Treatment for personality disorders

A personality disorder is a long-lasting pattern of thoughts, feelings and reactions that causes pain and makes life hard. It is not a character flaw. The good news is that treatment works for many people. Talk therapy is the main treatment, and several kinds have been tested.¹

Most of the research on this page is about borderline personality disorder (BPD), the most studied type. You can read about the signs on our borderline personality disorder page. For other types, see other personality disorders. Medicine plays a smaller part than many people expect, and this page explains why.

Does treatment work?

Yes. A large review from Cochrane (a group that combines results from many trials) looked at 75 trials with 4,507 people. It found that therapies made for BPD reduced BPD symptoms more than usual care did. The certainty of that result was moderate. Self-harm, suicide-related outcomes and day-to-day functioning also looked better, but the certainty was low, so those results are less firm.²

The review found no clear difference between the types of therapy. DBT and MBT were the most studied.² Most people in these trials were women between about 15 and 46 years old. Less is known about men and older adults.²

Many people also get better over time. In one study that followed 290 people with BPD for 16 years, most no longer met the criteria for BPD by the end (estimates ran from about 8 in 10 to nearly all, depending on how it was counted). Roughly 4 to 6 in 10 also reached good functioning at work and in relationships.³ In another study that followed people for 10 years, about 85 in 100 no longer met the criteria, and only about 12 in 100 had symptoms return.⁴ Social life and work stayed hard for many, which is why support beyond symptom relief matters.⁴

Talk therapies that help

All of these therapies share some features. They are structured, they build skills, and they give you a steady, caring relationship with a trained therapist. NICE (the health guideline group for England) says clinicians should approach treatment with hope and tell people that recovery is possible. It also says no one should be turned away from care because of a diagnosis or self-harm.⁶

Dialectical behavior therapy (DBT) Strong evidence

DBT was made for BPD. It teaches mindfulness (paying attention to the present moment) and skills for handling strong emotions, cutting down on self-harm, and getting along better with other people.¹ Many programs combine one-on-one sessions with a skills group. See our guide to DBT skills for the four skill areas.

NICE suggests a full DBT program for women when reducing repeated self-harm is the top goal.⁶ In the trials, DBT reduced BPD symptoms and self-harm compared with usual care, though the certainty was low.²

Mentalization-based treatment (MBT) Moderate evidence

"Mentalizing" means noticing what is going on in your own mind and in other people's minds, especially when feelings run high. MBT helps you slow down and think about your reactions and theirs.

In one trial of 134 people, MBT was compared with a structured clinical management program for 18 months. Both groups improved. The MBT group had a steeper drop in problems, including suicide attempts and hospital stays.⁸

Good psychiatric management (GPM) Moderate evidence

GPM is a structured approach built on the American Psychiatric Association's guideline. It combines case management, talk therapy that looks at how past and present connect, and medicine aimed at specific symptoms. In one trial of 180 adults, GPM worked about as well as DBT over one year. Both groups had fewer self-harm episodes, fewer emergency visits and fewer hospital days.⁹ This is good news for people who cannot find a full DBT program nearby.

Schema therapy Moderate evidence

Schema therapy looks at long-held patterns, or "schemas," that often began in childhood, such as "I am not safe" or "I will be left." It helps you meet your needs in new ways. In a trial of 88 people, schema therapy was compared with transference-focused therapy. Both lasted three years, with sessions twice a week. More people in the schema therapy group met recovery criteria.¹⁰

Transference-focused psychotherapy (TFP) Moderate evidence

TFP uses the relationship with the therapist as a window into how you see yourself and others. In a one-year trial, people who got TFP were less likely to drop out than people seeing community therapists. More of them no longer met the criteria for BPD after a year. The TFP group did get more sessions, but the researchers found that this did not explain the results.¹¹

