Before we begin to discuss treatment, please remember that the authors of Out of the FOG are not licensed mental health professionals, nor are we affiliated with any licensed medical organization. We are not qualified to prescribe or dispense medications or treatment. Please consult with a qualified mental health professional and/or physician before attempting any treatment regime. This page is purely based on our own experiences and research. Read our Disclaimer.
Unfortunately, when it comes to personality disorders, there is no known quick fix or magic cure. However, some effective interventions, treatments, therapies, coping and management strategies do exist, which have been shown to make a difference.
Emergency Services
We list this first because it may be the most important thing you read here and may someday save your life or the life of a loved one.
When someone is threatening or trying to hurt themselves or others, that is not a time to go it alone. You must contact your local emergency services immediately.
There is nothing to be gained - and much to lose - from trying to negotiate, argue or bargain with a person who is behaving in a verbally or physically violent or threatening way. That is not the time for words, it is the time to get out of the way and let the professionals do their job.
Even if you do not believe they will go through with it, you must remove yourself and any children from the situation and get emergency services involved.
Recovery for a personality-disordered individual is not typically an easy road. First and foremost, it requires a strong, stable and sincere commitment from the person seeking recovery - an acknowledgement of the need for change, a willingness to take on the challenges and a determination to see it through.
Some personality-disordered individuals are resistant to treatment.
Some may resist because they don't want to put in the work of dealing with their illness.
Others may prefer to stay in a state of denial where a person does not want to believe or admit that they have a problem.
Some may resist treatment because of the perceived stigma that is sometimes attached to mental illness.
In such cases, it is sometimes common, but rarely effective, for the non-personality-disordered individual to cajole, coerce, threaten or use bargaining or ultimatums to try to force the issue. While there may be short term co-operation in the face of overwhelming pressure, we have found that the initial energy tends to wane after a few months and regress back to its normal state. The result is often energy spent and disillusionment and harboring resentment. Whether we stay in a relationship with a personality-disordered individual or go "No Contact" with them, most of us in the Non community have discovered in the long run that it is far more productive to spend our energy working on ourselves.
Professional Avoidance of Diagnosing or Treating Individuals who suffer from Personality Disorders
Definition:
Professional Avoidance - Professional Avoidance of Individuals who suffer from Personality Disorders describes a common reluctance among mental health providers to diagnose or treat individuals whom they suspect may suffer from a personality disorder.
Description:
Even when mental health professionals suspect a personality disorder may be the root cause of a family situation, there is often a reluctance to apply the label of personality disorder to an individual.
This can happen for a number of reasons:
Lack of knowledge about PD's - Even among mental health professionals, there is often a lack of understanding about how people who suffer from personality disorders function and how that affects the dynamics of a relationship. Some even doubt if personality disorders are "real" mental illnesses.
Stigma - most people don't like being labeled as "personality-disordered" or having a mental health diagnosis assigned to them for fear of what people will think. This creates reluctance among certain mental health professionals to label someone as "personality-disordered".
Avoidance of conflict - sometimes people who suffer from personality disorders can become angry, vindictive or even violent - and many mental health professionals who want to create a positive environment for themselves and their clients will skirt around the issue without applying the label "personality disorder" in the hope that they can avoid conflict.
Sense of Hopelessness - there is a belief among some mental health professionals that personality disorders are incurable and therefore not treatable effectively.
Lack of Qualification - Many therapists who are the first line of care for people who suffer from personality disorders do not have the requisite psychiatric or psychological qualifications to perform a full-blown clinical diagnosis or to prescribe medications.
Fear of losing a client - Many therapists fear that if they confront a client with a label or diagnosis of a personality disorder, the client will leave them.
Fear of dependency - Some people who suffer from personality disorders can become very emotionally attached to a therapist and begin to feel increasingly dependent on them. Some therapists will avoid people who suffer from certain types of personality disorders - especially DPD, BPD, ASPD & HPD for fear of stalking, harassment, after-hours calls, inappropriate or unprofessional sexual advances etc.
