Rep36 Understanding Personality Disorder

Drug treatments
There are no drugs that specifically treat personality disorder although medication can be helpful
in alleviating some of the symptoms. There is little evidence as to which medication may be most
effective with which problems, and research has been hampered by inadequate research
methodology, small sample sizes, high dropout rates and strong placebo effects. Despite this, drugs
are frequently used, and often several different types of drugs are used at the same time. This can
be very counter-productive, especially if ever increasing doses are used when problems seem
intractable: drug treatments may lead to unacceptable side effects and can be dangerous in
overdose. Also, because everyone is unique, it is difficult to know which medication will be best for
each person. This means that drug treatment can involve some trial and error before the most
helpful medication is identified. Therefore, it is important that patients understand the limitations
of medication so that their expectations are not raised unrealistically. Reviews by Markovitz (2001)
and Tyrer and Bateman (2004) are helpful summaries of outcome studies.
Psychologists generally feel that in most cases treatment works better if patients are not taking
medication. The fact that some therapeutic communities insist that patients are medication free
before undergoing treatment also suggests that even in cases of severe personality disorders
medication is often not necessary if psychological treatments are in place to support the patient.
References 
Markovitz, P. (2001) Pharmacotherapy. In W. Livesley (Ed.) 
Handbook of personality disorders: Theory, research, and
treatment
(pp.84–104). New York: Guilford Press.
Tyrer, P. & Bateman, A.W. (2004). Drug treatment for personality disorders. 
Advances in Psychiatric Treatment, 10
,
389–398.

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Other problems associated with clinical trials
are to do with measurement and statistical power
(Roth & Fonagy, 1996). In personality disorder
treatment research, there are a variety of
important outcomes that could be measured
such as self-harm, depression, hopelessness,
anger, and offending behaviour. Note that these
are not measures of change in personality or
personality disorder status. Therapy tends to
focus on the patient’s presenting problems and
few individuals come to therapy asking for their
personality disorder to be changed.
Psychological therapy for a specific disorder may
be based on a recognisable set of therapeutic
strategies and techniques but clinicians will tend
to base their interventions on an individualised
formulation of a patient’s problems rather than
diagnosis 
per se
. It could therefore be argued that
psychological therapy is based on an individual
and that the effectiveness of an intervention
should be assessed at a more individual-level
research design, such as single case designs.
However, this in itself raises other problems,