Cognitive–behavioural therapy as a comprehensive treatment for personality disorders

Summary & key facts

Personality disorders are long‑lasting patterns of thinking, feeling and behaving that cause major problems at work, in relationships and for the person’s own sense of self. Different studies put community rates between about 7.8% and 12.2%, with one common estimate near 8%, and rates in psychiatric in‑patients can be as high as 76%. The article reviews diagnosis models (the DSM categorical view and the ICD‑11 severity view) and describes how cognitive–behavioural therapies—especially schema therapy, cognitive interpersonal therapy and dialectical behaviour therapy—are used and studied as treatments for these disorders.

Key facts:

• Personality disorders are defined by persistent problems in thinking, emotion, interpersonal functioning or impulse control that cause significant distress or impairment.
• One review found a pooled worldwide prevalence of any personality disorder of 7.8%, and a meta‑analysis in Western countries reported 12.2%; the article also cites an estimate of about 8% in community settings.
• In psychiatric in‑patient samples, the reported prevalence of personality disorders can be as high as 76%.
• People diagnosed with personality disorders have been reported to live on average 18.3 years fewer than people without such diagnoses (Fok 2012).
• A cited study found that as many as 57% of suicide victims had a personality disorder diagnosis (Lesage 1994), with suicide attempts especially common in cluster B disorders.
• Personality disorders are associated with higher rates of accidental injury, criminal behaviour and substance use, and with poorer work functioning, according to the article's review of the evidence.
• A Netherlands study estimated the economic burden of personality disorders at about €11,000 per patient per year, including direct health costs and lost productivity (Soeteman 2008).
• The article states that cognitive–behavioural therapies focus on identifying and changing unhelpful thoughts and behaviours and reports that CBT approaches have shown effectiveness for various types of personality disorder.
• The paper outlines three CBT‑informed models used for personality disorders—schema therapy, cognitive interpersonal therapy and dialectical behaviour therapy—and explains their treatment goals, strategies and techniques.

Abstract

SUMMARY Personality disorders are a group of psychological disorders characterised by a developmental nature, long-lasting impairment and emotional suffering. Personality disorders have an estimated prevalence rate of approximately 8% in community settings, but in in-patient settings the rate might be as high as 76%. Cognitive–behavioural therapies (CBTs) include psychotherapies that emphasise the identification and modification of maladaptive thought patterns and behaviours that contribute to the maintenance of psychological disorders. CBTs have demonstrated their effectiveness in treating various types of personality disorder. This article focuses on the nature of personality disorders and their categorial and dimensional assessment and neurobiology. We present three influential CBT models used in personality disorders: schema therapy, cognitive interpersonal therapy and dialectical behaviour therapy. For each one, we outline the rationale, intervention strategies and therapeutic techniques, with practical examples and summary tables to illustrate their application.

Topics

Mental Health and Psychiatry Personality Disorders and Psychopathology Psychotherapy Techniques and Applications

Categories

Clinical Psychology Psychology Social Sciences

Tags

Borderline personality disorder Clinical psychology Cognition Cognitive therapy Computer science Dialectical behavior therapy Interpersonal communication Intervention (counseling) Machine learning Personality Personality disorders Psychiatry Psychology Psychotherapist Schema (genetic algorithms) Social psychology