Personality Disorders: Management

Because personality may have temperamental components and is developed over a lifetime of interacting with the environment, personality disorders are generally resistant to treatment. In general, psychotherapy is recommended for most personality disorders. Psychodynamically based therapies are commonly used, although they must be modified to each individual and each disorder. Cognitive, behavioral, and family therapies are also used to treat these disorders. Empirical studies validating the efficacy of various therapies are generally lacking. Dialectical behavior therapy (DBT) was developed specifically for the treatment of borderline personality disorder and has been validated in empirical studies. Group therapy incorporating various psychotherapeutic modalities is also used.

Pharmacotherapy is widely used in personality disorders, although no specific medication has been shown to treat any specific disorder. Instead, medications are targeted at the various associated symptoms of personality disorders. For example, mood stabilizers may be used for mood instability and impulsiveness. Benzodiazepines are commonly used for anxiety, although the potential for abuse and dependence is too often overlooked. Beta-blockers are also used frequently. For depression, obsessive-compulsive symptoms, and eating disturbances, selective serotonin reuptake inhibitors (SSRls) and other antidepressants have been successfully used.

Psychotic or paranoid symptoms are commonly treated with low-dose antipsychotics.

KEY POINTS 1. Personality disorders are categorized into three symptom clusters. 2. Personality disorders consist of an enduring pattern of experience and behavior. 3. They can produce transient psychotic symptoms during stress. 4. They are treated with psychotherapy and medications targeted at symptom relief. 5. Personality disorders are resistant to treatment. 6. They may have genetic associations with Axis I disorders.