Patient information from BMJ

Personality disorders: what treatments work?

Last published:Apr 06, 2021

Personality disorders can cause difficulties with how we interact with other people. There are several types of personality disorder and they affect people in different ways. But they all affect how we think, deal with our feelings, and get on with others.

What are personality disorders?

If you find that you think or behave differently from most people in ways that distress you, and that you can’t control, you might be affected by a personality disorder.

Personality disorders are fairly common, and there are several types, which have different symptoms. But they all affect people in some similar ways, including:

• the way you think about and understand yourself, other people, and the world around you

• how much you can control your moods and emotions

• the way you get along with other people, including family and friends

• how much you can control how you behave and speak to people. Doctors call this ‘impulse control’.

It can be distressing to be told by a doctor that you might have a personality disorder. But it doesn’t mean that you’re a ‘bad’ person or that anyone is judging you. In fact, it can be really helpful to finally understand why you think and behave in some of the ways that you do, and that you find hard to control. 

It’s not clear what causes personality disorders. Some people are simply born with them as part of the genes they inherit from their parents. But some things that happen to people can make personality disorders more likely.

What treatments work?

Trust and continuity

Getting help with a personality disorder can be hard to begin with. First, either you or your doctor needs to realise that there is a problem. But that’s only the start of the process.

Many people with personality disorders find it hard to trust people, especially if talking about their feelings makes them anxious. And some people with personality disorders might be reluctant to ask for help even when they need it.

What seems most important for people with this condition is that they establish a long-term, trusting relationship with one doctor or support worker who they feel safe with and who they can go to when they are having difficulties.

This doesn’t mean that you can call or visit your doctor whenever it suits you. Your doctor will have plenty of other patients, as well as a life of his or her own. You will need to agree rules of when and how you contact your doctor at the start of your treatment.

You should also be involved in your treatment from the start. For example, your doctor will want you to be involved in making decisions about what you want from your treatment, and how to achieve it. Your family might also be involved, as well as support groups in your area.

Treatment for people in immediate danger

Some people need urgent help straight away. This includes people:

• who are at risk of self-harm or suicide

• who might not be able to take care of their children, or

• who might neglect or harm their children. 

If you need urgent help for any of these reasons, your doctor should refer you to emergency psychiatric services immediately. 

Many people with personality disorders abuse alcohol or drugs. This is usually because it can make them feel less anxious in the short term. But it makes people feel worse over time, as the drugs or alcohol cause other mental-health problems.

If you have been abusing drugs or alcohol, you might need detoxification (detox) treatment before any other treatment can start.

Psychotherapy

Once you are in no immediate danger, the main treatment for personality disorders is psychotherapy. This means regularly meeting with a psychiatrist or psychologist, to discuss how you feel, and talk about ways to help you.

Psychotherapy is tailored to whatever will help you most. It will probably include help with how to deal with other people, and how to control your impulses. But it could also include things like:

• advice on good diet

• help with substance abuse, and

• help with how to do your best for your children.

Medicines

There are some medicines that can help people with personality disorders. They can help you feel less anxious and more in control of your moods. Depending on your individual needs, your doctor might recommend one or more of the following medicines:

• Antidepressants. These drugs are usually used to help with depression. But they can also help with some personality disorders.

• Antipsychotics can help if you are having strange thoughts that you can’t control.

• Mood stabilisers do what their name suggests. They can help you control your moods.

• Anticonvulsants are usually used to help people with epilepsy. But they can help people with personality disorders to feel more calm.

All medicines cause side effects in some people. Your doctor should explain the ones that you might get. If you find that your medicines cause unpleasant side effects, talk to your doctor. You might be able to change to a different medicine. 

If you are a girl or woman of childbearing age, your doctor should not usually prescribe a mood stabiliser called valproate unless there are no other options. This is because valproate causes serious birth defects in babies.

If you need to take valproate, your doctor should discuss the risks with you, and make a plan with you so that you don’t become pregnant.

Specialist services

In some areas, specialist services for people with personality disorders bring together many of the treatments discussed above. These services are not available everywhere. But ask your doctor where you can get the best help.

What will happen?

It’s not possible to say what will happen to you as an individual. Treatment can’t ‘cure’ personality disorders. But it can help people to deal with their anxiety and social issues, among other things.

And perhaps most important, treatment can help people to understand and be more at ease with themselves.

Treatment takes time, and you will need to have regular follow-up appointments with your doctor and mental-health professional.

Personality disorders are common, and they affect all kinds of ordinary people. And there is plenty of help and advice available if you look online, including from people who are happy to share their own stories to help others like themselves. Your doctor might be able to direct you to a support group in your area.