Personality Disorders
Personality Disorders (DSM-5-TR)
Enduring patterns of inner experience and behavior that deviate from cultural expectations, are pervasive and inflexible, and cause distress or impairment. Recommendations must be matched to the specific diagnosis, presentation and treatment goals; the assessment below has a defined borderline personality disorder population.
Sources for the corrected statements:
Prevalence: ~8% globally and ~9.6% in high-income countries (Winsper et al., 2020, meta-analysis); ~40-60% of clinical populations
Clinical Picture
Personality disorders, particularly borderline, narcissistic, and avoidant, represent some of the most challenging and most rewarding clinical work. These are not acute symptoms that developed in response to a specific stressor but enduring patterns of experiencing self and others that developed early and have become the water the client swims in. The diagnostic label itself is controversial: 'personality disorder' can pathologize adaptations that made sense in context, and the 'Cluster B' stigma in clinical settings is well-documented. The most clinically useful framing may be characterological patterns that cause suffering and that the client wants to understand and potentially change.
Treatment Considerations
For borderline personality disorder, NICE CG78 asks clinicians to consider treatment preferences, impairment, engagement and available support, and to provide information about treatment options and their evidence. It calls for structured care and therapist supervision. Its recommendation 1.3.4.5 says to consider a comprehensive DBT programme for women with BPD when reducing recurrent self-harm is a priority. This specific recommendation is not a ranking of therapies for all personality disorders and does not imply that other populations cannot benefit.
Sources for the corrected statements:
Approaches and Evidence
Of 24 associated approaches, 12 have completed assessments for this topic, 0 have source checks awaiting assessment, and 12 have neither recorded yet. Each completed assessment states its population and rationale; source checks alone do not establish effectiveness. These categories describe different findings and review stages; they are not a ranking of treatments.
Guideline recommendation (5)
These assessments record a guideline recommendation for the stated population. Read the scope and rationale; a broad topic label does not make a recommendation applicable to everyone.
Dialectical Behavior Therapy
Marsha Linehan · 1993
Reviewed population: Women with borderline personality disorder for whom reducing recurrent self-harm is a priority, receiving a comprehensive DBT programme. This is the exact population and treatment scope of NICE CG78 (2009) recommendation 1.3.4.5.
NICE CG78 (2009) recommendation 1.3.4.5 says to consider a comprehensive DBT programme for women with BPD when reducing recurrent self-harm is a priority. This is a qualified “consider” recommendation, not a strong recommendation for every BPD presentation or personality disorder. It does not separately grade standalone DBT skills, DBT-A or suicide prevention across diagnoses. The narrow assessment does not imply that people outside this source population cannot benefit; their evidence requires its own review.
Reviewed
- NICE (2009; updated presentation 2024): Borderline personality disorder: recognition and management (CG78) — Recommendation 1.3.4.5, current short guideline printed/physical PDF p. 14; July 2024 update history, p. 30; original full volume §5.12.1.3, printed p. 208 / physical PDF p. 209
- NICE CG78 (2009), Recommendation 1.3.4.5, p.14 — women with BPD and recurrent self-harm
Guidelines and official sources (3)
2 clinical guideline checks · 1 evidence registry check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Borderline personality disorder: recognition and management (CG78)
Recommendation for the stated population
NICE says to consider a comprehensive DBT programme for this specified population. This does not establish a recommendation for every personality disorder or every presentation.
Scope: Women with BPD for whom reducing recurrent self-harm is a priority.
- Psychotherapie bij persoonlijkheidsstoornissen
Recommendation for the stated population
DBT is named among recommended specialist BPD treatments.
Scope: BPD; treatment delivered as described and studied
- Dialectical behavior therapy for BPD
Discussed in the source
The archive lists Strong under 1998 criteria, with 2015 re-evaluation pending; this is an evidence listing.
Scope: DBT for BPD
Mentalization-Based Treatment
Fonagy / Bateman · 2004
Reviewed population: Adults with borderline personality disorder receiving protocol-based mentalization-based treatment.
