Personality Disorders

A personality disorder is diagnosed with people who show chronic patterns of thought and behavior that cause great difficulty dealing with others. Most people with personality disorders are inflexible and rigid and are often distressed. Personality disorders typically emerge during adolescence and do not change or improve significantly over time. Self-destructive behaviors, addictions, and legal problems are more common for people with personality disorders. The exact cause of personality disorders is unclear. However, genes and difficult childhood experiences appear to play a role.

People with personality disorders show little awareness of their difficulties and tend to believe their problems are caused by others or by life circumstances. As a result, they are less likely to seek treatment and adhere to treatment recommendations than others. For many years, it was believed that people with personality disorders do not respond to treatment. However, over the past several years several psychotherapeutic treatment approaches have proven effective to treat personality disorders.

Much attention has recently been given to Borderline Personality Disorder (BPD). The essential feature of BPD is a pervasive pattern of instability of interpersonal relationships, self-image, and emotions, and marked impulsivity that begins by early adulthood and is present in a variety of contexts. This instability often disrupts the sense of self-identity. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts. BPD is common, affecting two percent of adults, and is seen mostly in women.

I am trained and experienced in the following empirically supported treatments for BPD:

Transference Focused Psychotherapy (TFP) – a psychodynamic treatment developed by Dr. Otto Kernberg. This treatment is based on the assumption that the specific symptoms of BPD are caused by a disruption in the development of normal psychological structures during childhood. According to this approach, patients experience a fundamental internal split in the way they experience themselves and others. TFP uses the patient-therapist relationship in order to achieve a greater integration of the patient’s perceptions of self and others.

Dialectical Behavior Therapy (DBT) – a specialized form of cognitive behavior therapy, developed by Dr. Marsha Linehan. DBT was originally designed for the treatment of suicidal patients, but was proven effective for various emotional symptoms. DBT assumes that invalidating environments during childhood and biological predisposition, lead patients to react in extreme ways to emotional stimulations. In DBT patients learn skills to better react to strong emotions, to tolerate distress and improve interpersonal effectiveness.