Personality disorders

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What treatments are available?

There are a range of treatments that can help you if you experience a personality disorder. These include:

• talking therapies
• therapeutic communities
• medication.

For information on how to access treatment for a personality disorder and how to have a say in your treatment, see our information on:

• getting access to treatment
• having a say in your treatment.

"All my life I have felt different, alienated and completely alone. It is only since my diagnosis of BPD that I began to understand why and, with help, to realise that I could actually do something to change those feelings and feel that I can achieve a life worth living."

Talking therapies

More research needs to be done into which talking therapies can help people with personality disorders. The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – suggests that the following kinds of talking therapies may be helpful:

• Dialectical behaviour therapy (DBT) – a treatment specifically developed for borderline personality disorder (BPD). It uses individual and group therapy to help you learn skills to manage your emotions. See our pages on DBT for more information.

"The one-to-one sessions I received were invaluable. My therapist was able to help me understand the DBT skills I was learning and help me to apply them to my life. My greatest lesson was to learn to fail and to accept that this and continued practise was the key to using DBT."

• Mentalisation-based therapy (MBT) – a long-term talking therapy which aims to improve your ability to recognise and understand your and other people's mental states, and to help you examine your thoughts about yourself and others to see if they're valid.

"Mentalisation is best summed up as "thinking about thinking". It is being able to understand our own mental state and that of other people, and how this effects our behaviour. I identified with it immediately, as I really struggle with identifying what my emotions are and where they come from."

NICE says that other types of talking therapy could also potentially be helpful, including the following:

• Cognitive behavioural therapy (CBT) – aims to help you understand how your thoughts and beliefs might affect your feelings and behaviour. See our pages on CBT for more information.
• Cognitive analytic therapy (CAT) – combines CBT's practical methods with a focus on building a trusting relationship between you and your therapist who will help you make sense of your situation and find new, healthier ways to cope with your problems.
• Other talking therapies – such as schema-focused cognitive therapy, psychodynamic therapy, interpersonal therapy or arts therapies. See our pages on talking therapies and arts therapies for more information.

Therapeutic communities

Therapeutic communities are programmes where you spend time in a group supporting each other to recover, with the help of a facilitator. Most therapeutic communities are residential (often in a large house) where you might stay for all or part of the week. Activities can include different types of individual or group therapy, as well as household chores and social activities. The Consortium for Therapeutic Communities provides a directory of therapeutic communities in the UK.

"I spent 18 months as part of a Therapeutic Community, and I'm not exaggerating when I say it's changed my life. My mood swings are far less frequent, and it's rare that they reach the extremes that they used to."

Medication

There are no drugs specifically licensed for the treatment of personality disorders. Many people with personality disorders also have other mental health diagnoses though, such as depression, anxiety or psychosis, and may be prescribed medication for these.

These medications could include antidepressants, antipsychotics or mood stabilisers.

Where can I get treatment?

• Whether a treatment is available in your area will depend on where you live. To get treatment through the NHS you should first visit your GP, who can refer you to your local community mental health team (CMHT) for an assessment.
• In some areas there may be services that allow you to get in touch yourself and ask to be referred for treatment, which is called self-referral. You can talk to your CMHT for advice on self-referrals.

If you receive NHS treatment, it should be in line with NICE guidelines. These say that:

• Anyone with possible personality disorder should have a structured assessment with a mental health specialist before being given a diagnosis.
• You should have a say in the type of treatment you’re offered. If you’re not getting the type of treatment you think would most help you, it could help to talk to an advocate. See our pages on advocacy for more information.

You can read the principles of care for people with a personality disorder and full guidelines and additional recommendations for BPD in English or Welsh on the NICE website. For details of specialist services in the UK, see the UK Department of Health’s personality disorder website.

Can I go private?

Waiting times for talking treatments on the NHS can unfortunately be long. If you feel that you don’t want to wait and you can afford the expense, or would like to see a therapist who specialises in the types of experiences you have had, you may choose to see a counsellor or psychotherapist privately.

See our pages on seeking private sector therapy for more information.

Talking about borderline personality disorder (BPD)

Lechelle and Debbie talk about having borderline personality disorder and how a combination of medication and dialectical behaviour therapy (DBT) has helped them develop the skills to manage it.

How can I have a say in my treatment?

A really important factor in your treatment is the relationship you form with the professionals who are helping you – whether they are a social worker, psychiatric nurse, therapist or psychiatrist. Having good treatment also depends on you being actively involved in it and having your say. You should expect to:

• Have your say in treatment – your GP or psychiatrist should discuss all your treatment options with you, and your views and preferences should always be taken into account when making decisions about your treatment. See our pages on seeking help for a mental health problem for more information on having your say.
• Be involved in your care plan – a care plan is an agreement between you and the professionals you're working with, about what you want to get out of your treatment. It should include the problems you want help with, any treatments you may need and planning for a crisis.

"It was only when I met some dedicated professionals willing to go that extra mile that I started to change and believe in myself. I was able to begin therapy and develop a good trusting relationship which has been consistent and secure."

This information was published in January 2020. We will revise it in 2023.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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