Are Personality Disorders Treatable?
A personality disorder is a deeply ingrained, maladaptive pattern of behavior that typically begins in adolescence and continues throughout adulthood creating emotional pain and interpersonal difficulties. Personality disorders are believed to be caused by a combination of genetics and childhood experiences, specifically abusive and neglectful treatment from parents.
Since personality disorders are so deeply ingrained from genetics and childhood, they have long been believed to be difficult to treat by both the public and mental health professionals. Some are generally viewed as more treatable than others. Also, different types of treatment work best for different disorders.
Of the ten personality disorders described in the DSM-5, the four in Cluster B: Antisocial, Borderline, Narcissistic and Histrionic, have been the ones considered to be the most difficult to treat.
In recent years a significant number of studies have emerged which contribute to the understanding of Borderline and Narcissistic, in particular. They have been found to be far more responsive to treatment than was previously believed.
For example, a 2014 study by Jorgensen, et al. showed that 75% of borderline patients showed great improvements in their borderline symptoms 18 months after treatment ended.
The chart below outlines the types of treatment that are most commonly used for each personality disorder.
Borderline: Dialectic Behavior Therapy (DBT); Mentalization-Based Treatment
Antisocial: Schema Therapy
Narcissistic: Psychodynamic; Schema Therapy
Schizotypal, Schizoid, Paranoid: Medication; Social Skills Training
Avoidant, Obsessive-Compulsive, Dependent: Behavioral; Social Skills Training; Psychodynamic; Medication
Dialectic Behavior Therapy (DBT): DBT is a cognitive-behavioral treatment that is geared toward increasing the patient’s ability to moderate between what his intense emotions and his actions. It is typically done by weekly individual sessions, accompanied or followed by group sessions. Its focus is a combination of mindfulness, interpersonal skills, distress tolerance, and emotion regulation. DBT is the most scientifically-supported treatment method for people with Borderline PD. Since it is targeted directly at symptoms and can be done in a group, it is also one of the most cost-effective treatment modes. It can also be shorter than many other types of therapies.
Mentalization-Based Treatment: This is a form of psychodynamic treatment whose goal is to teach the patient how to “mentalize,” or picture/imagine what others are feeling in response to her behavior, and in general. It is less directive than DBT, and relies heavily on the relationship between the therapist and the patient. Because it’s relationship-based and individual, it can be somewhat longer in nature, and therefore more expensive than DBT.
Schema Therapy: Schema Therapy involves a combination of techniques from four other types of established, time-tested treatments. The goal of the treatment is to challenge the maladaptive “schemas,” or beliefs/feelings, that the patient learned in childhood. Part of this involves the therapist essentially re-parenting the patient. Schema Therapy can take longer, but takes place at a deeper level for the patient. Research suggests that may be more costly, but is nevertheless cost-effective, because it is so highly effective.
Psychodynamic Therapy: This time-tested treatment is typically conducted individually. Its focus is upon helping the patient uncover how her childhood is affecting her current life. The relationship with the therapist is used to help the patient understand how her emotions, feelings and actions affect others. Psychodynamic therapy tends to be longer, so is generally more expensive.
Behavioral Therapy: This is a highly targeted treatment. It is typically applied to one symptom, which is the focus of the treatment. It is most effective when applied to a particular behavior which a patient is trying to stop, especially when the behavior is a result of anxiety. Hence it can be most helpful with anxiety-based personality disorders. Since it is targeted and specific, it is one of the shortest and most cost-effective treatments. However, it treats symptoms, and does not necessarily affect the underlying personality structure.
Social Skills Training: Some personality disorders, especially those that involve psychosis, interfere with the sufferer’s ability to understand and read other people’s behaviors and feelings, and respond appropriately. Schizoid, Schizotypal and Paranoid PDs often benefit from direct education in this area. Social Skills Training is often done in groups. Since it is a targeted, educational, group treatment it is highly cost-effective and can sometimes be fairly brief.
Medication: Medication is somewhat controversial in the treatment of personality disorders. This is because it does not cure the disorder itself. However, it can be vital in reducing symptoms such as anxiety, depression or psychosis so that treatment can be more effective. When done properly, medication can be a helpful aid for PD treatments of all kinds.
PDAN believes that no one treatment is right for everyone. But one factor which must be present for anyone with a personality disorder to benefit from treatment is this: a true and sincere motivation to change.
Special thanks to Jonice Webb, PhD for contributing to this site.