PERSONALITY DISORDER

Personality disorder can be define as a mental disorder in which the individuals tend to develop rigid
and irrational pattern of thinking, behaviour and personal functionality.

CLINICAL FEATURES OF PERSONALITY DISORDER

The general features that characterize most personality disorders are chronic interpersonal difficulties,
problems with one’s identity or sense of self, and an inability to function adequately in society
For a personality disorder to be diagnosed, the person’s enduring pattern of behaviour must be
pervasive and inflexible, as well as stable and of long duration.
It must also cause either clinically significant distress or impairment in functioning and be manifested
in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse
control
Stressful events early in life may help set the stage for the development of these inflexible and
distorted personality patterns
The DSM-5 personality disorders are grouped into three clusters
Cluster A: Includes paranoid, schizoid, and schizotypal personality disorders. People with these
disorders often seem odd or eccentric, with unusual behaviour ranging from distrust and
suspiciousness to social detachment
Cluster B: Includes histrionic, narcissistic, antisocial, and borderline personality disorders.
Individuals with these disorders share a tendency to be dramatic, emotional, and erratic
Cluster C: Includes avoidant, dependent, and obsessive compulsive personality disorders. In contrast
to the other two clusters, people with these disorders often show anxiety and fearfulness
Due to the high comorbidity between clusters, some individuals meet criteria for personality disorders
in more than one cluster
Personality disorders are often associated with (or comorbid with) anxiety disorders, mood disorders,
substance use problems and sexual difficulties and disorders.

CHALLANGES IN PERSONALITY DISORDER RESEARCH

We should note that several important aspects of doing research in this area have hindered progress
relative to what is known about many other disorders
DIFFICULTIES IN DIAGNOSING PERSONALITY DISORDER
One problem is that diagnostic criteria for personality disorders are not as sharply defined as they are
for most other diagnostic categories, so they are often not very precise or easy to follow in practice.
Because the criteria for personality disorders are defined by inferred traits or consistent patterns of
behaviour rather than by more objective behavioural standards the clinician must exercise more
judgment in making the diagnosis than is the case for many other disorders.
Diagnoses made on the basis of different structured interviews or self-report inventories is often rather
low, there are still substantial problems with the reliability and validity of these diagnoses
Given problems with the unreliability of diagnoses, the model that has perhaps been most influential
is the five-factor mode help researchers understand the commonalities and distinctions among the
different personality disorders
DIFFICULTIES IN STUDYING THE CAUSE OF PERSONALITY DISORDER
One reason for this is that personality disorders only began to receive consistent attention from
researchers after they entered the DSM in 1980
Another problem stems from the high level of comorbidity among them
This substantial comorbidity adds to the difficulty of untangling which causal factors are associated
with which personality disorder.
One of the problems with the diagnostic categories of personality disorders is that the exact same
observable behaviours may be associated with different personality disorders and yet have different
meanings with each disorder
Genetic propensities and temperament may be important predisposing factors for the development of
particular personality traits and disorders.
Parental influences, including emotional, physical, and sexual abuse, may also play a big role in the
development of personality disorders.