When diagnosis does happen
Full blown diagnosis of personality disorders often has to be completed by a clinical psychologist or psychiatrist, and often involves the use of written exercises, interview exercises and observation over several visits. This makes diagnosis expensive and rare and few people volunteer themselves to be tested for such a diagnosis.
For this reason, diagnosis of personality disordered individuals is typically only performed on those who are hospitalized, those who are subjected to diagnosis through the criminal justice system or those who are involved in a civil dispute - most commonly in a custody dispute over parental access to children.
Where diagnosis is administered in this way, people are often incentivized by the stakes or institutions involved to pursue treatment, therapy or work on their behavior. Therefore the prognosis for diagnosed people is better than that for those who are not diagnosed. A number of studies done on treatment programs such as CBT or DBT have had high success rates.
Personality Disorder Recovery
Recovery - Recovery is a term broadly used to describe proactive self-management & mitigation of symptoms by a personality-disordered individual.
Recovery - Real or Fake?
Because of the rapid, often-dramatic mood swings that personality-disordered individuals experience, it can be difficult to tell whether a change in their behavior is evidence of a substantial improvement or just part of the normal up and down of their feelings.
Occasionally, someone will say "I did "X" or the personality disordered person in my life did "Y" and things have become much better."
Whenever you observe a significant change in behavior from a person who suffers from a personality disorder, you should always ask: "How long ago did this happen?" Changes which last 12 months or more may be indicators of a long term shift. Changes lasting shorter than 12 months and much shorter durations - such as weeks or days, are more commonly part of the ebb and flow of the personality-disordered person's changing moods and emotions.
When it comes to recovery from personality disorders, the old adage usually applies:
If something sounds too good to be true, it probably is.
Fake Recoveries
Not all recoveries in personality-disordered individuals are "fake" - and not all recoveries in personality-disordered individuals are "real". See our section on Real Recoveries. Every situation is different and no two personality disordered people are exactly alike. However, these situations are described here to help you understand some of the more common pitfalls when it comes to recovery.
The following sections contain descriptions of some of the more common "false positives" or "fake recoveries" that are seen when dealing with recovery in personality disordered individuals.
Placebo Effect - The Placebo Effect is when a medical patient is given a "placebo" or fake medicine - one in which there is no ingredient known to have any effect on their stated medical condition, but the patient, believing that the medicine is real, starts to feel better or reports an improvement in their symptoms.
Post hoc ergo propter hoc - The "Post hoc ergo propter hoc" fallacy is a common mistake in the diagnosis and treatment of medical and psychological conditions. "Post hoc ergo propter hoc" is Latin for "After this, therefore because of this" or in other words "If A happened then B happened, then A must have caused B to happen".
Cum hoc ergo propter hoc - "Cum hoc ergo propter hoc" is Latin for "with this, therefore because of this" or, in other words "A and B happen at the same time, therefore A must be causing B to happen". The "cum hoc ergo propter hoc" fallacy is a common mistake in the diagnosis and treatment of medical and psychological conditions.
Hoovers & Hoovering - A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.
Moments of Clarity - Spontaneous periods when a person with a Personality Disorder becomes more objective and tries to make amends.
Elements of a Successful Recovery
Just as it is important to understand that not everything that looks like a recovery is a real recovery, it is equally important to understand that not all attempts at recovery are false.
It is a commonly held myth that nobody ever recovers from personality disorders.
People do.
There are many who do commit themselves to recovery, make a genuine effort to stumble and fight for themselves first - and for their loved ones second. You will find many such people in recovery groups or at sites like BPDRecovery. You can also discuss with non-personality-disordered individuals who are in a relationship with personality-disordered individuals in our Support Forum. You can also find some important information and advice in our Committed to Working on it section.
Most successful recoveries for a person who suffers from a personality disorder have all of the following components.
As with many things in life, acknowledging that there is a problem is often the first step in recovery - and sometimes the most difficult.
Stigma - Coming to a point of acknowledging that you may suffer from a mental illness is a tremendously courageous thing to do - and many are afraid to do that. There exists a social stigma about mental illness that often makes it harder to acknowledge than physical illness.
