Personality Disorders - Treatments
How are personality disorders treated?
There is no general approach to treating personality disorders.
If your GP feels you have a complex personality disorder, they may refer you to a:
- community mental health team, or
- specialist personality disorder service or unit, if there is one locally.
These services are made up of professionals such as psychologists, psychiatrists and therapists who will have experience in helping people with personality disorders. Sometimes you can contact these services yourself to get help.
You and your doctor or healthcare team should agree on a treatment plan that works best for you. One-to-one and group psychological treatments or ‘talking therapies’ are often recommended. They all involve talking with a therapist, but are different from one another. The options for treating personality disorders are continuously developing.
Care Programme Approach
Having a personality disorder may put you at risk, mean you have a lot of needs, and need a high level of care. You can be supported through the Care Program Approach (CPA). The CPA is used to plan and outline the support you need to manage complex needs and your mental health if you are on the CPA you will have a care coordinator. They will work with you to write a care plan, which will set out how the NHS will support you.
You can find more information about the ‘Care Programme Approach’ here.
The following treatments can help if you have a personality disorder:
Cognitive behavioural therapy (CBT)
CBT can help you to change how you think (‘cognitive’) and what you do (‘behaviour’), which are both linked to how you feel. CBT looks at problems and difficulties in the ‘here and now’ more than your past or childhood. CBT can help you understand how you think about yourself, the world and other people and how that affects how you deal with things in your life.
Dialectical behaviour therapy (DBT)
Dialectical behaviour therapy (DBT) can help you learn to spot and control your emotions and behaviour. It is adapted from CBT.
It helps you recognise then change unhelpful behaviour by learning new skills. Unhelpful behaviour might include thinking about suicide, self-harming, drinking alcohol or using drugs to cope with your emotions.
The National Institute for Health and Care Excellence (NICE) says DBT can be helpful if you have borderline personality disorder. Normally, you get one-to-one and group therapy appointments, education groups and telephone support. A course of BDT usually takes between 12 and 18 months to complete.
Cognitive analytical therapy (CAT)
Cognitive analytical therapy (CAT) helps you recognise relationship patterns that can cause you problems and are difficult to change. You may have learnt these patterns while growing up to cope with difficult emotions. You and the therapist will work together to recognise these patterns and then to try and change them. This type of therapy usually lasts 16-20 sessions. You and your therapist will agree the end goal at the start of the therapy.
Mentalisation based therapy (MBT)
Mentalising is about making sense of what other people think, need, or want. It is about being aware of what’s going on in your own mind and in the minds of others. Mentalising refers to the fact that sometimes when you feel distressed, it can be harder to ‘mentalise.’
You would attend group and one-to-one therapy. This may help you better understand yourself and others, and learn how to mentalise.
This type of therapy gives you time to talk about how you feel about yourself and other people. This might include:
- what has happened in the past,
- what's happening in your life now, and
- how the past can affect how you are feeling, thinking and behaving now.
You would usually have weekly or fortnightly sessions on a one-to-one basis. This type of therapy can be ongoing.
A therapeutic community is a place you would get long-term group therapy. You would visit, or sometimes stay, for a number of weeks or months. Sometimes you may visit for just a few days a week (called a ‘day programme’). You learn from –spending time with other people in the treatment group. It offers a safe place if there are any disagreements or upsets. People in a therapeutic community often have a lot of say over how the community runs.
There are only a few therapeutic communities in the UK. You could check with your local Patient Advice Liaison Service (PALS) if your NHS trust has one. You can search for your PALS office here.
There is no recommended medication for the treatment of personality disorders. But your doctor may give you medication to help with symptoms such as anxiety, anger, or low mood. These might include antidepressants, mood stabilisers, or antipsychotics.
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It is always worth asking why a certain treatment is being offered and if there are other things that could help you to get better. If you are given any medication, your doctor should tell you how it should help and about any side effects you might get.
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