CLUSTER A PERSONALITY DISORDER

People with Cluster A personality disorders display unusual behaviours such as distrust,
suspiciousness, and social detachment and often come across as odd or eccentric.
PARANOID PERSONALITY DISORDER
Are suspicious and distrustful of others, often reading hidden meanings into ordinary remark
Tend to see themselves as blameless, instead blaming others for their own mistakes and failures—
even to the point of ascribing evil motives to
Such people are chronically tense and “on guard,” constantly expecting trickery and looking for clues
to validate their expectations while disregarding all evidence to the contrary
Often preoccupied with doubts about the loyalty of friends and hence are reluctant to confide in others
They commonly bear grudges, refuse to forgive perceived insults and slights, and are quick to react
with anger and sometimes violent behaviour & all of this leads them to have to numerous
interpersonal difficulties
Casual Factor
One reason for this is that people who are highly suspicious and lacking in trust tend not to want to
participate in research studies
Modest genetic liability to paranoid personality disorder itself, may occur through the heritability of
high levels of antagonism (low agreeableness) and neuroticism (angry-hostility), which are among the
primary traits in paranoid personality disorder
Psychosocial causal factors that are suspected to play a role include parental neglect or abuse and
exposure to violent adults,
Symptoms of paranoid personality disorder also seem to increase after traumatic brain injury and are
often found in chronic cocaine users, alcohol abuse.
SCHZOID PERSONALITY DISORDER
Have difficulties forming social relationships and usually lack much interest in doing so
Tend not to have good friends, with the possible exception of a close relative
Such people are unable to express their feelings and are seen by others as cold and distant
Lack social skills and can be classified as loners or introverts, with solitary interests and occupations,
although not all loners or introverts have schizoid personality disorder
This disorder tend not to take pleasure in many activities, including sexual activity, and rarely marry
Not very emotionally reactive, rarely experiencing strong positive or negative emotions
These deficits contribute to their appearing cold and aloof
The prevalence of schizoid personality disorder is more common in males than females
People with schizoid personality disorder show extremely high levels of introversion low on openness
to feelings and on achievement striving
Casual Factor
Like paranoid personality disorder, schizoid personality disorder has not been the focus of much
research attention probably schizoid personality disorder are not exactly the people we might expect
to volunteer for a research study
Schizoid personality traits have been shown to have fairly high heritability
Symptoms of schizoid personality disorder do precede psychotic illness in some cases (also some link
between schizoid personality and autism spectrum disorders.)
Severe disruption in sociability seen in schizoid personality disorder may be due to severe impairment
in an underlying affiliative system
Individuals with schizoid personality disorder exhibit cool and aloof behaviour because of
maladaptive underlying schemas that lead them to view themselves as self-sufficient loners and to
view others as intrusive
Their core dysfunctional belief might be “I am basically alone” or “Relationships are messy [and]
undesirable”
SCHIZOTYPAL PERSONALITY DISORDER
Schizotypal personality disorder are also excessively introverted and have pervasive social and
interpersonal deficits
But in addition they have cognitive and perceptual distortions, as well as oddities and eccentricities in
their communication and behaviour
Highly personalized and superstitious thinking is characteristic of people with schizotypal personality,
and under extreme stress they may experience transient psychotic symptoms
They often believe that they have magical powers and may engage in magical rituals, Ideas of
reference (the belief that conversations or gestures of others have special meaning or personal
significance), odd speech, and paranoid beliefs.
Oddities in thinking, speech, and other behaviours are the most stable characteristics of schizotypal
personality disorder
Schizotypal appear related to the five-factor model of normal personality (specifically facets of
introversion and neuroticism)
Casual Factor
Unlike schizoid and paranoid personality disorders, there has been a significant amount of research on
schizotypal personality disorder
Prevalence of this disorder in the general population is estimated to be around 1 percent, with more
males affected than females
Schizotypal personality disorder has moderate heritability
This disorder appears to be part of a spectrum of liability for schizophrenia and often occurs in some
of the first-degree relatives of people with schizophrenia
The biological associations of schizotypal personality disorder with schizophrenia are remarkable
Have shown the same deficit in the ability to track a moving target visually that is found in
schizophrenia
mild impairments in cognitive functioning including deficits in their ability to sustain attention and
deficits in working memory both of which are common in schizophrenia
Show deficits in their ability to inhibit attention to a second stimulus that rapidly follows presentation
of a first stimulus. May be related to their high levels of distractibility and difficulty staying focused
Schizotypal personality disorder also show language abnormalities that may be related to
abnormalities in their auditory processing
Teenagers who have schizotypal personality disorder have been shown to be at increased risk for
developing schizophrenia and schizophrenia-spectrum disorders in adulthood
Linked to a history of childhood abuse and early trauma, been associated with elevated exposure to
stressful life events, and low family socioeconomic status
CLUSTER B PERSONALITY
Remember that people with Cluster B personality disorders share a tendency to be dramatic,
emotional, and erratic
HISTRIONIC PERSONALITY DISORDER
Excessive attention-seeking behaviour and emotionality are the key characteristics of individuals with
histrionic personality disorder
Individuals tend to feel unappreciated if they are not the centre of attention; their lively, dramatic, and
excessively extraverted styles often ensure that they can charm others into attending to them
These qualities do not lead to stable and satisfying relationships because others tired of providing this
level of attention
In craving stimulation and attention, their appearance and behaviour are often quite theatrical and
emotional as well as sexually provocative
May attempt to control their partners through seductive behaviour and emotional manipulation, but
they also show a good deal of dependence
Speech is often vague and impressionistic and they are usually considered self-centred, vain, and
excessively concerned about the approval of others, who see them as overly reactive, shallow, and
insincere
Prevalence of histrionic personality disorder in the general population is a little over 1 percent occurs
more often in women than in men
Many of the criteria for histrionic personality disorder involve maladaptive variants of femalerelated
traits such as overdramatization, vanity, seductiveness, and over concern with physical appearance
Men than in women (e.g., high excitement seeking and low self-consciousness)
Casual Factors
Very little systematic research has been conducted, difficulty researchers have had in differentiating it
from other personality disorders
Highly comorbid with borderline, antisocial, narcissistic, and dependent personality disorder
diagnoses
Evidence for a genetic link with antisocial personality disorder and underlying predisposition that is
more likely to be manifested in women as histrionic personality disorder and in men as antisocial
personality disorder
May be characterized as involving extreme versions of two common, normal personality traits,
extraversion and, to a lesser extent, neuroticism
High levels of extraversion of patients with histrionic personality disorder include high levels of
gregariousness, excitement seeking, and positive emotions
High levels of neuroticism particularly involve the depression and self-consciousness
High on openness to fantasies
Core dysfunctional beliefs might include “Unless I captivate people, I am nothing” and “If I can’t
entertain people, they will abandon me”

