Help for personality disorders

Personality disorders are notoriously hard to treat. But research suggests that dialectical behavior therapy and cognitive therapy can help people with one of the most common disorders.

People with personality disorders experience abnormal thoughts and behaviors that keep them from functioning as well as they should.

The nature of those thoughts and behaviors depends on which personality disorder a person has, such as obsessive-compulsive disorder, paranoid personality disorder or borderline personality disorder. The disorders do have one thing in common: They usually don’t go away without treatment.

Psychologists are finding new approaches to treating these notoriously hard-to-treat disorders. Two interventions show promise for treating borderline personality disorder, the most-studied personality disorder.

Dialectical Behavior Therapy

People with borderline personality disorder can be challenging to treat.

  • While they often seek help, they also tend to drop out of therapy. While they’re quick to open up, they’re even quicker at shutting down. And while they crave approval, a small provocation can result in abusive or violent behavior toward those trying to help.

  • Dialectical behavior therapy helps clients stop bouncing between these two extremes. The approach features weekly one-on-one sessions with a counselor, plus group skills training.
  • Helping clients regulate emotion is key, especially since many harm themselves as a way of stabilizing their emotions. Dialectical behavior therapy teaches clients alternative ways to control overwhelming or confusing feelings.

  • Therapists might share a technique called mindfulness, which allows clients to observe their emotions without reacting.

  • At the same time, therapists acknowledge clients’ emotions. People with borderline personality disorder may crave emotional acceptance, for example, because their parents never provided it.

  • Evidence suggests that dialectical behavior therapy works.

  • In a study comparing dialectical behavior therapy and traditional psychotherapy, women who underwent dialectical behavior therapy were more successful at reducing suicide attempts, self-mutilating and such self-damaging behaviors as gambling and substance abuse.

  • They were also almost twice as likely to stay in therapy.

Cognitive Therapy

This therapy focuses on thoughts rather than emotions. In weekly sessions, therapists help clients identify and change dysfunctional beliefs about themselves, others and the world.

  • People with borderline personality disorder, for instance, often think they’re bad and then interpret everything that happens to them in a way that confirms that belief.

  • Cognitive therapy helps clients eliminate such dysfunctional beliefs by revisiting and reinterpreting childhood experiences.

  • A client who feels inadequate may come to understand that that belief comes from his parents giving him responsibilities he wasn’t ready for, for instance.

  • Once clients understand the origins of dysfunctional beliefs, they can work on changing them. Preliminary research supports the technique’s effectiveness.

  • In one study of cognitive therapy, borderline personality symptoms dropped significantly after a year. At follow-up, 55 percent of study participants no longer met the criteria for a diagnosis of borderline personality disorder.

Adapted from “Treatment for the ‘untreatable’APA Monitor on Psychology®