Personality Disorders Change Over Time
'Flamboyants' Get Better, Others Get Worse
"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."
Darwin says her clinical experience backs Tyrer's finding that untreated personality disorders become worse in elderly people.
"Good mental health is flexibility," Darwin says. "Personality disorder speaks to an inflexibility of reactions. All the stresses of aging rigidify us. As we age we become more of who we are, and if that is something difficult, well, we become a pain in the neck."