Swallowing your Pride - Acknowledging that your words and your actions may have hurt others is equally difficult. There may be reparations to make. You may have to turn from blaming others to blaming yourself. It takes great courage and humility to do this.
Fear of the Unknown - it's normal to feel afraid of things which you do not understand or know well. When it comes to seeking help for a mental illness it is even more so. Baring your soul to strangers who will analyze you, observe you, possibly judge you. Possibly spending time in a mental health facility or coming into contact with other mentally ill people. Taking medications which may have unwanted side effects. These are all frightening ideas to most people.
Longevity
Because of the rapid, dramatic mood swings that personality-disordered individuals sometimes experience, it can be difficult to tell whether a change in their behavior is evidence of a substantial improvement or just part of the normal up and down of their feelings.
Perhaps the most reliable indicator of real recovery in a personality-disordered individual is longevity.
Whenever you observe a significant change in behavior from a person who suffers from a personality disorder, you should always ask: "How long ago did this happen?" Changes which last 12 months or more may be indicators of a significant long-term shift.
The 12 month threshold may seem over-conservative, but it is necessary in order to observe the effects of
Seasonal events - including the effects of climate changes in spring, summer, fall and winter.
Personal events - and holidays including Birthdays, Christmas, Easter, Mother's Day, Father's Day and important anniversaries.
Circumstantial events - including financial worries, employment stress, disappointments and opportunities.
Changes lasting shorter than 12 months and much shorter durations - such as weeks or days, are more commonly part of the normal ebb and flow of the personality-disordered person's changing moods and emotions.
Self-Work
The second necessary ingredient of real recovery in a personality-disordered individual is self-work.
Recovery from a personality disorder is not a sprint but a marathon. And just as it is impossible to run a marathon without putting in a lot of self-work over a long period, it is impossible for a person to recover from a personality disorder without a sustained, determined and costly personal effort.
It is impossible for one person to do the training for someone else who wants to run a marathon. Likewise, it is impossible for a non-personality-disordered individual to do the critical work on behalf of another person who is trying to recover from a personality disorder.
Yielding Control
Relationships with people who suffer from personality disorders are often all about control. There is an underlying struggle for control between the personality disordered individual and the Non-PD.
One of the necessary ingredients for recovery of a personality-disordered individual - and perhaps one of the most difficult, is to relinquish control of the relationship and to give the Non-PD back control over their own life.
Some key areas of control which may need to be yielded include:
Relationships - who the Non-PD is allowed to interact with, how and when they associate with others and how often.
Interests - Social groups, churches, hobbies and activities which are attractive to the Non-PD but which may not be a priority or of value to the personality-disordered individual.
Finances - How the family finances are budgeted, what takes priority and how to resolve conflicts.
Children - How children are cared for, how they are disciplined, what freedoms they are allowed and how medical and educational decisions are made.
Roles & Responsibilities - Who does the chores and when, who is responsible for what, what to do when there is an unexpected issue or problem.
Household Rules - What is acceptable and unacceptable behavior. What boundaries are to be respected so that everybody can feel safe.
Freedom of Independent Thought - Allowing others to believe what they want, think what they want, like and dislike what they want.
If someone is working on recovering from a personality disorder, yet is not able to yield control over these and similar issues, there is likely to be conflict down the road.
Medications
Medications - While no medications are known to cure personality disorders, a number of pharmaceutical medications are commonly prescribed to mitigate symptoms.
Here are some of the more commonly-used medications in the treatment of people who suffer from personality disorders
SSRI's - Selective Serotonin Reuptake Inhibitors
Definition:
SSRI - Selective Serotonin Reuptake Inhibitors, are the most commonly prescribed antidepressants for people who suffer from personality disorders. Popular SSRI's include Celexa, Lexapro, Prozac, Paxil, & Zoloft.
Description:
SSRI's relieve symptoms of depression by blocking the re-absorption (re-uptake) of a neurotransmitter in the brain called serotonin. More serotonin in the brain has been shown to improve mood.
SSRI's are generally considered milder than other types of antidepressants. Therefore, SSRI's are typically the first line of approach for practitioners.
