Experts Tell Us Personality Disorders Are Curable, But Are They Really?

About 9 percent of Americans suffer from a personality disorder: A type of mental health condition that causes long-term patterns of inflexible and unhealthy ways of thinking, functioning and behaving.

It's common for people living with a personality disorder to encounter problems at work, school and in their relationships because they don't perceive the world or specific situations in the same way others do, often resulting in difficulties relating to other people, according to the Mayo Clinic.

Royce Lee, an associate professor of psychiatry and behavioral neuroscience at the University of Chicago, explained that the "cure metaphor" may not be quite right in the case of personality disorders.

"A personality disorder isn't a disease—it's not like neurosyphilis or Parkinson's," Lee said. "There's really nothing strikingly different about brain or brain function in people with personality disorders."

That being said, Lee did say there have been brain changes detected in people with personality disorders that are similar to those seen in people with specialized occupations.

"So for example, there are famous studies of London taxi cab drivers, where a certain part of their brain grows a little bit because they're using that part of their brain involving the complex map of London. Or professional dancers may develop dystonia because they're over-using a certain part of their brain for muscle coordination," he said. "So we think that problems that people with personality disorders have are sort of like those kinds of problems. And that means they absolutely can get better."

In order to fully understand how personality disorders can get better over time, it helps to first take a closer look at the different kinds of personality disorders and how they're typically treated.

Martin Drapeau, a clinical psychologist and professor at McGill University who conducts research on and teaches about best practices in mental health, explained that experts don't quite understand what exactly causes personality disorders, although genetic, social and psychological factors are likely to play a role.

"Trauma, neglect and abuse as a child is associated with some personality disorders although it is unclear if these factors are truly causal and for what disorders specifically," Drapeau said.

There are 10 types of personality disorders, which are all organized into clusters. The personality disorders within each cluster share similar characteristics and symptoms.

People who have a personality disorder that falls within Cluster A typically have odd and eccentric ways of thinking and behaving, according to the Mayo Clinic. Cluster A includes paranoid personality disorder, schizotypal personality disorder and schizoid personality disorder.

Cluster B is made up of antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder. Symptoms for the disorders in Cluster B usually include behavior and thinking that is unpredictable, dramatic and excessively emotional.

Borderline personality disorder (BPD) is one of the most well-known disorders in Cluster B. For people with BPD, these symptoms often manifest in impulsive and risky behaviors, affecting every area of life—including their sex life, as one of the common symptoms of BPD is unsafe sexual promiscuity.

"Cluster B (personality disorders) are particularly difficult because they often involve a lot of acting out through impulsive behaviors," Drapeau said. "That may include suicidal acting out, but also a lack of impulse control that leads to drinking and driving, having unprotected sex, etcetera."

Lee added that it's important to remember the clustering system is only an approximation used to identify patterns and isn't completely precise. In fact, when it comes to actually diagnosing personality disorders, the field is moving toward looking at them through less of a qualitative, categorical lens and more of a quantitative, dimensional one, where individual personality traits are given a score from 0-100.

A dimensional approach is thought to allow for more specificity in quantifying what personality traits a person has rather than categorizing individuals based on broader symptoms and traits.

"I don't think there's any easy way to simplify the pattern, but generally, we could say that the Cluster B disorders are what we sometimes call the externalizing disorders," Lee explained. "The problems associated with these disorders often lead to impulsivity and relationship problems and maybe also some medical problems like suicide or even aggression. And if we think about personality problems dimensionally, they all seem to be somewhat interrelated with each other. So if you have one, say you have a borderline personality disorder, you're very likely to meet the criteria for another disorder as well."

The hallmark symptoms of Cluster C personality disorders are anxiety, fearful thinking and behavior. Cluster C includes avoidant personality disorder, obsessive-compulsive personality disorder and dependent personality disorder.

In order to receive a diagnosis with a personality disorder, an individual first must undergo a physical exam and a psychiatric evaluation, and then a mental health professional will compare their symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) published by the American Psychological Association.

That being said, the Mayo Clinic reports that it's often difficult to determine what type of personality disorder a person may have because most share common symptoms. It's also worth noting other mental health issues like depression, anxiety or substance abuse can make confirming diagnosis more difficult, too.

"Psychiatric disorders all face the same kinds of scientific problems in our understanding," Lee said. "And so most of us in the field accept that the diagnostic classification is very imperfect. And when we try to apply it to real people in the clinic, sometimes there's a good match. But usually, it's only approximate. And generally, science tells us when we can diagnose one problem, whether it's depression or personality disorder, we're going to find many other problems. And we call that the comorbidity problem."

Since personality disorders vary greatly in their degree and symptoms, treatment looks different for everybody.

The most common treatment for personality disorders is psychotherapy in which an individual talks with a mental health professional to learn more about how their moods, thoughts and behaviors operate so they can then begin to learn various coping strategies to manage the stress and symptoms associated with the disorder.

There are different types of psychotherapy, all of which can be conducted individually, in groups or sessions that include loved ones. Ultimately, you'll need to talk to a mental health professional to determine what form of therapy is right for you. It's also important to remember—because of the nature of personality disorders—that it's not uncommon for treatment to be needed long term.

There are no medications specifically for the treatment of personality disorders that are approved by the Federal Drug Administration (FDA), although antidepressants, mood stabilizers, antipsychotic medications and anti-anxiety medications are sometimes used to address specific symptoms of personality disorders.

Drapeau noted that while treatment may be necessary if the person with the personality disorder or those around them are struggling because of it, there are plenty of times when treatment isn't strictly needed.

"Some people with some personality disorders will in fact never seek therapy for their personality disorder," Drapeau explained. "Just think of the narcissistic personality disorder as an example. They won't seek services for their personality disorder per se, although they can of course seek services for depression or anxiety for example. Having a personality disorder will require treatment if the person suffers or those around them suffer."

Lee also highlighted treatments such as dialectical behavioral therapy have proven to be extremely effective in helping people with personality disorders dramatically improve their symptoms in only a year.

"We know that these things are very treatable," Lee said. "And we even see some mild cases where a personality disorder can go away, possibly on its own. One thing that we see in longitudinal studies of brain function in people with personality disorders is that there's change over time. And there is also a natural process of brain maturation that we now realize lasts a little bit longer than we used to think. We used to think brain maturation was finished in late teen years, but now we know it extends all the way to the 30s. And so not surprisingly, we see a lot of personality disorder symptoms get a little bit better as the brain matures."

In addition to natural brain maturation that can sometimes have a positive impact on the symptoms associated with a personality disorder, other factors are at play.

"There's also people changing their lives, maybe getting out of a bad situation;. Maybe they're also going into treatment," Lee said. "And then finally, and very importantly, many people with personality disorders have been traumatized. So either in the form of childhood trauma or adult trauma, those people may often suffer from PTSD in addition to the personality disorder. But as the PTSD is addressed and starts to get better, a lot of other things can get better at the same time, including many personality disorder symptoms."