Personality Disorders Can Change With Age

Symptoms Become Better or Worse, Therapy Helps

From the WebMD Archives

Oct. 7, 2004 -- There is new evidence that the symptoms of personality disorder don't remain stagnant but actually wax and wane over time. It also turns out some personality disorders may also be more treatable than previously thought, researchers say.

Antisocial personality disorder, obsessive-compulsive personality disorder, and borderline personality disorder -- these are just a few of the personality disorders addressed by researcher Mark F. Lenzenweger, PhD, a clinical psychologist with the State University of New York at Binghamton. His report appears in this month's Archives of General Psychiatry.

People with personality disorders have extreme and inflexible personality traits that are distressing to the person and can cause problems in every aspect of life. Difficulty forming stable relationships is one aspect of these disorders. Also, the person's patterns of thinking and behavior significantly differ from society's expectations -- and are so rigid that they interfere with the person's normal functioning.

"They feel emotionally distraught and horrible most of the time," Lenzenweger explains. "Like most complex disorders, there probably is a neurobiological and genetic basis to the disorder, which is impacted by environmental factors, like severe childhood sexual abuse."

The American Psychiatric Association has long viewed personality disorders "as very carved in stone, that once you have a personality disorder, it stays with you throughout your life, that there's not much you can do about it," he tells WebMD. "Conventional treatments such as psychotherapy, group therapy, family therapy, or medication are not much help."

His study is helping change that mindset.

A Lifetime Study

It is a lifetime study of this pattern, Lenzenweger says. He and his colleagues gave personality disorder assessment tests to 2,000 college freshmen. Out of the group of 250 --134 had symptoms of possible personality disorder, some with more symptoms than others. The rest of the students were controls in the study, and had no signs of personality disorders.

The data he presents are from the students' first four years in college, when they were between 18 and 21 years old. Three times during the four-year study period, students were tested for personality disorder symptoms.

Continued

"We saw massive changes in personality disorder features over just four years," Lenzenweger tells WebMD.

On average, the students showed a significant decline of symptoms from the personality disorder with every passing year, he reports. This was true whether students got treatment from a health care professional or not.

Also, the presence of another mental illness -- such as depression -- did not impact the decrease in personality disorder symptoms, Lenzenweger notes. "People have often thought that people with a personality disorder actually have major depression, which is throwing their personality out of order. But our study showed that presence of major depression didn't affect the decrease in the other symptoms."

This study "highlights that change is possible, and that's good news," he says. "We know that one in 10 people in the U.S. probably suffers from personality disorder. These disorders have a tremendous impact on people's lives. But if the disorders are flexible, then we need to apply newer approaches to treatment. And what's exciting is newer approaches are beginning to appear."

Modified versions of psychotherapy and cognitive behavioral therapy are taking the focus off the past and bringing it to "the here and now," Lenzenweger tells WebMD. "In traditional treatment, patients talk about their parents, about their childhood, yet their current life is a wreck. In modified therapy, we focus on how they handled the transaction at the bank, how they dealt with the boss, how they're dealing with their therapist."

Researchers will study this group across their lifespan, he says. "As they now approach their 30s, we are eager to see what their life looks like -- their marital relationships, employment, etc. Are they more impaired, less impaired?"

"This study shows that, while a lot of kids have symptoms of personality disorders, a certain percentage of them may grow out of it. This runs counter to folklore in psychiatry," says Kenneth Levy, PhD, professor of psychology at Pennsylvania State University in Pittsburgh.

While not involved in the study, Levy offered his insights.

Another important aspect: "It shows that how well people function may be due to environmental events," Levy tells WebMD. "They may have symptoms of a personality disorder, but function relatively well if things are going well in their lives, as long as things are calm. As soon as things erupt, as they do in anyone's life, they may fly off the handle."

"I expect this study to open up more sophisticated research on the effects of stress on personality disorders," he tells WebMD.

WebMD Health News Reviewed by Charlotte E. Grayson Mathis, MD on October 07, 2004

Sources

SOURCES: Lenzenweger, M. Archives of General Psychiatry, Oct. 2004; vol 61: pp 1013-1024. Mark F. Lenzenweger, PhD, a clinical psychologist with the State University of New York at Binghamton. Kenneth Levy, PhD, professor of psychology at Pennsylvania State University in Pittsburgh. WebMD Medical Library with the Cleveland Clinic: "Types of Mental Illness."

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