The Dutch 2022 guideline recommends MBT among specialist BPD treatments, delivered as studied. Bateman and Fonagy (2009) randomized 134 patients to 18-month outpatient MBT or structured clinical management. Both improved; MBT showed steeper reductions in several problems, including suicide attempts and hospitalization. The primary endpoint combined suicidal behavior, severe self-injury and hospitalization. This record does not generalize to all personality disorders or prove reduced suicide mortality.
Reviewed
Guidelines and official sources (3)
1 clinical guideline check · 1 research recommendations check · 1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- CG78: recommendations for research
Research recommendation
MBT is named as an example in a research question about structured psychological programmes. This is not a named recommendation to offer MBT in CG78’s clinical recommendations.
Scope: Comparative research on psychological programmes for people with BPD.
- CG78: 2018 surveillance, Appendix A
Discussed in the source
NICE surveillance explicitly notes that CG78 does not currently recommend MBT by name. Discussion of evidence is not a recommendation to offer it.
Scope: People with BPD
- Psychotherapie bij persoonlijkheidsstoornissen
Recommendation for the stated population
MBT is named among recommended specialist BPD treatments.
Scope: BPD; treatment delivered as described and studied
Schema Therapy
Jeffrey Young · 1990
Reviewed population: Adults with borderline personality disorder receiving schema therapy; trial findings distinguish combined individual/group from predominantly group delivery.
The Dutch 2022 guideline names schema therapy among recommended specialist BPD treatments. In Arntz et al. (2022), 495 adults were randomized across schema-therapy formats and optimal usual care; combined individual/group treatment reduced BPD severity more than predominantly group treatment or usual care. The 2026 BOOTS superiority trial of 204 outpatients found no significant difference between combined-format schema therapy and DBT in BPD-severity change or secondary outcomes. A nonsignificant superiority test does not establish equivalence. These findings should not be generalized across formats or personality-disorder subtypes.
Reviewed
Guidelines and official sources (2)
2 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Psychotherapie bij persoonlijkheidsstoornissen
Recommendation for the stated population
Schema therapy is named among recommended specialist BPD treatments.
Scope: BPD; protocol delivered as described and studied
- Borderline personality disorder: recognition and management (CG78)
Discussed in the source
CG78 recommendations do not name schema therapy; general programme guidance does not create a named endorsement.
Scope: Psychological programmes for people with BPD
Short-Term Psychodynamic Psychotherapy
Davanloo / Sifneos / Malan · 1968
Reviewed population: People with avoidant personality disorder receiving a specialist short-term psychodynamic psychotherapy protocol.
The Dutch 2022 guideline recommends specialist STPP protocols for avoidant personality disorder. Its evidence discussion acknowledges scarce high-quality research for this subtype. This source-specific recommendation does not establish efficacy for every brief psychodynamic variant, ISTDP or all personality disorders.
Reviewed
Guidelines and official sources (1)
1 clinical guideline check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Psychotherapie bij persoonlijkheidsstoornissen
Recommendation for the stated population
The Dutch guideline separately names short-term psychodynamic psychotherapy for avoidant personality disorder.
Scope: Avoidant personality disorder
Transference-Focused Psychotherapy
Otto Kernberg · 1999
Reviewed population: Adults with borderline personality disorder receiving manualized transference-focused psychotherapy.
The Dutch 2022 guideline names TFP among recommended BPD treatments. Clarkin et al. (2007) randomized 90 patients to yearlong TFP, DBT or dynamic supportive treatment, with medication when indicated. All groups improved on depression, anxiety, functioning and social adjustment; TFP was associated with change across additional measured domains. Within-treatment significance does not establish superiority over another active treatment. This assessment does not extend to every personality-disorder subtype.
Reviewed
Guidelines and official sources (2)
2 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Treatment of patients with borderline personality disorder: Guideline Statements and Implementation
Discussed in the source
APA discusses TFP within structured psychotherapy for BPD. Statement 5 gives the structured-psychotherapy class a 1B recommendation; it does not assign TFP a separate grade.