NARCISSTIC PERSONALITY DISORDER

Show an exaggerated sense of self-importance, a preoccupation with being admired, and a lack of
empathy for the feelings of others
Two subtypes of narcissism: grandiose and vulnerable narcissism
Grandiose presentation of narcissism is manifested by traits related to grandiosity, aggression, and
dominance
Reflected in a strong tendency to overestimate their abilities and accomplishments while
underestimating the abilities and accomplishments of others
Their sense of entitlement is frequently a source of astonishment to others
Behave in stereotypical ways (e.g., with constant self-references and bragging) to gain the acclaim
and recognition they crave
They often think they can be understood only by other high-status people or that they should associate
only with such people
Vulnerable presentation of narcissism have a very fragile and unstable sense of self-esteem
For these individuals, arrogance and condescension is merely a façade for intense shame and
hypersensitivity to rejection and criticism
Vulnerable narcissists may become completely absorbed and preoccupied with fantasies of
outstanding achievement but at the same time experience profound shame about their ambitions
May avoid interpersonal relationships due to fear of rejection or criticism.
High on grandiosity were additionally described as being “aggressive, hard headed, outspoken,
assertive, and determined,” while those high on vulnerability were described as “worrying, emotional,
defensive, anxious, bitter, tense, and complaining”
Narcissistic personalities are unwilling or unable to take the perspective of others, to see things other
than “through their own eyes
1 percent of people meet the diagnostic threshold for narcissistic personality disorder, common in men
than women
Casual Factor
Was a great deal of theory but precious little empirical data on the environmental and genetic factors
involved in the etiology of narcissistic personality disorder
Grandiose narcissism has not generally been associated with childhood abuse, neglect, or poor
parenting, also grandiose narcissism is associated with parental overvaluation
Vulnerable narcissism has been associated with emotional, physical, and sexual abuse, as well
parenting styles characterized as intrusive, controlling, and cold

