Personality Disorders 579
Boutilier, 2002). A shy and retiring boy may retreat from taking risks; his parents
may force him into anxiety-provoking social situations, where he may get rejected by
peers, increasing his trepidation about venturing into such situations again. His par-
ents may then get angry at him for being afraid. In contrast, parents who understand
their son’s temperament might gently encourage him to take social risks in a gradual
way, so that he might come to see that the feared humiliation or rejection doesn’t
materialize. Thus, two shy boys, growing up with different types of parenting, can
readily develop different views of themselves and the world (Pretzer & Beck, 2005).
And some of the resulting beliefs and attitudes may contribute to the child’s develop-
ing a personality disorder.
Treating Personality Disorders: General Issues
Rachel Reiland wanted to kill herself. She called a church-sponsored hotline, and
the hotline counselor convinced her not to be alone and to talk to her pastor. If she
didn’t show up at the pastor’s by a certain time, the counselor said that he’d call an
ambulance to get her. She arranged for a babysitter to watch the kids. Her pastor
persuaded her to go with him to the emergency room, where she was seen by mental
health clinicians and began treatment.
People with Axis I disorders often say that their problems “happened” tothem—the problems are overlaid on their “usual” self. They want the problems
to get better so that they can go back to being that usual self, and thus they seek
treatment. In contrast, people with personality disorders don’t see the problem as
overlaid on their usual self; by its very nature, a personality disorder is integral to
the way a person functions in the world. And so people with these disorders are
lesslikely to seek treatment unless they also have an Axis I disorder (in which case,
they typically seek help for the Axis I disorder; however, people with both a person-
ality disorder and an Axis I disorder generally respond less well to treatments that
target the Axis I disorder; Piper & Joyce, 2001).
Addressing and reducing the symptoms of a personality disorder can be challeng-ing because patients’ entrenched maladaptive beliefs and behaviors can lead them to
be less motivated during treatment and less likely to collaborate with the therapist.
Treatment that targets personality disorders generally lasts longer than does treat-
ment for Axis I disorders. Unfortunately, there is little research on treatment for
most personality disorders. The next section summarizes what is known about treat-
ing personality disorders in general; later in the chapter we discuss treatments for the
specifi c personality disorders for which there are substantial research results.
Targeting Neurological Factors in Personality Disorders
Treatments for personality disorders that target neurological factors include anti-
psychotics, antidepressants, mood stabilizers, or other medications. Generally, how-
ever, such medications are only effective for comorbid Axis I symptoms and not
very helpful for symptoms of personality disorders per se (Paris, 2005; 2008). Nev-
ertheless, some of these medications may provide temporary relief of some symp-
toms (Paris, 2003; Soloff, 2000).
Targeting Psychological Factors in Personality Disorders
Both cognitive-behavior therapy (CBT) and psychodynamic therapy have been used
to treat personality disorders. Both therapies focus on core issues that are theorized to
give rise to the disorders; they differ in terms of the specifi c nature of the inferred
core issues. Psychodynamic therapy addresses unconscious drives and motivations,
whereas CBT addresses maladaptive views of self and others and negative beliefs
that give rise to the problematic feelings, thoughts, and behaviors of the personality
disorder (Beck, Freeman, & Davis, 2004). In treating all personality disorders, CBT
is intended to increase the patient’s sense of self-effi cacy and mastery and to modify
the negative, unrealistic beliefs that lead to maladaptive behaviors.