Personality Disorders

• Take-Home Message


  • Working with patients with personality disorders is challenging but rewarding
  • Focus on the here-and-now, building a strong therapist-patient relationship
  • Remember that all patients are human beings. Provide care to the patient and take care of the therapist
• DSM-5 General Criteria for Personality Disorder (GCPD)

  • Impairments in Functioning: Significant difficulties in self (identity/self-direction) and interpersonal (empathy/intimacy) functioning
  • Personality Trait Domains/Facets: One or more pathological personality trait domains or facets
  • Stability and Consistency: Impairments and trait expressions are stable across time and situations
  • Not Developmentally Expected: Impairments are not typical for the individual's age or socio-cultural environment
  • Not Due to Medical Condition: Impairments are not solely caused by substance use or a general medical condition
• Borderline Personality Disorder (BPD)

  • Fear of abandonment
  • Difficult interpersonal relationships
  • Uncertainty about self-image or identity
  • Impulsive behavior
  • Self-injurious behavior
  • Emotional changeability or hyperactivity
  • Feelings of emptiness
  • Difficulty controlling intense anger
  • Transient suspiciousness or "disconnectedness"
• Evidence-Based Treatments for BPD

  • Mentalization Based Treatment (MBT): Focuses on improving mentalization skills (understanding the mental states underlying behavior)
  • Dialectical Behavioral Therapy (DBT): Combines cognitive behavioral therapy (CBT) with mindfulness and distress tolerance techniques
  • Schema Focused Therapy (SFT): Targets early maladaptive schemas (negative beliefs about oneself and the world) that contribute to BPD symptoms
  • Transference Focused Psychotherapy (TFP): Explores the patient's transference reactions (unconsciously projecting past experiences onto the therapist) to understand the roots of their difficulties
• Working with patients with personality disorders requires specialized skills and knowledge
• Providing therapy for patients with BPD is challenging but can be effective with evidence-based treatments
• Building a strong therapeutic relationship and focusing on the here-and-now are essential for success