- Some Cluster B personality disorders show responsiveness to cognitive-behavioral therapies.
- Few people with personality disorders seek therapy as they don't believe they have a problem.
- An antisocial personality disorder may be more genetically based and less able to change.
The manual of mental disorders of the American Psychiatric Association (the DSM-5-TR) defines a personality disorder as “An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.”
Problems manifest in at least two areas: “perceiving oneself, others, and events;” “appropriateness of emotional responses;” “interpersonal functioning;” and/or “impulse control.”1
Traditionally, this has meant that those with personality disorders were not expected ever to be able to change their behavior. For this reason, many mental health professionals and insurance companies would not provide or cover treatment for personality disorders. In addition, most people with personality disorders do not know they have a disorder, do not believe they have a problem, and do not seek therapy.
However, over the past two to three decades, there has been growing knowledge about personality disorders and some successful efforts to provide treatment for them.
Of the 10 personality disorders described in the DSM-5-TR, four are in Cluster B: borderline, narcissistic, antisocial, and histrionic. Some are considered more amenable to treatment now, but their “enduring patterns” still make them more difficult to treat than substance use disorders, for example, which many with personality disorders (PD) also have. Since the DSM indicates that more than 10 percent of adults may have a personality disorder and 4.5 percent have a Cluster B disorder, many people wonder whether they can change. This post briefly introduces this important subject.
It is helpful to know that there is no medication for treating personality disorders at this time, whereas there is for most other forms of mental illness. This is because personalities develop over many years; changing them is like learning a new language and culture. However, if an individual has another problem, such as depression or anxiety, then medications which helps manage these issues can be helpful to stabilize those with personality disorders.
Borderline Personality Disorder
In recent years, dialectical behavior therapy (DBT) has become well-known to mental health professionals as an effective treatment that helps clients manage wide mood swings, extreme (all-or-nothing) thinking, and aggressive behavior toward those close to them.
Various therapists and studies indicate that one-to-five years of this counseling method may help a person potentially outgrow the diagnosis of borderline personality disorder. The ideal format of this method includes three parts: group therapy for learning self-management skills, an individual therapist, and a consultation group for therapists to help them maintain their energy and knowledge for working with repeatedly angry clients.
Many people with this disorder have been helped by this and similar cognitive-behavioral methods (ones that focus on changing one’s thinking and way of behaving). Therapists doing this work have to balance being supportive with guiding the client to apply DBT methods.
Narcissistic Personality Disorder
Fewer people with this disorder seek counseling, although some do. Cognitive-behavior therapies are generally recommended, usually with an individual therapist. Schema therapy is one approach that has been lauded as having some success with this disorder, as it helps a client dig deep into the underlying beliefs which keep their narcissistic thoughts and behaviors going.
Once again, this is a long-term process that may take a year or longer for significant change. Individuals are often disruptive in group therapies, which is less recommended, as they may seek to draw all the attention to themselves. Therapists doing this type of work have to balance being supportive while helping the client challenge their self-defeating beliefs.
Histrionic Personality Disorder
This is a less common personality disorder, but it may be more easily attracted to individual therapy. These individuals tend to like being the center of attention, so talking with a therapist may feel rewarding. However, therapists must be careful not to simply be supportive and give advice but to ensure they expect such clients to actively try new behaviors. Otherwise, clients may simply enjoy telling dramatic stories without any change occurring in themselves.
As with narcissistic personalities, those with histrionic traits can be unhelpful in group therapies because of a drive to be the center of attention. Therapists must be careful not to let the client simply tell dramatic stories instead of getting down to work.
Antisocial Personality Disorder
This personality is also known as sociopathic, and many become involved with the criminal justice system. This is the personality that may be most in-born and the least likely to change. However, many individuals may be treatable in adolescence, especially through highly structured group programs. They have traditionally been thought to be not treatable, but some therapists report finding some success with moral recognition therapy. This approach is relatively new, and research suggests slight improvement. These individuals are discouraged from group therapies, as they can be disruptive by trying to undermine the leader and dominate the group.
Substance Abuse Treatment
According to research, people with Cluster B disorders have a higher incidence of substance abuse and addiction. Therefore, many end up in substance abuse treatment programs. Such programs can be helpful for those with these personality disorders because they are structured, expect personal accountability, and teach small self-management skills, all of which help reduce the impact of a personality disorder on the individual and those around them.
When there is a substance use disorder, it is usually recommended that a person get clean and sober before embarking on treatment for personality disorders. However, they do not necessarily need to wait too long to address both issues, as they often reinforce each other. Some substance abuse treatment programs now include treatments for personality disorders, such as DBT groups in outpatient drug treatment programs.
To find a therapist near you, visit the Psychology Today Therapy Directory.
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022, 734.