Personality disorder is a major risk factor for attempted and completed suicides, as well as self-mutilation. Therefore, seek emergency treatment for someone who appears to be threatening self-harm. The risk for suicide is even greater for people who are also depressed, alcoholic, have had a recent personal loss, or have other chronic mental illnesses. Indications that a person may be contemplating suicide include giving away belongings, saying goodbye to their friends and relatives, and resolve about their intended method of death.
Persons with borderline personality disorders have a higher risk for self-mutilation or cutting themselves. People may slash themselves to release built-up tension, to get attention, to punish themselves, or for symbolic reasons. Mutilation is most often seen during a time of perceived or actual loss, and is more often due to anger than depression.
Your doctor is the best source of information on the drug treatment choices available to you.
For most personality disorders, the primary treatment is psychotherapy, often in combination with medication. While psychotherapy works better for some patients than for others, there is considerable evidence that psychotherapy is helpful for many personality disorders. For avoidant personality disorder, behavior therapy and social skills training are quite useful. Psychotherapy is effective for borderline personality disorder, but requires at least a year of once- or twice-weekly therapy to work. Both individual and group psychotherapy seem to help for borderline personality disorder.
Patients with antisocial personality disorder tend to have the worst response to psychotherapy because they are often dishonest and unmotivated for therapy. At least one study suggests that if patients with antisocial personality disorder are also depressed, they may be more responsive to psychotherapy. Patients with paranoid, schizoid, and schizotypal personality disorder do not often seek out psychotherapy.
Patients with histrionic personality disorder, narcissistic personality disorder, obsessive-compulsive personality disorder, and dependent personality disorder tend to do well with psychotherapy. However, there are significant individual variations, and much depends on how much motivation the individual patient has to participate in the psychotherapy process.
The usefulness of self-help groups varies greatly depending on the specific personality disorder. Self-help groups have limited effectiveness in various settings. For example, they are not generally useful for people with avoidant personality disorders since these people are likely to be too anxious to attend the sessions.
Histrionic personality disorder patients would likely be very dramatic in their interactions with the group, and come across as shallow or artificial. Those with paranoid or schizotypal disorders are likely to be mistrustful and suspicious of others, which might make the dynamics of the group harmful to them early in their treatment.
People with antisocial personality disorder typically feel at ease talking about their feelings and behaviors in front of peers. Someone with a borderline personality disorder may get benefit from a self-help group if it can be used as a place to try out new coping skills, or as a place to practice keeping their emotions controlled. Obsessive compulsive personality disorder sufferers often find these groups to be useful, and a way to gain support.
Those with schizoid personality disorders usually receive a great deal of benefit from participating in groups later on in their treatment. The social network within a group can lead to higher functioning and fewer problems dealing with stress. It can also help them overcome fears of closeness and feelings of isolation.
Some medical conditions, such as brain injury from trauma or tumor, can cause changes in personality.
In many people, personality disorders can develop as a consequence of substance abuse. Since those with personality disorders commonly also abuse drugs, it can be very hard to tell if the personality disorder caused the substance abuse or vice versa.
The prognosis for personality disorders is highly variable. Much depends on the patient's motivation. Some patients suffer very little because they feel they do not have a problem. These individuals are unlikely to seek out treatment or to stay involved in psychotherapy once they have started it. On the other hand, some patients with personality disorders experience considerable suffering and are motivated to stay in therapy for a long period of time. Those who stay in effective psychotherapy for a year or more often have substantial improvements.
The prognosis is best for patients with borderline personality disorder, obsessive-compulsive personality disorder, dependent personality disorder, and avoidant personality disorder. The prognosis is worse for antisocial personality disorder, paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
Most experts strongly suggest long-term participation in psychotherapy to maintain and build on new behavior patterns.
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