Side-effects include: nausea, sexual dysfunction, headache, diarrhea, nervousness, rash, agitation, restlessness, sweating, weight gain, drowsiness and sleeplessness.
SNRI's work by increasing the levels of two of the three neurotransmitters in the brain - serotonin and norepinephrine. SNRI's have reportedly increased efficacy over SSRI's - which only work on serotonin - with comparable side effects. However, there is an additional risk of withdrawal symptoms associated with the use of SNRI's
Commonly prescribed SNRI's include Effexor and Cymbalta.
Bupropion
There are three neurotransmitters in the brain called serotonin, norepinephrine and dopamine. SSRI's increase the levels of serotonin in the brain but not the other two.
Bupropion increases the levels of the other two neurotransmitters - norepinephrine and dopamine - in much the same way as SSRI's, by acting as an absorbent inhibitor.
Bupropion is often prescribed as an additional medication when SSRI's - which increase serotonin, are ineffective at treating depression.
Bupropion is also commonly used to treat nicotine-withdrawal effects for smokers who are trying to quit.
Unlike SSRI's, Bupropion does not normally cause weight gain or sexual dysfunction. However, side effects do include an increased risk of seizure.
Common brand names for Bupropion include Wellbutrin or Zyban.
Tricyclics
Tricyclics are less commonly prescribed now due to the development of newer antidepressants which are considered safer. Tricyclics work by blocking the re-uptake absorption of two neurotransmitters - norepinephrine and serotonin in the brain.
Side effects of Tricyclics include increased heart rate,blurred vision, dizziness, confusion, constipation, urinary retention, drowsiness, and sexual dysfunction.
Tricyclics can be highly toxic at high doses. However, they are still prescribed in serious cases because of their efficacy.
MAOI's - Monoamine Oxidase Inhibitors
Monoamine Oxidase Inhibitors - or MAOI's increase levels of neurotransmitters in the brain, known as monoamines (serotonin, norepinephrine, and dopamine), by blocking a protein known as monoamine oxidase, which is normally responsible for burning them up. Increasing the level of monoamines in the brain has been shown to reduce symptoms of depression. MAOI's are powerful antidepressants.
MAOI's have been shown to have serious side effects, most notably a sudden, sometimes fatal, increase in blood pressure. Consequently, MAOI's are sometimes considered the last-resort antidepressant for serious cases.
More information on Medications
Some reputable sites with information of Pharmaceuticals:
American Psychiatric Association Practice Guidelines - The APA makes the practice guidelines freely available here to promote their dissemination and use. Contains their medication recommendations for some disorders including Borderline, Bipolar, OCD and Major Depression.
Medline Plus - Medline Plus is operated by the National Institutes of Health (NIH) and has a searchable database of drugs on the market.
Centerwatch - Clinical Trials in Psychiatry/Psychology - This contains a searchable database of currently active and completed clinical trials by condition. CenterWatch is a publishing company that focuses on the clinical Trial Listings industry. The information provided in this service is designed to help patients find clinical Trial Results that may be of interest to them, and to help patients contact the centers conducting the research. CenterWatch is neither promoting this research nor involved in conducting any of these Trial Listings.
ClinicalTrials.gov - ClinicalTrials is a registry of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from health care professionals.
Therapy & Psychological Intervention
Therapy - Therapy is a term used to describe a wide variety of interactive programs offered by mental health professionals to mitigate personality disorder symptoms.
Personality disorders are notoriously difficult to treat and are sometimes even avoided by some mental healthcare professionals. The most effective strategies involve an intense process of individual and group therapy extending over a number of years, often shored-up with medication. This requires a serious, sustained commitment on the part of the PD sufferer to their own recovery.
Some therapists avoid patients with certain kinds of personality disorders because of the risk to themselves and their practice. PDI's are not good at respecting the professional and personal boundaries of therapists and can become just as demanding to a therapist as they are to the others in their lives.
Individual Therapy
Individual psychotherapy varies greatly from practice to practice and is generally dependent on the personal style of the therapist and the condition of the patient or client.
Therapy for people with personality disorders varies from validation and listening on the part of the therapist to more rigorous programs such as DBT and CBT.
