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Can personality disorders be changed?

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Netherlands Journal of Psychology

Abstract

For a long time character pathology, or personality disorder as it is known today, was associated with therapeutic nihilism. The general idea was that people with character pathology have a qualitatively different character make-up than healthy people. Their character was considered to be unchangeable which explained the lack of therapeutic success. Recent insights have radically changed this view. Specialised treatments have high success rates and seem to lead to dramatic changes in maladaptive personality features. An important issue, however, is the extent of the changes that are brought about. Is the change only superficial, or does psychological treatment cause deeper changes, so that a person who used to have a personality disorder really undergoes a change in character? There is now some evidence that psychotherapy can lead to fundamental changes, which again suggests that pessimism is ill founded. On the other hand, we argue that traces of the former character set-up cannot be completely removed so that some vulnerability remains and people may return to old maladaptive patterns. In this respect there is no fundamental difference between treatment of axis-1 disorders such as anxiety or depression, and personality disorders. (Netherlands Journal of Psychology, 62, 9-18.)

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Notes

  1. An intention-to-treat analysis takes into account all the patients who were included in the trial; a completers analysis ignores the patients that dropped out and analyses only the patients who completed the treatment. Usually, a completers analysis overestimates the effects of treatment, as poor effects of treatment are often associated with dropout.

  2. Schema-focused therapy is psychotherapy for PDs integrating elements from cognitive, experiential, behavioural and psychodynamic treatments in a schema model (Young et al., 2003). SFT focuses on the patient’s childhood, present life and on the patient-therapist relationship.

  3. Transference-focused psychotherapy is a psychodynamic psychotherapy developed by Kernberg on the basis of his object-relation theory for patients with a borderline personality organisation. In contrast to most psychodynamic therapies, TFP focuses almost solely on the transference between patient and therapist, i.e. clarifies, confronts and interprets the object representations the patient projects on the therapist and associated defence mechanisms in here and now terms.

  4. The reason for comparing these foci was that the effects of experiential methods focusing on childhood experiences in the treatment of PDs had never been tested, but has gained increasing popularity.

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    Arnoud Arntz

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  1. Arnoud Arntz
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  2. David Bernstein
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* Maastricht University, Maastricht

Correspondence to: Arnoud Arntz, Department of Medical, Clinical and Experimental Psychology, Maastricht University, PO Box 616, NL-6200 MD Maastricht. E-mail: Arnoud.Arntz@MP.Unimaas.nl

Submitted 13 April 2006; revision accepted 8 June 2006.

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Arntz, A., Bernstein, D. Can personality disorders be changed?. NEJP 62, 8–18 (2006). https://doi.org/10.1007/BF03061046

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