The Development and Treatment of Personality Disorders - Treatment and Development of Personality Disorders

Written by HealthyPlace.com Staff Writer

David: ladyw5horses, we have an excellent site on Borderline Personality Disorder in the HealthyPlace.com Personality Disorders Community. It's called "Life at the Border."

If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There's over 9000 pages of content.

Here's the link to the HealthyPlace.com Personality Disorders Community. You can click on this link and sign up for the mail list at the top of the page, so you can keep up with events like this.

Here's the next question:

SuzyR: Is it at all possible for a person with a personality disorder to 'just decide' to get better?

Dr. Mihura: I'm not completely sure of your question. If you are asking if one can 'just decide' to get better and everything will markedly change, that is not likely. But 'just deciding to get better,' could be rephrased by saying that one could decide 'to change.' And then one can make progress towards that change by identifying the problems and the methods and ways to address them.

terriej: How much success have you had with treatment of PPD (Paranoid Personality Disorder)? If they are suspicious of everything and will not accept blame or dismiss the idea of having the slightest problem, it seems that the efforts would be in vain

Dr. Mihura: You are very right in the sense that PPD is a very difficult problem to treat. Part of the initial problem is that the person is not likely to be present for therapy on their own accord, because they have such a lack of trust and expect malevolent intent and actions from others. And therapists are 'others.' I have treated PPD in an inpatient setting, but not in an outpatient basis. You are right, it is very difficult. In treating PPD, it takes a long time to build trust and address the anger.

mj679: Do you find that behavioral methods or medications are more successful in treating personality disorders, or is some combination of both best?

Dr. Mihura: Those methods have been effective with certain disorders and symptoms of the disorder. For example, people with Schizotypal Personality Disorder can sometimes be helped with a low-dose anti-psychotic. For people with borderline personality disorder, sometimes different combinations of medications are used to address the problematic symptoms, like labile mood or transient psychotic symptoms. The issue is that the personality disorders are treated by different methods depending on the disorder, and also, that some people within personality disorders may use some therapies better or have different types of predominant symptoms to address.

David: Here's the next audience question:

C.U.: Is it rare for me to see my acting out behaviors as a problem for others but not for myself?

Dr. Mihura: To not see one's acting out behaviors as a problem for themselves is common. I'm not sure whether you mean 'a problem for others' as in 'that is their problem' or you are concerned that it might be a problem for others. That is a complicated question, either way because sometimes people who have acting out problems may see it not as a problem for others at the time, but at other times, they can see that it was a problem for others. Often people with acting out problems may think that it is someone else's problem, not theirs, as they can't see the problems that arise from their behavior, yet someone is telling them that there are problems. So it must be 'their problem.'

seeking peace: Please advise me on where to go for help. My therapist and several clinics have refused to help. I am bipolar with psychosis. I had therapy for years and was recently diagnosed with BPD and have no more services.

Dr. Mihura: It depends on the specifics of why they refuse to help. I am certainly not familiar with that happening. If it is because of financial problems, community mental health centers should be able to help because they will treat those people with severe disorders, and bipolar with psychosis would fit this category.

ladyofthelake: How difficult is it to get a person with a personality disorder to realize they have a disorder and that they may need help?

Dr. Mihura: It often takes a meaningful event in their lives to bring them to therapy. And the 'distress or dysfunction' part of the disorder is key here. Often, it is something negative that happened that is very meaningful in their lives, like a relationship or their job, and either it was a highly significant thing, and/or it has happened over and over again. The events must hold significance to the person, and/or the distress has gotten to where the person feels they have tried everything possible and nothing has helped.

I am speaking, by the way, about someone who is having difficulty acknowledging a problem and seeking treatment. Some people more easily will seek therapy, but for most people, it is still a difficult decision. Sometimes people will seek treatment to relieve distress, and often that will bring them to therapy, but for those who have trouble trusting, that is a challenge.

moonNstars: When you have two disorders that are somewhat similar, for example Bipolar and BPD, which one is treated first, or can they be treated together ?

Dr. Mihura: They can be treated together, but are treated with different methods (although one may also help the other). For bipolar disorder, it is the general consensus, and based on research, that this needs to be treated with bipolar medications, and the person needs to stay on that medication so they will not relapse. The BPD can be helped with medication, but it is recommended the person seek psychotherapy also. Additionally, treating the bipolar disorder will help the BPD symptoms not be as unstable (mood swings, for example).

Any approach that helps the person address their stress/anxiety points, whether internal or external sources, can help reduce the occurrence of the symptoms of a disorder. So, the psychotherapy could also help the person learn how to notice when their mood is shifting and how to modulate it, and when to increase their meds, but the bipolar part does need the medication. So, yes, they can be treated at the same time in one's life.