Personality disorders: diagnosis and treatment

Personality disorders are generally treatable, although therapy is often lengthy and often requires a considerable amount of patience and endurance from the sufferers (and therefore their immediate environment).

How is a personality disorder diagnosed ?

Diagnosis requires knowledge, experience and intuition and is usually performed by a psychiatrist or psychotherapist . A clinical psychologist may also be invited to establish the diagnosis . A correctly determined diagnosis makes it easier to find a suitable form of treatment so that the affected person can lead as full a life as possible. In the Czech Republic, the International Classification of Diseases ( ICD-10 ) or some other international diagnostic schemes (e.g. DSM-5 ) are used to diagnose personality disorders .

According to ICD-10, the diagnostic criteria for a personality disorder include the following:

• The persistent patterns of behavior characteristic of the respective personality disorder (see the article Personality disorders: an overview of the different types ) differ significantly from generally accepted cultural values ​​overall in the following areas: cognition , affectivity (expressing and experiencing feelings), control of impulsivity, fulfillment of needs, and interpersonal relationships.
• The resulting behavior is inflexible, inappropriate or inappropriate in many situations.
• The affected person feels psychological tension, and can transfer it to his immediate surroundings.
• The symptoms of the personality disorder have lasted for a long time, they began to manifest themselves in older school age or during adolescence. However, it is not excluded that personality disorders only become apparent with age, often in connection with attempts to manage the symptoms of aging.
• The observed pattern of behavior is not caused by another psychological disorder, or is not a consequence of it. At the same time, it is possible that at the same time as the personality disorder, another mental illness may occur , which may come to the fore.
• An organic cause or functional brain disorder is clearly excluded .

In order for a specialist to rule out a physical illness (e.g. changes to the brain), it is necessary to undergo a medical examination. In the anamnestic interview (often with relatives), important life events and previous illnesses are ascertained – i.e. everything that could have an influence on the emergence of a personality disorder. Persons suffering from a personality disorder have an increased risk of developing other mental illnesses as well as the risk of suicide .

How is personality disorder treated?

It is usually difficult for disabled people to seek help. Many of them do not even recognize that they need help. It often happens that advice or treatment is sought by people from their immediate environment, who do not know how to deal with the behavior of their loved one, but their efforts are not successful – on the contrary, they work on their own mental problems. The treatment of personality disorders takes some time, but in principle these disorders are treatable.

Principles of treatment

Treatment is based on several basic pillars: psychotherapy (including psychoeducation , i.e. the affected person learns to better understand his disorder and live with it), sociotherapy, (re)acquisition of social skills , provision of basic social needs and rehabilitation . In the course of treatment, among other things, disabled people individually learn new ways of behaving and looking at their surroundings, and subsequently try to use them in everyday life.

In the framework of group psychotherapy, disabled people can primarily point out the differences between how they perceive their surroundings and how others perceive them, experience togetherness in a protected environment and support each other.

Depending on the symptoms of the affected person, or whether they have been diagnosed with another disease or disorder at the same time, the doctor may also prescribe certain drugs (e.g. anxiolytics , drugs to reduce anxiety). Antidepressants , mood stabilizers or even antipsychotics are relatively often prescribed . In connection with personality disorders, these drugs can be used to prevent or alleviate anxiety states, impulsive behavior, but also delusions and distorted thinking and perception.

Note: Your attending physician or pharmacist will inform you about the effects, side effects and drug interactions .

The problems with which the disabled have to fight (closeness/distance, trust, etc.) do not make the treatment itself any easier, on the contrary. Quite often it happens that the affected person (or his immediate surroundings) cannot persevere in the treatment. It is therefore very important that all participants gradually build trust in the therapist .

Psychotherapy

As part of psychotherapy, various methods have been gradually developed that focus on the treatment of personality disorders, e.g. psychotherapy focused on transference (sometimes the abbreviation TFP from the English term transference focused psychotherapy ) or therapy focused on schemas (abbreviation SFT, from the English schema-focused therapy ). Depending on the type of personality disorder, the specialist will choose an appropriate approach. So far, the best researched is therapy for emotionally unstable personality disorder (borderline type). Dialectical-behavioral therapy (abbreviation DBT, from English dialectical behavior therapy ) and therapy based on mentalization (abbreviation MBT, from English mentalisation-based therapy ) are used in it .

During treatment, it is necessary to take into account possible comorbidities , i.e. other diseases or disorders occurring at the same time as the personality disorder (e.g. addiction , depression , etc.).

Who can I contact?

If you suspect that you suffer from a personality disorder, or if you would like to help someone close to you, or if you yourself need mental support as a relative of an affected person, the best advice is a psychiatrist or psychotherapist. Child psychiatrists specialize in psychiatric care for children and adolescents (under 18). You can also contact a clinical psychologist.