Most therapists will not give a diagnosis of a client or patient. Psychological diagnosis is generally only performed by clinical psychologists or psychiatrists only and reserved for people who are hospitalized, criminally prosecuted or ordered to take a psychological evaluation during a child custody dispute.
The most effective therapy situations are those in which the person with a personality disorder is committed to getting help, following up on treatment, substituting healthy behaviors for destructive behaviors and taking medications where necessary,
DBT - Dialectical Behavioral Therapy
Definition:
Dialectical Behavioral Therapy - Dialectical Behavioral Therapy (DBT) is a psychosocial treatment developed for patients with borderline personality disorder which combines intensive individual and group therapy.
Description:
Dialectical Behavioral Therapy (DBT) was developed for treating Borderline Personality Disorder by Marsha M. Linehan. Some therapists avoid treating patients whom they suspect may suffer from BPD, because of the demands some BPD patients put on the therapist. These demands include multiple phone calls after hours, suicidal ideation and suicidal threats, lack of respect for the therapist's boundaries or the boundaries of other patients and staff, aggressive outbursts and stalking.
DBT incorporates an intense program of weekly individual therapy sessions and weekly group therapy sessions.
Individual therapy focuses on addressing a prioritized set of issues starting with self-injury, then behaviors which disrupt therapy, then behaviors which disrupt healthy living. Patients are trained in a regime of four skills known as mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.
Cognitive Behavioral Therapy (CBT)
Definition:
Cognitive Behavioral Therapy - Cognitive-Behavioral Therapy (CBT) is a structured form of therapy based on the belief that thoughts - not outside circumstances - control our feelings and behaviors and that our feelings and behaviors are consequently under our own control.
Description:
In contrast to traditional psychotherapy, most CBT regimes are time-limited. The average number of sessions is 16. Homework assignments are an integral part of CBT.
CBT sessions focus on teaching rational thought processes, establishing life goals, learning to accept disappointments, analysis of the patient's personal world view, learning cause and effect and rationalizing feelings to match facts.
Less rigorous forms of therapy such as couples therapy, marriage therapy or family counseling are extremely common. Visits to a therapist’s office are the most common form of treatment that anyone who suffers from a personality disorder will see. Techniques vary across the board as does the efficacy of treatment.
Many forms of couple’s therapy come under criticism for being ineffective and prone to manipulation by the personality-disordered individual. Therapists who treat personality-disordered patients as merely having communication difficulties, needing validation without acknowledgement of the underlying mental illness or confrontation of the abusive behavior are generally ineffective.
Many psychotherapists assume a validating advisory role rather than an assertive or intervening role with their clients, which can be counter-productive when addressing a relationship between a non-personality-disordered individual and a personality-disordered individual. It can easily be manipulated by the person with the personality disorder into a means of controlling the non-personality-disordered individual.
A common scenario is where the therapist offers both disputing parties validation of their feelings - which can be misrepresented by the personality-disordered individual as an endorsement of their position or support of their abusive behavior. This is usually followed by a suggestion from the therapist that both parties make some sort of compromise, meet in the middle somewhere. This approach makes perfect sense when both parties are rational, reasonable individuals who just have competing interests.
However, in the typical PD-Non-PD relationship, both parties are not rational, logical individuals. What usually happens is that the non-personality-disordered individual yields ground (while increasing their level of resentment) while the personality-disordered individual makes a verbal commitment to yielding ground which is not followed through on or maintained over a significant period of time.
The result can be a short-term appearance of progress, which is very gratifying for the therapist, with a long-term return to the old roles when the deal is broken. This increases disillusionment for the non-personality-disordered individual and an overall increase in resentment. They have yielded ground on something that was important to them and lost one of their bargaining chips because the personality-disordered individual has gone to therapy and can thus argue that this proves that they are “working on it”. Even worse, some of the confessions of their feelings made in therapy can be turned into weapons which are subsequently used against them.
