People with a personality disorder experience severe distress often on a daily basis. Many have seen their plans for the future and their relationships with others get derailed over and over again. These recurrent experiences can lead to despair, hopelessness, and an experience of the world as unfair.
Personality disorders are caused by a complex interplay of genetic, temperamental, and developmental conditions. The American Psychiatric Association (DSM V, 2013) defines personality disorders as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: 1) Cognition (i.e. ways of perceiving and interpreting self, other, people, and events); 2) Affectivity (i.e. the range, intensity, lability, and appropriateness of emotional response); 3) Interpersonal functioning; and 4) Impulse control.” Further, this enduring pattern is “inflexible and pervasive across a broad range of personal and social situations” and leads to “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” In 2007, NIMH-funded research reported that roughly nine percent of U.S. adults have a personality disorder (Biological Psychiatry, 2007).
I worked for six years as a Supervising Psychologist at the Center for Intensive Treatment of Personality Disorders at Mount Sinai West in New York City (CITPD), and during that time, I worked as a psychotherapist with many patients who had personality disorders. At CITPD, I saw patients experience a decrease in their symptoms, including a reduction in self-harming and other risky behaviors. Many patients at CITPD also increased their capacity to regulate and tolerate their feelings, and they improved their day to day functioning as well as their interpersonal skills.
In treating patients with personality disorders in my private practice, I make use of psychodynamic therapy and Dialectical Behavioral Therapy – both evidence-based treatments for personality disorders. Treating a personality disorder in my private practice may also entail a referral to a DBT Group in order to accelerate and strengthen progress with new skills. If a patient with a personality disorder is experiencing significant psychiatric distress, I may recommend a consultation with a psychiatrist who would assess the need for psychotropic medications as an adjunct to therapy.