Treatment

Treatment of a personality disorder is difficult because of certain key issues
related to these disorders. People with personality disorders tend to lack insight
about their dysfunctional ways of interacting with others. Because they
do not see themselves as having a problem, they are unlikely to pursue treatment.
When a person with a personality disorder does seek treatment, it is
usually for some secondary issue, such as alcoholism or depression. People
suffering from personality disorders tend to end therapy prematurely, a result
of their perception that their behavior is not the source of problems.
One of the central features of the personality disorders is an impaired ability
to maintain relationships with others; therefore, developing a relationship
with a therapist is difficult. When the opportunity for treatment does arise,
treatment approaches differ depending on the unique characteristics of
each of the personality disorders.
The treatment of borderline personality disorder has received much research
attention. American psychologist Marsha M. Linehan is credited with
the development of dialectical behavior therapy (DBT), a treatment approach
for borderline personality disorder which integrates cognitive, behavioral,
and Zen principles to help the patient to develop essential coping
skills. One of the basic tenets of DBT is that individuals with borderline personality
disorder may react abnormally to a normal stimulus (such as an interaction
with another person) because of negative or traumatic past experiences
(such as sexual abuse). Such individuals may quickly display an
increase in emotion and may take a longer period of time to reduce their
emotional arousal. Treatment focuses on decreasing self-destructive behaviors
and helping individual to regulate their emotions.
People with antisocial personality disorder who participate in treatment
usually are made to do so by the legal system. Efficacy of treatment interventions
for the person with antisocial personality disorder is often measured in
terms of the number of crimes committed by the person after treatment,
rather than by any significant change in personality characteristics. Treating
any substance abuse issues is an integral component of treatment of antisocial
personality disorder. Some believe that prevention is the most important
part of managing antisocial behavior.
Researchers have found that low levels of antipsychotic medications are
effective in alleviating some symptoms of schizotypal personality disorder.
Several studies suggest that antipsychotic medications such as haloperidol
may decrease symptoms of depression and impulsivity in the schizotypal individual.
People with narcissistic personality disorder are more apt than
those with other personality disorders to seek out treatment, using the therapist’s
office as yet another stage to be the center of attention.

Sources for Further Study
Claridge, Gordon. Origins of Mental Illness. 2d ed. Cambridge, Mass.: Malor
Books, 1996. The author explores the basic dimensions of personality,
personality theories, and basic research and treatment of mental disorders.
Erikson, Erik H. Identity: Youth and Crisis. New York: W. W. Norton, 1968. A
compilation of Erikson’s notable essays about adolescent identity crisis.
Articles explore theories of personality development and intrapersonal
conflict.
Linehan, Marsha M. Cognitive-Behavioral Treatment of Borderline Personality Disorder.
New York: Guilford Press, 1993. The author provides an overview of
the symptoms of borderline personality disorder followed by an extensive
description of an exploration of the foundations of dialectical behavioral
therapy. Specific treatment strategies are clearly described, and the book
contains several helpful charts and checklists.
Livesley,W. John, Marsha L. Schroeder, Douglas Jackson, and Kerry L. Jang.
“Categorical Distinctions in the Study of Personality Disorder—Implications
for Classification.” Journal of Abnormal Psychology 103, no. 1 (1994): 6-
17. This article focuses on the foundation of the classification of personality
disorders and challenges some of the empirical evidence regarding
the effectiveness of classification.
Maxmen, Jerrold S., and Nicholas G. Ward. Essential Psychopathology and Its
Treatment. New York:W.W. Norton, 1995. The authors provide a comprehensive
overview of the various forms of psychopathology and treatment
approaches.
Nathan, Peter E., Jack M. Gorman, and Neil J. Salkind. Treating Mental Disorders:
A Guide to WhatWorks. New York: Oxford University Press, 1999. Outlines
current standards of care for mental illnesses in a question-andanswer
format. Offers guides for further information.
Paris, Joel. “A Diathesis-Stress Model of Personality Disorders.” Psychiatric
Annals 29, no. 12 (1999): 692-697. The author explores the possible relationship
between life stressors and the development of personality disorders.
Widiger, Thomas A., and Paul T. Costa. “Personality and Personality Disorders.”
Journal of Abnormal Psychology 103, no. 1 (1994): 78-91. The authors
review the belief that personality disorders are representative of extreme
variants of normal personality traits. Using the five-factor model, the authors
explore the correlation between personality and personality disorders.
Janine T. Ogden
See also: Obsessive-Compulsive Disorder; Schizophrenia: Background, Types,
and Symptoms. 610