ANTISOCIAL PERSONALITY DISORDER

Outstanding characteristic of people with antisocial personality disorder (ASPD) is their tendency to
persistently disregard and violate the rights of others, combination of deceitful, aggressive, and
antisocial behaviours
Lifelong pattern of un-socialized and irresponsible behaviour with little regard for safety
These characteristics bring them into repeated conflict with society, and a high proportion end up
becoming incarcerated
Only individuals ages 18 or over can be diagnosed with ASPD
Prevalence of antisocial personality disorder in the general population is around 2 to 3 percent
common in men than in women
ASPD and psychopathy, they are not the same thing
Antisocial personality disorder place a heavy emphasis on observable behaviours such as lying,
getting into fights, or failing to honour financial obligations
Casual factor
Research suggests that genes play a role in antisocial personality disorder and criminality.
Inherited, could be impulsivity, low levels of anxiousness, aggressive tendencies, or a combination of
these and other dispositions
Many environmental factors have also been implicated in the development of antisocial personality
disorder
low family income, inner-city living, poor supervision by parents, having a young mother, being
raised in a single-parent family, conflict between parents, having a delinquent sibling, neglect, large
family size, and also harsh discipline from parents
Adopted away children of biological parents with ASPD were more likely to develop antisocial
personalities if their adoptive parents exposed them to an adverse environment.
Adverse environments were characterized by some of the following: marital conflict or divorce, legal
problems, and parental psychopathology
The relationship between antisocial behaviour and substance abuse is sufficiently strong that some
have questioned whether there may be a common factor leading to both alcoholism and antisocial
personality
Antisocial individuals may receive their genes from antisocial parents.
A child with a genetic liability to antisocial behaviour may also elicit problems in others because of
his or her behaviour
Developmental Perspective
ASPD has its roots in childhood, especially for boys
Childhood is the single best predictor of who will develop an adult diagnosis of ASPD,
The younger the age at which problems start, the higher the risk
Children with an early history of oppositional defiant disorder followed by early-onset conduct
disorder are most likely to develop ASPD as adults
Second early diagnosis that is often a precursor to adult ASPD is attention-deficit/hyperactivity
disorder (ADHD)
When ADHD co-occurs with conduct disorder this leads to a high likelihood that the person will
develop a severely aggressive form of ASPD and possibly psychopathy