It can also be frustrating and confusing for a non-personality-disordered individual in couples or family therapy with a personality-disordered individual to witness a therapist validating a personality-disordered individual’s dissociative memories. Sometimes the non-personality-disordered individual is characterized as stubborn for refusing to validate or agree to memories, beliefs or events that the non-personality-disordered individual knows or believes to be exaggerated, distorted or false. The non-personality-disordered individual is cornered into a defensive posture, afraid that the therapist will believe the unflattering stories about them and afraid that the personality-disordered individual will use the validation as encouragement to fabricate more. Once this happens, therapy sessions can easily descend into a he-said-she-said type of bickering back and forth with no resolution - other than the payment of the therapist’s fee at the end of the hour.
Both Seeing the Same Therapist Separately
Once it becomes clear that progress is not being made in joint therapy, it is common for therapists to advise couples to replace the joint sessions with individual sessions alternating between the two parties. This is generally more effective than joint sessions together as it allows the therapist to address each of the parties as individuals. However, there are 3 fundamental conflicts of interest that prevail:
Conflict of interest for the therapist. The therapist normally wants to validate both parties. This is very difficult when the parties are alternately contradicting one another. You are spending good money but instead of just listening to you and giving you good advice, your therapist is sitting there worrying about how his/her actions or statements might come back to haunt them via the other party.
Conflict of interest for you. Instead of working on yourself, you are spending your money and a valuable portion of your time thinking about the relationship between the therapist and the other party. You may be tempted to begin competing with your significant other for the therapist's approval and validation.
Conflict of interest for the person who has the personality disorder. Instead of working on themselves, they may begin to compete with you for the therapist’s validation and approval. They may also be tempted to try to “send a message” to their non-personality-disordered partner via the therapist.
Triangles are not a great setup. For this reason it makes more sense for people to see separate therapists.
As long as the therapist maintains a validating posture towards the PDI and avoids any sort of accountability for their behavior the therapy is unlikely to accomplish much more than an emotional back-rub. Most therapists deliberately keep their sessions at that level as it is less strenuous for them and breeds less conflict in the office. Many therapists are afraid of how their client will react if they adopt a more assertive role.
Eye Movement Desensitization and Reprocessing (EMDR) Therapy
Definition:
EMDR - EMDR is Eye Movement Desensitization and Reprocessing (EMDR), a psychological technique sometimes used in the treatment of post-traumatic Stress Disorder (PTSD).
Description:
EMDR is sometimes used to treat PTSD patients by asking them to focus on traumatic memories while moving their eyes from side to side following the therapist's finger or some object. Ssometimes headphones with alternating sounds from left to right ear are used. It is hypothesized that the switching from left brain to right brain establishes connections which allow the patient to access locked memories and emotions.
EMDR is a controversial treatment and has not been scientifically validated in clinical trials. You can find more info on EMDR at http://www.emdr.com.
How Family Members and Partners Can Help
Toolbox - The Out of the FOG Toolbox contains lots of helpful ideas on what works and what doesn't work when you are in a relationship with someone who suffers from a personality disorder.
In Conclusion
While it is true that some of these approaches may be deployed as part of a coping strategy, none is a cure. Some people with personality disorders do decide to work on their own recovery, seeking treatment and therapy, making better choicesand becoming healthier over the long haul. However, there are some who do not.
For More Information & Support...
If you suspect you may have a family member or loved-one who suffers from a personality disorder, we encourage you to learn all you can and surround yourself with support as you learn how to cope.
August 25, 2014 - OOTF announce an exciting new development - it's called Out of the Storm - a support site specifically designed for people who suffer from CPTSD - Complex Post Traumatic Stress Disorder. At OOTF we have often welcomed members who are dealing with CPTSD as a consequence of having been in a relationship with someone who suffers from a personality disorder. Nevertheless, for a long time we have recognized that CPTSD sufferers have a distinct and unique set of concerns and issues.
Nov 9, 2013 - OOTF has just launched a new "Future Goals" forum. This forum is a safe place to store your goals of what you would like to achieve. Setting goals can help us move forward, and give us something to focus on while we are working our way through day to day issues. Goals can change, be amended or added to over time as we either achieve them, or determine new goals as our lives unfold.
