The paper reviews literature regarding the nature of personality disorders and known treatments. The paper argues that there is no definitive cure-all for personality disorders. The paper also advocates for increased attention and research in the area of personality disorders regarding treatments and variation of treatment strategies. The paper explains the causes of personality disorders, the treatments available, the perceptions of personality disorders in the medical and general communities, and proposes methods personality disorders may be freshly perceived and treated.
Determining the Efficacy of Personality Disorder Treatments
Personalities are the consistent behavior and mental characteristics and patterns that each individual has. Personality disorders are disorders that describe prevalent ways in which people's experiences and behaviors are not aligned with relative cultural norms or expectations. Areas that personality disorders affect patients are impulse control, emotional expression and comprehension, and cognition. Personality disorders refer to patterns that substantially hinder a person's ability to function normally. These disorders manifest as disturbances of behavior and disruptions of a social and personal nature. These disorders manifest across an array of situations and may seem normal to the patient. The inception of personality disorders occurs during childhood, adolescence, or early adulthood. There exist more than a dozen personality disorders. These personality disorders are divided into clusters and a few are still left unspecified or uncategorized. The clusters of personality disorders are as follows: Cluster A for disorders that are odd; Cluster B for disorders that are more dramatic; Cluster C are for anxiety related personality disorders; and unspecified disorders include passive-aggression, depression, and sadism. There are treatments available for personality disorders, yet not all treatments prove effective and not all disorders can be effectively treated. This paper will explore the varieties of personality disorders and the varieties of treatments for personality disorders. The paper will evaluate the research regarding personality disorders and personality disorder treatment so as to conclude which treatments are effective for which disorders.
Personality disorders are prevalent throughout the world's cultures and have warranted increased attention from the psychological community, specifically over the past few decades. Personality disorders in general pose a significant challenge to professionals of mental health. Svrakic et al. succinctly contend:
Personality disorder has become a major medical and social problem. It is a common disorder, as most studies report prevalence of about 10 -- 15%in the community, and about 50%in psychiatric patients. It is also a chronic and debilitating disorder, as the symptoms usually first occur in adolescence, sometimes even earlier, peak in the early 20s, and then persist for decades causing personal suffering, family dysfunction, and social deviance (the latter often includes criminality and addictions). Some of the symptoms never resolve, but the most disruptive ones tend to subside with time and age. Clinically, personality disorder is not only difficult to treat, but also interferes with treatment of other comorbid psychiatric and medical conditions, increasing personal incapacitation, morbidity, and mortality of these patients. (2002,-Page 189)
The authors make note that personality disorders are medical problems, and social problems. The affects of personality disorders are not limited to the individual who suffers from them. Personality disorders often are not the only medical condition with which the patient is diagnosed. For example, often, persons with personality disorders additionally suffer from substance abuse and suicidal predisposition. (van den Bosch, & Verheul, 2007) Adolescence is a grueling process for many people. The stress of puberty as well as internal factors in conjunction with environmental factors can bring upon a personality disorder that can potentially plague a person for the duration of his/her lifespan. Lieb et al. state
Many patients report various types of adverse events during childhood, including ongoing experiences of neglect and abuse. The most frequent of these is childhood sexual abuse, which is reported by 40 -- 71% of inpatients with borderline personality disorder. (2004,-Page 454)
Childhood traumas, harmful experiences during adolescence, and recurring trauma such as abuse, contribute directly to the likelihood that a personality disorder will manifest in a person. The above statement also implies as other authors referenced here do that people with personality disorders are likely to have other medical or psychological conditions, likely ones that contribute to the onset of or are additional results of the personality disorder. The quotation by Svrakic et al. above implies the distinct challenge of treating personality disorders in that some symptoms never go away completely. Therefore, there are no completely effective treatments to the personality disorders. The treatment of existing personality disorders within a patient may additionally interfere with the treatment of other medical conditions the patients has, adding to the complexity and challenge of treating personality disorders effectively, if at all.
Personality disorders also pose a challenge to treatment as their very nature manifests in resistance to change, including change that is positive and may benefit the patient. Svrakic et al. explain:
Personality disorder represents a point of developmental stability for many individuals, as it involves maladaptation, i.e. deviant or poor adaptation (but still some adaptation) to the local environment. In other words, personality disorder represents a sub-optimal developmental outcome, with established, although maladaptive, personal and social roles, support network, etc. These suboptimal outcomes, which are clearly maladaptive relative to the possible maximum for that individual, tend to be stable (to resist change) because search for higher adaptive levels is discouraged by the necessity of initially losing the established maladaptive stability before new stability is reached. (2002,-Page 194)
Though personality disorders demonstrate themselves with deviant behaviors, for the sufferer, his/her personality is normal or is the status quo. People may not consider or be aware that they have a personality disorder. Though the personality disorder produces social disruptions, those behaviors and patterns are normal for the person. People, regardless of whether they have personality disorders or not, are generally resistant to change. That urge coupled with a personality disorder compounds the resistance to change, even to improve health. A patient with a personality disorder will initially prefer the stability of their inappropriate behaviors and traits to the uncertainty and instability of transitioning into healthier habits and practices.
There are several kinds of modalities of treatment regarding personality disorders. Treatments include therapy, which may be individual, for the family, in groups, in the long-term or for the short-term; pharmaceutical therapy/medication(s); psychological education about the sufferer's condition/disorder; and residential centers or milieu therapy. Because, as previously established, there is no one definitive and wholly effective treatment of personality disorders, a multidisciplinary approach to the problem of personality disorders may prove useful. van den Bosch & Verhaul recommend that
It would therefore be worthwhile to examine the possibility of integrated, multitargeted treatment programs, rather than separate symptom-specific programs. This might imply that the therapists are trained to address a range of symptomatic manifestations of personality pathology in the impulse control spectrum, including suicidal and self-damaging behaviors, binge eating, and substance abuse. (2007,-Page 70)
Thus, in order to forge a more effective treatment plan for sufferers of personality disorders, changes in how professionals in this area are trained may be in order. In addition to continued research into the efficacy of personality disorder treatments, professionals in mental health should also consider changing how they approach personality disorders and seek areas of collaboration with professionals who specialize in a different cluster of disorders and/or those who do not treat the same disorder in the same manner. Though a more integrated approach may prove more effective than individual treatments, we must still keep in mind that at this point, there is no complete cure for personality disorders. Professionals and sufferers can hope for reduction of kinds of and frequency of symptoms of the disorder(s).
There are medical facilities that will not treat persons with personality disorder(s) because of the nature of the condition. There are professionals and facilities that will not take on patients with personality disorders because they are aware of the severe treatment challenge they pose. They also know that there is no cure for personality disorders. The exclusion of persons with personality disorders from treatment centers and other forms of health care because of a personality disorder may be direct or indirect. Mental health services that reject people with personality disorders may do so because they regard personality disorders as overly complex and an overwhelming challenge with which to deal. Moreover, as aforementioned, the sufferers themselves may be in denial that they have a mental health problem. It is very difficult to convince a person to receive medical treatment when that person does not perceive a condition that mandates medical treatment. This denial or lack of awareness may be the result or symptom of the personality disorder itself.
There are no cures for personality disorders. There are treatments for most personality disorders. Some, such as antisocial and narcissistic personality disorders are extremely difficult to treat, let alone cure. At best, patients and mental health professionals should aim for reducing symptoms with a combination of treatments including therapies, pharmaceuticals, and education. More attention…