Multimodal approaches to the treatment of personality disorder.

INTRODUCTION: Personality disorder is the most common of all psychiatric disorders and is best perceived as a diagnostic spectrum extending from no personality dysfunction to severe personality disorder. The position on the spectrum is determined mainly by problems in interpersonal social dysfunction, self-perception and awareness, and dangers to the self and others.

AREAS COVERED: We examine psychological and psychodynamic treatments, pharmacotherapy, neuromodulation and other related approaches, environmental treatments, and therapeutic communities. Although many published studies refer to individual categories, these are now linked to the diagnostic spectrum in this review.

EXPERT OPINION: There is some evidence that focused psychological treatments linked to problem solving (STEPPS), mentalization based therapy and dialectical behavior therapy, are successful in treating moderately severe personality disorder, especially regarding self-harm, but there is also benefit from well organized standard care that is similarly effective. There is no good evidence that drug treatment is of real value in personality disorder. Brain stimulation approaches have limited evidence. Psychodynamic approaches, environmental interventions, nidotherapy, and therapeutic communities appear to be of some value, but good data are few. Long-term studies of treatment effectiveness are few but some show that personality disorder can respond to treatment and remit.