Individuals with personality disorders are usually aware that their life is not going well. Approaching a friend about their painful feelings or the frustrations and disappointments in their life, and offering to listen, might be a way to help them consider treatment. If you have had a successful experience in therapy, share that with your friend, even if it wasn’t necessarily for “personality problems” (an off-putting term for many people). Most people with personality disorders enter treatment with another problem, such as depression, anxiety, substance use, a job loss, a romantic break-up, etc. The challenge is to get your friend “in the door,” so to speak, not to commit to long-term treatment at the beginning.
People with borderline personality disorder usually have significant problems in relationships. On the one hand, they can be very needy and clingy in relationships. On the other hand, they might push people away because they are insecure themselves and distrust others. They would rather be the one who leaves than the one who is left. To be able to tolerate the borderline person’s anger and aggression, family members must appreciate that the person with borderline personality disorder is reacting out of a sense of emotional pain and insecurity. That is not to say that family members should accept anger and abuse directed at them – limits must be set and clearly communicated. Family members must be able to walk away, if necessary, from a situation for their own good, and without guilt. To help a person with borderline personality disorder people need to respect themselves enough to protect themselves. If you let yourself be treated badly, you will react with anger, push your brother away and confirm his suspicion that you do not love him (enough).
Dialectical behavior therapy (DBT) is one type of psychotherapy that is effective in treating people with borderline personality disorder. Other effective psychotherapies include transference-focused psychotherapy (TFP), mentalization-based therapy (MBT), cognitive-behavioral therapy (CBT) and various forms of supportive psychotherapy. DBT was developed to treat self-harm and suicide-related behaviors (such as self-cutting and drug overdoses) that are common in people with borderline personality disorder. It seems to be particularly suited for these problems. DBT usually involves a weekly individual psychotherapy session and a weekly group session. The treatment helps by increasing a person’s awareness of the situations and feelings that lead to self-destructive acts, and by helping people learn ways to gain control over and manage emotions, feel more competent and able to handle relationships, and understand ways of dealing with painful feelings. Therapy ordinarily lasts a year, at least. Therapists should be well-trained.
Some theories of personality disorder view it as developmental delay, which a person may be able to grow out of. Studies show that a fair number of children and early adolescents report signs and symptoms consistent with a personality disorder. For many, these symptoms decrease over time. Children with more symptoms are at greater risk for being diagnosed with a personality disorder in early adulthood. So, on the one hand, it could be argued that time will address many personality problems. On the other hand, if a young person is at risk for a serious mental disorder that may have devastating effects, then early intervention and prevention should be recommended. Currently, this approach appears to be gaining steam. Clinics and therapists are increasingly recognizing and developing treatment interventions for personality disorder symptoms in children and adolescents.
Both borderline personality disorder and bipolar disorder involve impulsivity and unstable emotional experiences and mood. People with borderline personality disorder, however, also have problems in self-image and relationships. Specifically, individuals with borderline personality disorder have identity disturbances, such as an unstable sense of self and chronic feelings of emptiness. They also have relationships in which they alternate between extremes of seeing someone as good/worthy and seeing them as bad/worthless. They experience intense fears of abandonment by others on whom they feel dependent. Typically, the signs of borderline personality disorder are evident over at least several years (although they appear to wax and wane over time), while the signs and symptoms of bipolar disorder appear in episodes.
According to DSM-5*, a person can receive more than one personality disorder diagnosis. People who are diagnosed with a personality disorder most often qualify for more than one diagnosis. A person with a severe personality disorder might meet the criteria for four, five or even more disorders! In practice, clinicians usually recognize that meeting more criteria for personality disorders means more severe disorder.
*Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association. (2022).
Schizotypal personality disorder involves a pattern of social and interpersonal problems and extreme discomfort with close personal relationships. Individuals with schizotypal personality disorder also experience distorted thinking and perception, and they have odd behaviors. Schizophrenia involves psychotic symptoms, such as delusions, hallucinations and disorganized speech. Schizophrenia also involves “negative symptoms,” such as limited emotional expression. Individuals with schizotypal personality disorder rarely become psychotic in the sense of being unable to tell the difference between reality and the products of his/her mind. However, there are similarities in the genetics and neurobiology of schizotypal personality disorder and schizophrenia, so schizotypal personality disorder is often considered to be on the “schizophrenia spectrum.”