Can People with Cluster B Personality Disorders Change?
© by Bill Eddy, LCSW, Esq.
It’s not unusual these days for employers, therapists, lawyers, judges, mediators, and sometimes family members to realize that they are dealing with someone with a personality disorder. Slightly more than ten percent of adults are considered to have a personality disorder according to the diagnostic manual for mental health professionals and approximately 4.5% have a Cluster B personality disorder (narcissistic, borderline, antisocial, and histrionic). Often the people around the person want to help, yet such a person usually rejects help and does not agree that they have a problem. While most personality disorders do not change much over a lifetime, some can change. If you think you know someone like this, seek professional advice rather than trying to change the person yourself, which usually backfires and makes things much worse – sometimes for months or even years. The following article gives an overview of this issue, which was first published on the PsychologyToday.com website.
The manual of mental disorders of the American Psychiatric Association (presently the DSM-5-TR) defines a personality disorder as “An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.” It is manifested by problems in at least two of these areas: “perceiving oneself, others and events;” “appropriateness of emotional responses;” “interpersonal functioning;” and/or “impulse control.” Traditionally, this has meant that those with personality disorders were not expected to be able to ever change their behavior. For this reason, many mental health professionals and insurance companies would not provide treatment for personality disorders. In addition, most people with personality disorders do not know they have this disorder, do not believe they have a problem, and therefore do not seek therapy for it.
However, over the past 2-3 decades there has been growing knowledge about personality disorders and some successful efforts to provide treatment for them. It’s not unusual these days for employers, therapists, lawyers, and sometimes family members to realize that they are dealing with someone with a personality disorder. This means that the person may have a rigid pattern of dysfunctional interpersonal behavior that includes distortions of their sense of self, events, and others; may have extreme and unmanaged emotions; and may have behavior that is well outside of the norm for our society. Slightly more than ten percent of adults are considered to have a personality disorder according to the DSM-5-TR, the diagnostic manual for mental health professionals.
Some are considered more amenable to treatment now, but their “enduring patterns” generally make them more difficult to treat than substance use disorders, for example, which many with PDs also have. Since the DSM indicates that more than 10% of adults may have a personality disorder and 4.5% have a Cluster B personality disorder, many of those around them may wonder about (and hope) they can change. This blog is a brief introduction to this important subject and not an in-depth review.
It is helpful to know that there is no medication for treating personality disorders at this time, whereas there is for most other forms of mental illness, because personalities develop over many years and changing them is like learning a new language and culture. However, if they have another problem, such as depression or anxiety, then medications which help manage these issues can be helpful to stabilize those with personality disorders.
Borderline Personality Disorder
In recent years, Dialectical Behavior Therapy (DBT) has become well-known to mental health professionals as an effective treatment that helps clients manage their wide mood swings, their extreme (all-or-nothing) thinking, and aggressive behavior towards those close to them. Various therapists and studies indicate that one to five years of this counseling method may help a person potentially outgrow the diagnosis of borderline personality disorder. The ideal format of this method includes three parts: a group therapy for learning self-management skills, an individual therapist, and a consultation group for therapists to help them maintain their energy and knowledge for working with repeatedly angry clients. Many people with this disorder have been helped by this and similar cognitive-behavioral methods (ones that focus on changing one’s thinking and way of behaving). Therapists doing this work have to balance being supportive with guiding the client to apply DBT methods.
Narcissistic Personality Disorder
Fewer people with this disorder seek counseling, although some do. Cognitive-behavior therapies are generally recommended, usually with an individual therapist. Schema therapy is one approach that has been lauded as having some success with this disorder, as it helps the client dig deep into the underlying beliefs which keep their narcissistic thoughts and behaviors going. Once again, this is a long-term process which may take a year or longer for significant change. They are often disruptive in group therapies, which are less recommended, as they seek to draw all the attention to themselves. Therapists doing this type of work have to balance being supportive while also helping the client challenge their own self-defeating beliefs.
Histrionic Personality Disorder
This is a less common personality disorder but may be more easily attracted to individual therapy. They like to be the center of attention so that talking with a therapist may feel rewarding. However, therapists must be careful not to simply be supportive and give advice, but instead to make sure they expect such clients to actively try new behaviors. Otherwise, those with this personality may enjoy telling dramatic stories without any change occurring in themselves. As with narcissistic personalities, those with histrionic traits can be unhelpful in group therapies because of a drive to be the center of attention. Therapists must be careful not to let the client simply tell dramatic stories instead of getting down to work.
Antisocial Personality Disorder
This personality is also known as sociopathic and perhaps half become involved with the criminal justice system. This is the personality that may be most in-born and the least likely to change at all. However, in adolescence many of them may be treatable, especially with highly-structured group programs. They have traditionally been thought to be not treatable at all, but some individual therapists report finding some success with moral reconation therapy. This approach is relatively new and research suggests slight improvement. They are discouraged from being involved in group therapies, as they can be disruptive by trying to undermine the group leader and trying to dominate the group.
Substance Abuse Treatment
People with these disorders have a higher incidence of substance abuse and addiction, according to research. Therefore, many end up in substance abuse treatment programs. Such programs can actually be helpful for those with these personality disorders, because they are structured, expect personal accountability, and teach small skills of self-management, all of which helps them reduce the impact of their personality disorder on themselves and those around them. When there is a substance use disorder, it is usually recommended that they get clean and sober first before embarking on treatments for personality disorders. However, they do not necessarily need to wait too long to address both issues, as they often reinforce each other. Some substance abuse treatment programs now have treatments for personality disorders included, such as DBT groups in outpatient drug treatment programs.
Conclusion
Personality disorders are as big a problem in society as substance abuse, yet little discussed and recognized. With more awareness, there is hope for the future.
