Treatment for most personality disorders usually involves a course of psychological therapy. This normally lasts at least six months, often longer, depending on the severity of the condition and other co-existing problems.
Psychotherapy is a treatment that involves discussion of thoughts, emotions and behaviours with a trained professional. The aim of all psychological therapies is to improve people's ability to regulate their thoughts and emotions.
Some therapies focus on dysfunctional thoughts, while others focus on self-reflection and being aware of how your own mind works. Some therapies, especially group therapies, help people understand social relationships better.
Psychological therapies can be effective for many personality disorders. However, they should only be delivered by a trained professional who has experience of working with personality disorders and other clinical conditions. This is because personality disorders are serious conditions that can be associated with high-risk behaviours, such as self-harm.
As well as listening and discussing important issues with you, the psychotherapist can suggest strategies to resolve problems and, if necessary, can help you change your attitudes and behaviour.
A range of different psychotherapies are used to treat personality disorders. They can be broadly classified into three types of therapy, outlined below.
Psychodynamic (reflective) psychotherapy
Psychodynamic psychotherapy is based on the idea that many adult patterns of behaviour are related to negative early childhood experiences. These experiences cause patterns of distorted thinking and beliefs that may have been understandable in childhood, but do not work in adult life. The goal of therapy is to explore these distortions, understand how they arose, and find effective ways to overcome their influence on your thinking and behaviour.
Both individual and group psychodynamic therapy may be helpful for personality disorders, especially borderline personality disorder (BPD). A particular form, called mentalisation-based therapy, is recommended for BPD.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is based on the theory that how we think about a situation affects how we act. In turn, our actions can affect how we think and feel. Therefore, it is necessary to change both the act of thinking (cognition) and behaviour at the same time.
A type of CBT called dialectical behaviour therapy (DBT) has proved successful in helping people reduce impulsive self-harming behaviours, especially in BPD. DBT is designed to help you cope better with emotional instability, while at the same time encouraging you to behave in a more positive way.
Interpersonal therapy (IPT) is based on the theory that our relationships with other people and the outside world in general have a powerful effect on our mental health.
Several personality disorders may be associated with feelings of low self-esteem, anxiety and self-doubt, caused by problems interacting with people.
During IPT, the therapist will explore any negative issues associated with your interpersonal relationships and how these issues can be resolved.
Therapeutic communities (TCs) are a form of group therapy, in which the experience of having a personality disorder is explored in depth. TCs are an intensive form of therapy.
The minimum type of TC is one day a week, but others are 9am-5pm, five days a week. They have been shown to be effective for mild to moderate personality disorders, but require a high level of commitment.
No medication is currently licensed for the treatment of any personality disorder. However, medications may be prescribed to treat associated problems, such as depression, anxiety or psychotic symptoms.
For example, if you have moderate to severe symptoms of depression that make it difficult to approach your therapy with confidence or enthusiasm, you may be prescribed a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
Some people, especially those with BPD, have found mood-stabilising medication helpful.