Abstract
Introduction: Personality disorder is the most common of all psychiatric disorders and is best perceived as a diagnostic spectrum extending from no personality dysfunction to severe personality disorder. The position of each person on the spectrum is determined mainly by problems in interpersonal social dysfunction, self-perception and awareness, and dangers to the self and others.
Areas covered: In this review, the authors examine the psychological and psychodynamic treatments, pharmacotherapy, neuromodulation and other related approaches, environmental treatments and therapeutic communities. Although many published studies refer to individual categories these are now linked to the diagnostic spectrum in this review.
Expert opinion: There is some evidence that focused psychological treatments linked to education, particularly systems training for emotional predictability and problem solving (STEPPS), mentalization based therapy and dialectical behavior therapy, are successful in treating moderately severe personality disorder, especially regarding self-harm but there is also benefit from well organized standard care that is similarly effective. There is no good evidence that drug treatment is of any more than transient or limited benefit in all forms of personality disorder. Brain stimulation approaches have limited evidence. Psychodynamic approaches, environmental interventions, nidotherapy and therapeutic communities appear to be of some value, but good data are few. There are few long-term studies of treatment effectiveness but enough data to show that personality disorder can remit, and more attention needs to be made to adjusting to the problems of personality disorder rather than removing core features.