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In addition, because people with personality disorders may not be motivated
to address the problems associated with the disorder, treatment may employ mo-
tivational enhancement strategies to help patients identify goals and become
willing to work with the therapist. In general, guidelines for treating personality
disorders should be comprehensive, consistent, and fl exible enough to address the
myriad types of problems that these disorders create for the person and for others
(Critchfi eld & Benjamin, 2006; Livesley, 2007).
Treatment that targets psychological factors has been studied in depth only for
borderline personality disorder; we examine such treatment in the section discuss-
ing that personality disorder.Targeting Social Factors in Personality Disorders
Guidelines for treating personality disorders also stress the importance of the re-
lationship between therapist and patient, who must collaborate on the goals and
methods of therapy (Critchfi eld & Benjamin, 2006). In fact, the relationship be-
tween patient and therapist may often become a focus of treatment as the patient’s
typical style of interacting with others plays out in the therapy relationship. This
relationship often provides an opportunity for the patient to become aware of his
or her interaction style and to develop new ways to interact with others (Beck,
Freeman, & Davis, 2004).
Family education, family therapy, or couples therapy can provide a forum for
family members to learn about the patient’s personality disorder and to receive
practical advice about how to help the patient—for example, how to respond when
the patient gets agitated or upset. Family therapy can provide support for families
as they strive to change their responses to the patient’s behavior, thereby chang-
ing the reinforcement contingencies (Ruiz-Sancho, Smith, & Gunderson, 2001). For
instance, if family members are trying to respond differently to a patient’s overly
dramatic and emotional requests for money (“I just have to buy that dress, or
I won’t be able to go out in public”), family therapy can help them use more effec-
tive and less punitive ways of communicating and learn to set limits (for instance,
not give more money to the patient).
In addition, interpersonal or group therapy can highlight and address the
maladaptive ways in which patients relate to others. Therapy groups also provide
a forum for patients to try out new ways of interacting (Piper & Ogrodniczuk,
2005). For example, if a man thinks and acts as if he is better than others, the com-
ments and responses of other group members can help him understand how his
haughty and condescending way of interacting creates problems for him.Key Concepts and Facts About Diagnosing Personality Disorders
- A personality disorder is characterized by maladaptive person-
ality traits that begin by young adulthood and continue through
adulthood; these traits are relatively infl exible, are expressed
across a wide range of situations, and lead to distress or im-
paired functioning. A personality disorder affects three areas
of functioning: affect, behavior (including social behavior), and
cognition. - The diagnostic criteria for personality disorders were based on
the assumptions that maladaptive personality traits begin in
childhood and are stable throughout life. These assumptions
led to the disorders’ being placed on a separate axis (Axis II)
of DSM-IV-TR. Subsequent research indicates that some Axis I
disorders begin in childhood and that symptoms of personality
disorders may improve over time.- Personality disorders may be assessed through diagnostic
interviews, personality inventories, or questionnaires. The cli-
nician may make the diagnosis based on the pattern of the pa-
tient’s behavior and, given the preponderance of interpersonal
problems that arise with personality disorders, may also rely
on supplemental reports from family or friends.