Personality Disorders – Diagnosis and Treatment
Diagnosis
Diagnosing personality disorders includes several steps. The process often starts with a physical checkup.
Doctors look for any medical issues that might cause symptoms that seem like personality disorders. Tests, like blood work or screenings for alcohol and drugs, help rule out medical causes.
A mental health assessment follows. Mental health professionals ask about a person’s mood, thoughts, and actions. They might use surveys or interviews. Family members’ observations can also help if the person agrees.
Professionals then measure symptoms against guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
The American Psychiatric Association created this manual and describes the criteria for each type of personality disorder. Professionals use these criteria to separate different personality disorder types from each other.
Some people might need neuropsychological testing. These tests give more information about how the person understands and relates to others. The tests can help show if a personality disorder is present and how it might affect daily life.
There are three main groups of personality disorders:
| Cluster | Description | Examples |
|---|---|---|
| A | Odd or strange | Paranoid, Schizoid |
| B | Dramatic or impulsive | Borderline, Antisocial |
| C | Anxious or fearful | Avoidant, Obsessive-Compulsive |
Overlapping symptoms between the clusters or with other psychiatric conditions like anxiety, depression, or substance problems can make diagnosis challenging.
Treatment
Treatment for personality disorders depends on the specific diagnosis, its severity, and individual needs.
Talking Therapy
Clinicians use dialectical behavioral therapy (DBT), a structured type of psychotherapy, to help people manage personality disorders such as borderline personality disorder and others.
DBT focuses on reducing self-harm, handling impulsivity, and improving quality of life. Trained therapists usually hold sessions once a week as one-on-one meetings, and therapy can last a full year.
A key part of DBT is teaching new life skills through four main areas:
| DBT Skills | Brief Description |
|---|---|
| Emotion Regulation | Learn ways to control and express feelings. |
| Distress Tolerance | Tools for coping with stress and hard events. |
| Mindfulness | Practice being aware in the present moment. |
| Interpersonal Effectiveness | Build better communication and relationships. |
Therapists meet regularly with other DBT professionals to discuss treatment methods. They may be available outside sessions to coach clients on using DBT skills in real-life situations.
DBT helps different age groups, especially when managing disruptive thoughts, maladaptive patterns, and intense emotions. A certified team in DBT increases the chances of a better outcome.
Medications That May Help with Symptoms
No medicine is officially approved by the Food and Drug Administration for personality disorders.
Still, some mental health medications can help manage related symptoms like sadness, impulsive actions, or trouble connecting with others. These might include:
- Antidepressants: Target feelings of depression, anger, or hopelessness, which are common in many personality disorders, including avoidant, dependent, narcissistic, and borderline personality disorder.
- Mood Stabilizers: Help control mood swings, impulsive behaviors, or aggression, which can occur in disorders such as histrionic or antisocial personality disorder.
- Antipsychotics: Treat individuals who lose touch with reality (psychosis) or struggle with severe anxiety or anger. These can be useful for people with paranoid, schizoid, or schizotypal personality disorder.
- Anti-Anxiety Drugs: Can reduce anxiety or problems with sleep, but clinicians use them with caution since they might worsen impulsivity, which is seen in some personality disorders.
A doctor, psychiatrist, or pharmacist helps choose the right medicine based on the person’s symptoms and history. Regular check-ins ensure the medication works and adjust it if needed.
Inpatient and Residential Care Options
When symptoms are very severe, and someone can’t safely care for themselves, or there is a risk of harm, hospital treatment may become necessary. Hospitals provide short-term mental health care to stabilize a crisis.
Most people return home after their condition improves, but some may move to day programs, group therapy settings, or residential centers for longer-term support.
These programs offer a safe and structured environment with 24-hour support from mental health professionals. Staff focus on daily routines, medication management, and skill training.
This level of care is sometimes suggested for disorders with high risks—such as borderline personality disorder with repeated self-harm or antisocial personality disorder with ongoing aggressive actions.
The treatment team updates the plan over time based on progress. Outpatient services, including mentalization-based therapy, transference-focused psychotherapy, or ongoing medication management, help people maintain stability after leaving these programs.
Everyday Steps to Support Well-Being
Managing a personality disorder often means making changes at home and in daily life. Being active in one’s care is important. Attending therapy sessions regularly and following all treatment guidelines helps keep symptoms under control.
| Step | Benefit |
|---|---|
| Attend therapy | Stabilizes mood, builds skills |
| Physical activity | Eases stress, boosts mood |
| Avoid drugs/alcohol | Helps treatments work better |
| Learn about the condition | Supports long-term management |
| Keep medical appointments | Monitors health and side effects |
| Build social support | Reduces isolation and loneliness |
Even if someone starts to feel better, it is important to keep taking prescribed medication as directed by a healthcare provider.
Routine exercise can improve mood and lower stress. Activities like walking, gardening, or swimming are useful for managing symptoms such as anxiety or sadness.
It also helps to learn more about the condition. Understanding the nature of the disorder can encourage people to stick to their treatment plans.
Staying away from alcohol and street drugs is important. These substances may worsen symptoms or make medicines less effective. Keeping up with regular checkups allows healthcare providers to catch new issues or medication side effects early.
Having support from friends, family, or support groups can also reduce feelings of loneliness and isolation. Strong social connections play a key role in emotional stability.
Ways to Manage and Find Help
Supporting Someone Close with a Personality Disorder
Helping a friend or family member with a personality disorder can be challenging. Work with their care team to understand how best to offer comfort and motivation.
A mental health professional can also guide you on setting healthy boundaries and looking after your own well-being.
Tips for support:
- Listen without judgment.
- Stay calm and patient.
- Remind them of their strengths.
- Encourage them to seek help.
Self-Care For Supporters: Talking to a counselor can lessen stress and prevent burnout. Taking time for personal interests, hobbies, and relationships protects your emotional health.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Being organized before a visit can help make the appointment more useful. People should consider bringing a friend or family member for support and to help remember information.
Items to prepare:
- Write down your symptoms. Include all changes or concerns, even if they seem unrelated.
- List key personal events. Note any major life changes, stresses, or family issues.
- Bring a record of all medicines. This should include prescription and over-the-counter medicines, vitamins, herbs, and supplements, along with their dosages.
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Prepare questions for the doctor. Some examples include:
- What type of personality disorder might this be?
- What are the main options for treatment?
- How can talking with a professional help?
- Will medicine be needed, and for how long?
- What are the common side effects?
- How long does treatment usually last?
- What actions can patients take to support their own health?
Bringing a list of questions can make it easier to remember what to ask during the visit. It is important to ask anything that is on your mind.
What Your Healthcare Provider Might Do
Doctors or mental health professionals often begin by asking about mood, behavior, and thinking patterns. They may ask questions like:
| Area | Possible Questions |
|---|---|
| Symptoms | What changes have you noticed? When did they start? |
| Impact | How do these problems affect your daily life? |
| Previous care | Have you tried any treatments before? Was anything helpful? |
| Family history | Do family or friends notice changes? Any history of mental illness? |
| Self-help | What have you done to cope or feel better? |
| Medicines | What medicines or supplements are you taking right now? |
| Treatment Goals | What do you hope to achieve from treatment? |
The provider may also suggest next steps like seeing a specialist, talking to a mental health professional, or having a physical examination. Answering all questions honestly helps them provide the most accurate help.