STEPPS Moderate evidence

STEPPS stands for Systems Training for Emotional Predictability and Problem Solving. It is a group program of 20 weekly meetings, about two hours each. Family members attend a separate two-hour session. It is meant to be added to other care, such as individual therapy or medicine.¹²

In a trial of 165 people, those in STEPPS improved faster in BPD and depression symptoms than those getting usual care alone. They also had fewer emergency visits. Suicide attempts, self-harm and hospital stays did not differ between the groups.¹²

How these compare

Since no type has been shown to be best, your therapist's training and your comfort with the person matter a great deal. NICE says therapy services should provide supervision for their therapists.⁶ NICE also advises against very short treatments, under 3 months, made just for BPD unless they come from a service built for that purpose.⁶

What about medicines? Limited research

No medicine has been shown to treat the core of BPD, and the research does not support relying on pills. A Cochrane review of 46 trials with 2,769 people found that antipsychotics, antidepressants and mood stabilizers made little or no difference to the main BPD outcomes compared with a placebo (a pill with no active drug). The certainty was mostly very low.⁵

NIMH says the benefits of medicine for BPD are unclear. A clinician may suggest one as an add-on to therapy for a specific symptom or a co-occurring condition, such as depression.¹

NICE says drugs should not be used specifically for BPD or for single symptoms such as self-harm or mood swings. Antipsychotics should not be used for the medium or long term. In a crisis, short-term calming medicine may be used with care for no more than a week.⁶ NICE also says depression, PTSD or anxiety that goes along with BPD should be treated within a well-organized BPD treatment plan.⁶

Planning for a crisis

Strong emotions can peak fast. A crisis plan is a short, written guide you make with your therapist or doctor on a calm day. NICE says it should list your triggers, the coping steps that work for you, and how to reach help, including phone numbers for evenings and weekends. It should be used when a crisis comes and updated afterward, with family included if you wish.⁶

A related tool is the safety plan. In a study of nearly 1,200 U.S. veterans seen in emergency departments, people who made a safety plan and got follow-up calls were about half as likely to have suicidal behavior over the next six months. They also attended more mental health visits.⁷ The steps are:⁷

1. Name the warning signs that a crisis is coming.
2. List coping steps you can do alone.
3. List people and places that help you feel connected or distracted.
4. List people you can ask for help.
5. List professionals and crisis lines to call.
6. Make your surroundings safer, with help from your care team.

You can build one now with our safety plan tool. Share it with someone you trust.

If you are thinking about hurting yourself or ending your life, you are not alone, and the feelings can pass. Call or text 988 any time. If you are in danger right now, call 911.

NICE advises that a hospital stay be considered only when there is a serious risk that other services cannot manage. The length and purpose of the stay should be agreed in advance.⁶

Finding the right help

Look for a therapist who has training in one of the therapies above, or who has worked with BPD. Ask about their training, what a session looks like, and how they handle a crisis between visits. Our guide on how to find a therapist and our page on paying for therapy can help you get started.

A good assessment comes first, since BPD can look like depression, bipolar disorder, PTSD or ADHD. Read getting diagnosed for more. If you have another condition too, it should be part of your plan.⁶

Family and friends can be part of the plan. Some programs include a family session, as in STEPPS.¹² See supporting someone with a personality disorder. If you are caring for an older person, read personality disorders and personality change in later life.

What to expect and how to stay with it

Progress is usually slow and uneven. Setbacks happen and do not mean you have failed. Getting better often looks like fewer crises, shorter ones, and more days that feel steady. The long-term studies above show that many people end up in a very different place from where they started.^3,4

Questions to ask a therapist

When to get help

• Call your therapist or doctor soon if your feelings get stronger, you stop sleeping, or urges to hurt yourself grow.
• Call or text 988 any time you have thoughts of suicide or are in emotional pain you cannot bear. It is free and open 24 hours a day.
• Call 911 if you or someone else is in immediate danger, or if an injury needs urgent care.

Visit our help page for more support.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.