Treatments for personality disorder

Dynamic psychotherapy / Psychoanalytic psychotherapy
Dynamic psychotherapy recognises that problems in the present may have their roots in past experience and that current behaviour may be motivated by feelings derived from that experience.

Dynamic therapists assume that such problems will come out in the relationship with the therapist as well as in other relationships and that the therapeutic relationship is the central focus of therapy. The therapy uses the relationship between patient and therapist as a way to understand how the internal world of the individual affects relationships.

Cognitive Analytical Therapy (CAT)
CAT involves a therapist and a client working together by looking at what has created obstacles in the past in order to understand better how to move forward in the present.

Questions like 'why do I always end up like this?' become more answerable.

CAT is designed to allow clients to gain an understanding of how the difficulties they experience may be made worse by coping mechanisms that have become like habits. The focus is on recognising how coping strategies started and how they can be adapted and improved, and plans are developed to bring about change. The work is active and shared between the client and the therapist.

Cognitive Behavioural Therapy (CBT)
CBT combines two very effective kinds of psychotherapy - cognitive therapy and behaviour therapy.

Behaviour therapy break links between difficult situations and habitual reactions to them, such as fear, depression or rage and self-defeating or self-harm behaviour. It also teaches you how to calm your mind and body so you feel better, think more clearly and make better decisions.

Cognitive therapy teaches you how certain thinking patterns are causing your symptoms - by giving you a distorted picture of what's going on in your life and making you feel anxious, depressed or angry for no good reason or provoking you into ill chosen actions.

Dialectic Behavioural Therapy (DBT)
This is a special adaptation of CBT designed specifically for people with borderline personality disorder and DSPD.

DBT maintains that some people, due to aspects of their lives during upbringing and due to unknown biological factors,have abnormal emotional reactions to things. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to normal.

DBT is a method for teaching skills that will help in coping with sudden, intense surges of emotion. In crisis, individual therapists may be available over the phone. DBT is directed at reducing harm.

Therapeutic community treatments
Therapeutic communities provide intensive psychosocial treatment which may include a variety of therapies, where the therapeutic environment itself is seen as the main factor for making change.

They include democratic and concept types, the former including members of the community as decision makers and running the unit.

For more general information about psychological therapies, see the Talking treatments section

Antipsychotic drugs
These have been shown to have variable results as they may cause a reduction in hostility and impulsivity. 'Schizotypal features are helped the most and atypical (new generation) neuroleptics may offer advantages.

Antidepressant drugs
Both tricyclic and SSRI’s have been recommended in the treatment of borderline personality disorders. Improvement in borderline patients may be linked to helping relieve depressive symptoms rather than personality based improvements. Impulsiveness is particularly improved and SSRI’s may offer advantages in this respect.

Mood stabilisers
Lithium, carbamazepine and sodium valproate have all been used to treat symptoms of mood disorder in those with personality disorder. There is weak support for the possibility that cluster B (antisocial, borderline, histrionic, and impulsive) personality disorders may be helped by mood stabilisers.

For more information about medication for mental illness, see the Medication section