BORDERLINE PERSONALITY DISORDER

People with borderline personality disorder (BPD) show a pattern of behaviour characterized by
impulsivity and instability in their interpersonal relationships, their self-image, and their moods.
Central characteristic is affective instability
Unusually intense emotional responses to environmental triggers, and a slow return to a baseline
emotional state
Drastic and rapid shifts from one emotion to another
Combined with a highly unstable self-image or sense of self.
BPD often have chronic feelings of emptiness and have difficulty forming a sense of who they really
are, struggle to cope with a highly negative self-concept and find it hard to tolerate being alone
People with BPD have highly unstable interpersonal relationships
One problem is that those with BPD are very fearful of abandonment. This may be one reason why
they are so attuned to signs of rejection and quick to perceive rejection in the behaviours of others
Perhaps because of their fear of rejection, individuals with BPD often “test” their close relationship
Another important feature of BPD is impulsivity characterized by rapid responding to
environmental triggers without thinking (or caring) about long-term consequences
Individuals’ high levels of impulsivity combined with their extreme affective instability often lead to
erratic, self-destructive behaviours such as risky sexual behaviour or reckless driving
People diagnosed with BPD tend to Suicide attempts are common
Self-mutilation (such as repetitive cutting behaviour) is another characteristic feature of borderline
personality
BPD produces significant impairment in social, academic, and occupational functioning
Comorbidity with Other Disorder
BPD is rarely diagnosed alone. It commonly co-occurs with a variety of other disorder
Tends to be comorbid with both internalizing disorders (such as mood and anxiety disorders), as well
as externalizing disorders (such as substance use disorders
BPD was most strongly associated with major depressive disorder and mania, as well as with panic
Disorder, agoraphobia, generalized anxiety disorder, and post-traumatic stress disorder
BPD can be comorbid with the full range of other personality disorders, although comorbidity with
schizotypal, narcissistic, and dependent disorder is particularly high (
BPD is conceptualized as involving high neuroticism, low agreeableness, low conscientiousness, and
high openness to feelings and actions
Casual Factor
BPD runs in families. BPD diagnosis was found to be four times higher in the biological relatives of
patients with BPD
Environmental factors are thought to account for the largest proportion of variance in borderline traits
It is likely that such experiences as well as other environmental influences interact with genes to
determine who will develop problems at a later point. Child maltreatment and other extreme early life
experiences have long been linked to BPD
Childhood adversity and maltreatment increases the risk of developing BPD in adulthood (Childhood
adversity is commonly found in BPD)
People with this disorder usually report a large number of negative and sometimes traumatic events in
childhood
Patients with BPD reported significantly higher rates of abuse than did patients with other personality
disorders (emotional abuse, physical abuse, sexual abuse, childhood abuse or neglect)
Childhood abuse nearly always occurs in families with various other problem including poverty,
marital discord, parental separations, parental substance abuse, and family violence
Simply acknowledge that bad childhood experiences increase the risk of a wide array of personality
problems including, but not limited to, borderline personality disorder
CLSTER C PERSONALITY
People with Cluster C personality disorders often show anxiety and fearfulness
AVOIDANT PERSONALITY DISORDER
Show extreme social inhibition and introversion, leading to lifelong patterns of limited social
relationships and reluctance to enter into social interactions
Hypersensitivity to, and fear of, criticism and disapproval, they do not seek out other people, yet they
desire affection and are often lonely and bored
avoidant personality disorder do not enjoy their aloneness and want contact with other people but their
inability to relate comfortably to other people causes them acute anxiety
They are painfully self-conscious in social settings and highly critical of themselves
APD often associated with depression
Feeling inept and socially inadequate are the two most prevalent and stable features
Individuals with this disorder also show more generalized timidity and avoidance of many novel
situations and emotions and show deficits in their ability to experience pleasure as well
Commonly diagnosed in women, and has a prevalence of around 2 to 3 percent.
Avoidant personality disorder looks a lot like schizoid personality disorder. Both types of people are
socially isolated. Key difference is that the person with schizoid personality disorder has little desire
to form close relationships, person with avoidant personality disorder wants interpersonal contact but
is shy, insecure, and hypersensitive to criticism
Casual Factor
May have its origins in an innate “inhibited” temperament that leaves the infant and child shy and
inhibited in novel and ambiguous situations
Show a modest genetic influence, and that the genetic vulnerability for avoidant personality disorder
is at least partially shared with that for social phobia
Fear of being negatively evaluated, which is prominent in avoidant personality disorder, is moderately
heritable
Introversion and neuroticism are also both elevated and they too are moderately heritable.
Experience emotional abuse, rejection, or humiliation from parents who are not particularly
affectionate
Likely to lead to anxious and fearful attachment patterns in temperamentally inhibited children

DEPENDENT PERSONALITY DISORDER

Show an extreme need to be taken care of, which leads to clinging and submissive behaviour
Show acute fear at the possibility of separation or sometimes of simply having to be alone because
they see themselves as inept
Usually build their lives around other people and subordinate their own needs and views to keep these
people involved with them
They may be indiscriminate in their selection of mates
Fail to get appropriately angry with others because of a fear of losing their support, which means that
people with dependent personalities may remain in psychologically or physically abusive
relationships.
difficulty making even simple, everyday decisions without a great deal of advice and reassurance
because they lack self-confidence and feel helpless even when they have actually developed good
work skills or other competencies
Function well as long as they are not required to be on their own.
Dependent personality disorder is associated with high levels of neuroticism and agreeableness
1 percent of the population and is more common in women than in men
Higher prevalence in women of certain personality traits such as neuroticism and agreeableness,
which are prominent in dependent personality disorder
Often comorbid with other disorders including mood disorders, anxiety disorders, eating disorders,
and somatic symptom disorders. Comorbidity is also high between dependent personality disorder and
other personality disorders, especially schizoid, avoidant, borderline, and histrionic personality
disorder
Casual factor
Might be attributable to genetic factors
Traits such as neuroticism and agreeableness that are prominent in dependent personality disorder also
have a genetic component
Possible that people with these partially genetically based predispositions to dependence and
anxiousness may be especially prone to the adverse effects of parents who are authoritarian and
overprotective
This might lead children to believe that they must rely on others for their own well-being and are
incompetent on their own involving core beliefs about weakness and competence and needing others
to survive, such as “I am completely helpless” and “I can function only if I have access to somebody
competent”

