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Personality Disorders Change Over Time

'Flamboyants' Get Better, Others Get Worse

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How do you recognize a personality disorder? Andrew E. Skodol, MD, is professor of clinical psychiatry at New York's Columbia University and is deputy director of the New York State Psychiatric Institute. He leads a large, long-term study that is looking at people with personality disorders.

"Personality disorders are personality gone awry," Skodol tells WebMD. "They are maladaptive and inflexible patterns of looking at the world, relating to others, or viewing oneself. The personality becomes extreme and sort of fixed so that things may be going wrong in a person's life but they can't seem to change their attitudes or styles. I think that people who are experiencing adaptive problems in life, having chronic difficulties in work or relationships -- those kinds of people may very well have personality disorders."

So why do some people seem to get better while some get worse? Jaine Darwin, PsyD, has treated many patients with personality disorders. She is a private-practice psychotherapist, an instructor at Harvard University, and president-elect of the psychoanalysis division of the American Psychological Association.

"The people who have the kind of personality disorder that tends to leave them more isolated and out of contact get worse -- and that's the hallmark of the odd/eccentric and fearful/anxious personalities," Darwin says. "Those whose personality disorders tend to bring them into relationships -- flamboyant personalities -- tend to get better. I think some personality disorders are more amenable to treatment than others."

Darwin says that trouble forming relationships is the main characteristic -- and the main problem -- of people with personality disorders. Wanting to learn to form relationships is the beginning of the way out. Unfortunately, the Catch-22 of personality disorders is that people who have them don't see themselves as being the problem.

"It's not that they don't see anything wrong with themselves, it's that they see the problem as 'out there' and not within them," Darwin says. "People with personality disorders tend to externalize. That is the reason it often makes them hard to treat, because if you don't experience distress as coming from you, there is not much motivation to deal with the conflict that comes up in psychotherapy."

How does treatment work?

"We talk with people about how they think things happen, and what they are trying to find a solution to in their behavior," Darwin says. "We help then look at how there may be other plausible explanations and solutions for their behavior. If you think someone hurts your feelings only out of malice and evil, there are very few responses you can have. But if you help people widen their view of interactions, you help them. That usually won't happen in a regular relationship -- the other person will get fed up. The therapist is able to sit with them and tough out the hard parts."

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