality disorders may take as long as three to five years.

Insight-oriented approaches are not recommended for patients with paranoid or antisocial personality disorders. These patients are likely to resent the therapist and see him or her as trying to control or dominate them.

Supportive therapy is regarded as the most helpful form of psychotherapy for patients with schizoid personality disorder.

Cognitive-behavioral therapy

Cognitive-behavioral approaches are often recommended for patients with avoidant or dependent personality disorders. Patients in these groups typically have mistaken beliefs about their competence or likableness. These assumptions can be successfully challenged by cognitive-behavioral methods. More recently, Aaron Beck and his coworkers have successfully extended their approach to cognitive therapy to all ten personality disorders as defined by DSM-IV.

Group therapy

Group therapy is frequently useful for patients with schizoid or avoidant personality disorders because it helps them to break out of their social isolation. It has also been recommended for patients with histrionic and antisocial personality disorders. These patients tend to act out, and pressure from peers in group treatment can motivate them to change. Because patients with antisocial personality disorder can destabilize groups that include people with other disorders, it is usually best if these people meet exclusively with others who have APD (in homogeneous groups).

Family therapy

Family therapy may be suggested for patients whose personality disorders cause serious problems for members of their families. It is also sometimes recommended for borderline patients from overinvolved or possessive families.

Medications for Treating Personality Disorders

Medications may be prescribed for patients with specific personality disorders. The type of medication depends on the disorder. In general, however, patients with personality disorders are helped only moderately by medications.

Antipsychotic Drugs

Antipsychotic drugs, such as haloperidol (Haldol), may be given to patients with paranoid personality disorder if they are having brief psychotic episodes. Patients with borderline or schizotypal personality disorder are sometimes given antipsychotic drugs in low doses; however, the efficacy of these drugs in treating personality disorder is less clear than in schizophrenia.

Mood Stabilizers

Carbamazepine (Tegretol) is a drug that is commonly used to treat seizures, but is also helpful for borderline patients with rage outbursts and similar behavioral problems. Lithium and valproate (Depakene) may also be used as mood stabilizers, especially among people with borderline personality disorder.

Antidepressants and Anti-Anxiety Medications

Medications in these categories are sometimes prescribed for patients with schizoid personality disorder to help them manage anxiety symptoms while they are in psychotherapy. Antidepressants are also commonly used to treat people with borderline personality disorder.

Treatment with medications is not recommended for patients with avoidant, histrionic, dependent, or narcissistic personality disorders. The use of potentially addictive medications should be avoided in people with borderline or antisocial personality disorders. However, some avoidant patients who also have social phobia may benefit from monoamine oxidase inhibitors (MAO inhibitors), a particular class of antidepressant.

What is the prognosis for someone with a personality disorder?

The prognosis for recovery depends in part on the specific disorder. Although some patients improve as they grow older and have positive experiences in life, personality disorders are generally life-long disturbances with periods of worsening (exacerbations) and periods of improvement (remissions). Others, particularly schizoid patients, have better prognoses if they are given appropriate treatment. Prominent researcher and therapist, Dr. Aaron Beck and his coworkers estimate that effective cognitive therapy with patients with personality disorders takes two to three years on average. Patients with paranoid personality disorder are at some risk for developing delusional disorders or schizophrenia.

The personality disorders with the poorest prognoses are the antisocial and the borderline. Borderline patients are at high risk for developing substance abuse disorders or bulimia. About 80% of hospitalized borderline patients attempt suicide at some point during treatment, and about 5% succeed in committing suicide. Borderline patients are also the most likely to sue their mental health professional for malpractice.

Can personality disorders be prevented?

The most effective preventive strategy for personality disorders is early identification and treatment of children at risk. High-risk groups include abused children, children from troubled families, children with close relatives diagnosed with personality disorders, children of substance abusers, and children who grow up in cults or extremist political groups.

Go here for information on specific personality disorders.

more: Treatment of Personality Disorders in Elderly Patients

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Sources:

• American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
• Merck Manual Home Edition For Patients and Caregivers, Personality Disorders, 2006.
• Dingfelder, Sadie, Treatment for the 'untreatable', APA Monitor, Volume 35, No. 3 March 2004, p. 46.