OBSESSIVE COMPULSIVE PERSONALITY DISORDER

Perfectionism and an excessive concern with orderliness and control characterize individuals with
obsessivecompulsive personality disorder (OCPD)
Their preoccupation with maintaining mental and interpersonal control occurs in part through careful
attention to rules, order, and schedules.
Very careful in what they do so as not to make mistakes But, because the details they are Preoccupied
with are often trivial they use their time poorly & have a difficult time seeing the larger picture
Their perfectionism is also often quite dysfunctional in that it can result in them never finishing
projects
Tend to be devoted to work to the exclusion of leisure activities and may have difficulty taking
vacations, relaxing, or doing anything just for fun
OCPD have difficulty delegating tasks to others (“They will not do it exactly right and exactly how I
want them to do it”)
Seen by others as being rigid, stubborn, and cold
Rigidity, stubbornness, and perfectionism, as well as reluctance to delegate, are the most prevalent
and stable features of OCPD
People with OCPD do not have true obsessions or compulsive rituals as is the case with obsessive-
compulsive disorder
20 percent of patients with OCD have a comorbid diagnosis of OCPD
20 and 61 percent of people with anorexia nervosa have a comorbid diagnosis of OCPD
There is also significant comorbidity between OCPD and the usual suspects, namely, mood and
anxiety disorders
Prevalence of OCPD is around 2 percent more common in men than women
OCPD overlap with some features of narcissistic, antisocial, and schizoid personality disorders,
although there are also distinguishing feature
Casual Factor
OCPD note that these individuals have excessively high levels of conscientiousness lead to extreme
devotion to work, perfectionism, and excessive controlling behaviour
High on assertiveness (a facet of extraversion) and low on compliance (a facet of agreeableness).
Have low levels of novelty seeking (i.e., they avoid change) and reward dependence (i.e., they work
excessively at the expense of pleasurable pursuits) but high levels of harm avoidance (i.e., they
respond strongly to aversive stimuli and try to avoid them)
OCPD traits show a modest genetic influence

