Personality disorders

Diagnosis

Finding out if you have a personality disorder may involve:

• A physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, your doctor may link your symptoms to an underlying physical health concern. Your evaluation may include lab tests and a screening test for alcohol and drugs.
• A mental health evaluation. Your doctor may refer you to a mental health professional. This evaluation includes a discussion about your thoughts, feelings and behavior, and it may include a questionnaire to help pinpoint a diagnosis. With your permission, information from family members or others may help.
• Comparing your symptoms to standard guidelines. Your mental health professional may compare your symptoms to the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association.
• Neuropsychological testing. Your doctor may refer you to a neuropsychologist or clinical psychologist for personality or cognitive testing to better understand how you see and interpret the world around you.

Sometimes it's hard to find out the type of personality disorder because there's a lot of overlap between types of personality disorders. Other mental health conditions, such as depression, anxiety, post-traumatic stress disorder, eating disorders or substance abuse, may make it harder to know which personality disorder a person has or if a person has a personality disorder at all. It's worth the time and effort to get a correct diagnosis so that you get the proper treatment.

Treatment

The treatment that's best for you depends on your personality disorder, how serious it is and your life situation. Often, a team approach is needed to meet your mental, medical and social needs. You may need to be treated for months or years.

Your treatment team may include your doctor and a:

• Psychiatrist.
• Psychologist or another therapist.
• Psychiatric nurse.
• Pharmacist.
• Social worker.

Dialectical behavioral therapy, a form of psychotherapy that also is known as talk therapy, is the main way to treat personality disorders. Medicines also may be used during treatment.

Dialectical behavioral therapy

Dialectical behavioral therapy (DBT), a form of talk therapy, is used to treat personality disorders. This therapy focuses on treating dangerous behavior, including behavior that can lead to suicide, as well as behavior that can get in the way of treatment or affect quality of life.

DBT consists of weekly one-on-one sessions with a therapist. Treatment can last for about a year.

Therapists treating patients using DBT regularly attend a consultation group where they talk about issues related to treatment. DBT therapists also are available by phone or other means so they can provide coaching to help make sure that treatment talked about during sessions is applied in real life.

This therapy also includes modules on:

• Controlling your emotions.
• Handling distress.
• Practicing mindfulness.
• Effectively relating with other people.

This therapy has been shown to be effective for adolescents and adults, but a group certified in DBT is essential.

Medicines

The Food and Drug Administration (FDA) has not approved any medicines to treat personality disorders specifically. But several types of psychiatric medicines may help with personality disorder symptoms:

• Antidepressants. Antidepressants may help if you feel depressed, angry, impulsive, irritable or hopeless. These symptoms may be related to personality disorders.
• Mood stabilizers. These medicines can even out mood swings or reduce how irritable, impulsive and aggressive you are.
• Antipsychotic medications. These medicines, also called neuroleptics, may help if your symptoms include losing touch with reality. This is known as psychosis. They also may help with some anxiety or anger issues.
• Anti-anxiety medications. These medicines may help if you are anxious, agitated or cannot sleep. But in some cases, they can make you more impulsive. That's why they are not used with some types of personality disorders.

Hospital and residential treatment programs

In some cases, a personality disorder may be so serious that you need to stay in a hospital for mental health care. This is generally recommended only when you cannot care for yourself properly or when you're in immediate danger of harming yourself or someone else. After you become stable in the hospital, your mental health professional may recommend a day hospital program, residential program or outpatient treatment.

Lifestyle and home remedies

Along with your treatment plan, it's also important to:

• Take part in your care. This can help you manage your personality disorder. Do not skip therapy sessions, even if you do not feel like going. Therapy can take 6 to 12 months. Think about your goals for treatment and work toward achieving them.
• Take your medicines as directed. Even if you're feeling well, do not skip your medicines. If you stop, your symptoms may come back. You also could experience withdrawal-like symptoms from stopping a medicine too quickly.
• Learn about your condition. Knowing more about your condition can motivate you to follow your treatment plan.
• Get active. Physical activity can help manage many symptoms such as depression, stress and anxiety. You can walk, jog, swim or garden — or take up another form of physical activity that you enjoy.
• Stay away from drugs and alcohol. Alcohol and street drugs can make personality disorder symptoms worse or affect how a medicine works.
• Get routine medical care. Do not ignore checkups or skip visits to your doctor, especially if you are not feeling well. You may have a new health concern that needs to be discussed, or you may be feeling the side effects of a medicine.

Coping and support

Having a personality disorder makes it hard to take actions that may help you feel better. Doctors or mental health professionals can help you learn better coping skills and get the support you need.

If your loved one has a personality disorder

If you have a loved one with a personality disorder, work with their mental health professional to find out how you can offer support and encouragement.

You also may benefit from talking with a mental health professional about your worries. A mental health professional can help you set limits and learn ways to care for yourself so that you can enjoy life more.

Preparing for your appointment

Because personality disorders often need care from a specialist, your doctor may refer you to a mental health professional, such as a psychiatrist or psychologist. Taking a family member or friend along can help you remember something that you might have missed or forgot.

What you can do

Prepare for your appointment by making a list of:

• Your symptoms, including any that do not seem to be related to the reason for the appointment.
• Key personal information, including any major stresses or recent life changes.
• All medicines, including medicines available without a prescription, vitamins, herbal preparations or other supplements that you take — and the doses.
• Questions to ask your doctor or mental health professional.

Basic questions to ask your doctor include:

• What type of personality disorder do I have?
• How do you treat my type of personality disorder?
• Will talk therapy help?
• Can medicines help?
• How long will I need to take medicine?
• What are the major side effects of the medicines you're recommending?
• How long will treatment take?
• What can I do to help myself?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend visiting?

Do not hesitate to ask any other questions during your appointment.

What to expect from your doctor

During your appointment, your doctor or mental health professional will likely ask you several questions about your mood, thoughts, behavior and urges, such as:

• What symptoms have you noticed or have others said they notice in you?
• When did you or they first notice symptoms?
• How do your symptoms affect your daily life?
• What other treatment, if any, have you had?
• What have you tried on your own to feel better or control your symptoms?
• What things make you feel worse?
• Have your family members or friends made any comments about your mood or behavior?
• Have any relatives had mental health conditions?
• What do you hope to gain from treatment?
• What medicines, vitamins, herbs or supplements do you take?