What treatments are available?
The type of treatment you are offered, and its success, may depend on where you are (at home, in hospital or in prison) and on what is available locally.
Talking treatments designed specifically for personality disorders have been shown to be helpful, though much of the research, so far, has focused on treatment for borderline personality disorder (BPD) and milder forms of personality disorder. A recent paper showed evidence for the success of out-patient and day hospital psychotherapy for the ‘emotional and impulsive’ group of personality disorders.
There are certain keys to the success of talking treatments. You are more likely to benefit from treatment if you can:
- Think about and monitor your own thoughts, feelings and behaviour
- Be honest about yourself, your problems and imperfections
- Accept responsibility for solving your problems, even if you did not cause them
- Be open to change and stay motivated
Dialectical behaviour therapy (DBT)
DBT offers group therapy alongside individual treatment and can be very effective, especially with BPD. DBT teaches new skills to help you manage emotions, such as distress, and improve the way you interact with others. It helps change the behaviour that causes you most problems so you can deal better with day-to-day crises.
Cognitive behaviour therapy (CBT)
CBT has been especially helpful for people with dependent and avoidant personality disorders. It can help you examine your usual pattern of thoughts and attitudes and allow you to challenge ideas and beliefs that cause you problems. For example, if you are too dependent, therapy could focus on your belief that you are so helpless and incompetent you need someone else to rely on. If you have obsessive compulsive personality disorder (OCPD), therapy might help you explore your feeling that you must not, under any circumstances, make any mistakes. (See Mind’s booklet Making sense of cognitive behaviour therapy.)
“Avoidant personality disorder… at first it was a relief to know that I wasn’t alone in feeling the way I did, but for a couple of months afterwards I did use the label as an excuse to behave in particular ways and blame it on my ‘condition’. Fortunately, with the help of CBT I realised that I didn’t have to live like that.”
Cognitive analytic therapy (CAT)
CAT focuses on developing relationships, the problems you have with forming relationships, and the habits you have constructed in relation to how you think, feel and behave with others. Your therapist will help you to understand your problems and how they developed. You will usually be offered a set number of sessions of CAT.
This focuses on the relationship between client and therapist, and can be useful with borderline personality disorder (BPD) in particular. It can help you manage your relationships with other people and improve the way you feel about yourself.
This form of treatment focuses on developing your understanding of yourself and how others feel. It aims to help you to regulate your emotions and impulses, and develop fulfilling, meaningful relationships.
Group therapy can be helpful for anyone who prefers to avoid social situations, or who usually depends too much on another person. The groups may have very practical aims, with the emphasis on practising social skills and assertiveness training. If you tend to form intense, ‘special’, one-to-one relationships, a group can let you try out different relationships and broaden your range of attachments to other people.
Group therapy may include social problem-solving therapy, which aims specifically to boost your social confidence and help you to reduce impulsive behaviour. It does this by teaching you to stop and think and plan your actions.
Whichever personality disorder you are diagnosed with, you are likely to have difficulties with relationships with other people. Living in a therapeutic community for a number of months can be very helpful, and can be seen as a continuous form of group therapy.
The emphasis is on working together, democratically, so that staff and residents share responsibility for tasks and decisions. People are encouraged to express their feelings about one another’s behaviour in group discussions. This inevitably means having to face up to the impact your attitudes and behaviour have on others.
Communities vary, and while in some there may be no individual therapy, in others there may be a mixture of large or small group meetings, and one-to-one sessions with a member of staff. There is often no medication involved. You will benefit most if you are able to accept your own contribution to your problems and your ability to change.
“Having the knowledge about what borderline personality disorder is has helped me … to understand myself more and to forgive myself. I am now engaging with a preparation group with the hope of going into therapeutic community once I’m ready for it.”
Art, music and dance therapies may help you to express how you are feeling, especially if you are having difficulty putting things into words. If you are someone who finds social situations very difficult, meeting for a session of art or music, can help. Expressing yourself without words, in a group, can be an excellent way to begin to get used to trusting others and sharing experiences. Drama therapy may help you to say things that are normally difficult to express (see Mind’s online booklet Making sense of arts therapies).
There are no drugs specifically for personality disorder, but doctors may prescribe them to treat additional problems, such as irritability, depression or psychotic episodes. It may take some time to find a drug that works for you, and often medication may be most effective when combined with a talking treatment. If you have not been offered medication and would like to see if it would help you, you could ask to talk to a psychiatrist about it.