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.

The focus of the therapy is on the relationship between the therapist and the client. As problems arise in the relationship, they can be dealt with in the hope that new strategies can be used in other relationships. This is generally a long term treatment.

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.

It works on the basis that how you think affects how you feel and what you do. It works to try and change unhelpful thoughts and behaviours and break vicious cycles.

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

It focuses on enhancing someone’s skills in regulating their emotions and behaviour. It aims to look at and change behaviour patterns by finding a balance. It can help someone to gain control over behaviour such as self-harm.

Therapeutic community treatments
Therapeutic communities provide intensive psychosocial treatment which may include a variety of therapies. However, it is the therapeutic environment itself that 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. They may cause a reduction in hostility and impulsivity. 'Schizotypal' features are helped the most and atypical (new generation) antipsychotics may offer advantages.

Antidepressant drugs
Both tricyclic and SSRI antidepressants have been recommended in the treatment of borderline personality disorder. 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 general information about medication for mental illness, see the Medication section