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    Personality Disorders Change Over Time

    'Flamboyants' Get Better, Others Get Worse


    "These are very common disorders in the older population," Tyrer says. "We are going to have some more problems with people whose problems actually are becoming more pronounced. Old grandmother lives with us, she is a cantankerous old woman -- that sort of problem will become larger. We don't know why they get worse. It could be social isolation. Perhaps you can compensate by living in those gregarious communities you have in the U.S. But if left to their own devices they will get more cantankerous, nervous, and irritable."

    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.

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