TREATMENT & OUTOCME FOR PERONALITY DISORDER

Personality disorders are generally very difficult to treat, in part because they are, by definition,
relatively enduring, pervasive, and inflexible patterns of behaviour and inner experience
Many different goals of treatment can be formulated, and some are more difficult to achieve than
others.
Those from the odd/eccentric Cluster A and the erratic/dramatic Cluster B have general difficulties in
forming and maintaining good relationships, including with a therapist.
For those from the erratic/dramatic Cluster B, the pattern of acting out typical in their other
relationships is carried into the therapy situation.
Instead of dealing with their problems at the verbal level, they may become angry at their therapist
and create conflict during sessions
When people have a personality disorder as well as another disorder (such as depression or an eating
disorder) they tend to do less well than comparable patients without comorbid personality disorders
People with personality disorders have rigid, ingrained personality traits that often lead to poor
therapeutic relationships and additionally make them resist doing the things that would help improve
their other conditions.
ADAPTING THERAPEUTIC TECHNIQUE TO SPECIFIC PERSONALITY DISORDER
Therapeutic techniques must often be modified
Patients from the anxious/ fearful Cluster C, such as those with dependent and avoidant personalities,
may also be hypersensitive to any criticism they may perceive from the therapist, so therapists need to
be extremely careful to make sure that they do not come across in this way
People with severe personality disorders, therapy may be more effective in situations where acting-out
behaviour can be constrained For example, many patients with BPD are hospitalized at times, for
safety reasons, because of their frequent suicidal behaviour
Short-term inpatient treatment is more effective than outpatient treatment for both Cluster B and
Cluster C personality disorders
Cognitive approaches are also increasingly used, personality disorders are largely the result of
schemas (styles of thinking) that tend to produce consistently biased judgments, as well as tendencies
to make cognitive errors
Cognitive approaches use techniques such as monitoring automatic thoughts, challenging faulty logic,
and assigning behavioural tasks in an effort to challenge the patient’s dysfunctional beliefs
TREATING BORDERLINE PERSONALITY DISORDER
Of all personality disorders, most clinical and research attention has been paid to the treatment of
BPD. This is due to the severity of this disorder and the high risk of suicide that is associated with it
Psychosocial Treatment
These treatments share two common weaknesses: their relative complexity and long duration, both of
which make them challenging to disseminate to the broader population
1. Dialectical behaviour therapy (DBT) is a unique kind of cognitive and behavioural therapy
specifically adapted for BPD
Believes that patients’ inability to tolerate strong states of negative affect is central to this disorder.
One of the primary goals of treatment is to encourage patients to accept this negative affect without
engaging in self-destructive or other maladaptive behaviors
Decreasing suicidal and self-injurious behaviour and increasing coping skills
Combines individual and group components as well as phone coaching
Patients receiving DBT show reductions in self-destructive and suicidal behaviours as well as in
levels of anger
2. transference-focused psychotherapy- goal is seen as strengthening the weak egos of these
individuals, with a particular focus on their primary primitive defence mechanism of splitting
One major goal is to help patients see the shades of grey between these extremes and integrate
positive and negative views of themselves and others into more nuanced views
Often expensive and time consuming but it has been shown in at least one study to be as effective as
DBT,
3. Randomized controlled trials of mentalization-based therapy have revealed it to be an
efficacious treatment for BPD.
Uses the therapeutic relationship to help patients develop the skills they need to accurately
understands their own feelings and emotions, as well as the feelings and emotions of other
Biological Treatment
Drugs are often used in the treatment of BPD. Indeed, many patients with BPD are taking multiple
medications
Antidepressant medications are widely used, although there is no compelling evidence that they are
effective. They are most appropriate only when patients have a comorbid mood disorder
Second-generation antipsychotic medications and mood stabilizers may slightly reduce symptoms
over the short term
TREATING OTHER PERSONALITY DISORDER
Treatment of Cluster A and other Cluster B personality disorders is not, so far, as promising as some
of the recent advances that have been made in the treatment of BPD.
In schizotypal personality disorder, low doses of antipsychotic drugs may result in modest
improvements
Antidepressants from the SSRI category may also be useful However, no treatment has yet produced
anything approaching a cure for most people with this disorder. No systematic, controlled studies of
treating people with either medication or psychotherapy yet exist for paranoid, schizoid, narcissistic,
or histrionic disorder
One reason for this is that these people (because of the nature of their personality pathology) rarely
seek treatment.
Treatment of some Cluster C disorders, such as dependent and avoidant personality disorder, appears
somewhat more promising
Patients with Cluster C disorders using a form of shortterm psychotherapy that is active and
confrontational
Cognitivebehaviour treatment with avoidant personality disorder have also reported significant gains
Cognitive-behaviour and psychodynamic therapies resulted in significant and lasting treatment gains
Short-term inpatient treatment for Cluster C personality disorders is even more effective than long-
term inpatient or outpatient therapy
Antidepressants from the monoamine oxidase inhibitor (MAOI) and SSRI categories may also
sometimes help in the treatment of avoidant personality disorder, just as they do in closely related
social phobia