Scope: Patients with BPD receiving literature-supported structured psychotherapy
- Psychotherapie bij persoonlijkheidsstoornissen
Recommendation for the stated population
TFP is named among recommended specialist BPD treatments.
Scope: BPD; protocol delivered as described and studied
Randomized studies (3)
These assessments describe randomized studies in the stated population. Randomized studies may include pilot or null findings; this label alone does not establish benefit.
Intensive Short-Term Dynamic Psychotherapy
Habib Davanloo · 1980
Reviewed population: Adults with DSM-IV personality disorders in the 27-person Abbass et al. (2008) trial.
ISTDP was randomized against minimal-contact delayed treatment. Symptoms and interpersonal problems improved more with ISTDP during the controlled phase. Subsequent follow-up combined participants after controls also received treatment, so diagnostic reductions at follow-up are not randomized between-group effects. The small preliminary trial does not establish results for every PD subtype or superiority over an active psychotherapy.
Reviewed
Radically Open Dialectical Behavior Therapy
Thomas Lynch · 2018
Reviewed population: Adults with treatment-refractory depression and comorbid obsessive-compulsive personality disorder in a secondary analysis of the RefraMED randomized trial (117-person OCPD subgroup).
RO-DBT plus usual care was compared with usual care. At 12 months, the OCPD subgroup showed better emotional approach coping and psychological flexibility, but no significant differences in depression or interpersonal functioning. This is a secondary randomized-trial analysis of comorbid OCPD, not a dedicated trial establishing OCPD remission, effectiveness across PDs, or equivalence of effects across diagnostic groups.
Reviewed
Supportive Psychotherapy
Various (Rockland, Winston) · 1950
Reviewed population: Patients with borderline personality disorder receiving the structured dynamic supportive treatment evaluated by Clarkin et al. (2007), with medication when indicated.
In a 90-person randomized comparison of TFP, DBT and dynamic supportive treatment over one year, supportive treatment was associated with improvement in depression, anxiety, functioning, social adjustment, anger and facets of impulsivity. The abstract does not establish superiority to untreated or usual-care controls, nor a specific reduction in suicidality for supportive treatment. This assessment concerns the structured dynamic protocol, not every form of supportive counseling.
Reviewed
Limited evidence (4)
These assessments describe a reviewed, limited evidence base. The rationale explains the available evidence and its limitations.
Dialectical Behavior Therapy for Adolescents
Alec Miller, Jill Rathus, Marsha Linehan · 2007
Reviewed population: Adolescents with borderline personality disorder receiving DBT-A in Schmeck et al. (2023; online 2022).
A nonrandomized comparison included 37 DBT-A and 23 adolescent identity treatment patients. Both received 25 weekly individual sessions plus family sessions and improved in psychosocial and personality functioning, BPD criteria and depression. Baseline age and self-injury differed. These findings provide limited direct BPD evidence; the design cannot establish randomized comparative efficacy or transfer the separate adolescent self-harm guideline to all adolescent PD presentations.
Reviewed
Functional Analytic Psychotherapy
Robert Kohlenberg / Mavis Tsai · 1991
Reviewed population: One patient meeting diagnostic criteria for depression and histrionic personality disorder, receiving FAP techniques added to CBT.
Busch et al. (2009) examined an A / A+B single-case sequence: CBT followed by added FAP techniques. In-session target behavior improved after FAP was added. The process findings do not isolate standalone FAP efficacy, establish diagnostic remission, or support broad generalization across personality disorders.
Reviewed
Psychodrama
Jacob Moreno · 1921
Reviewed population: One 33-year-old man described as having borderline personality disorder, receiving individual psychodrama with an auxiliary ego.
The 2025 hermeneutic single-case study followed 54 sessions over 17 months. It reported improvements in distress, emotional regulation, work-related stress and substance use, with fluctuations. A single case cannot establish comparative efficacy, broad safety, or applicability to group psychodrama and other personality disorders.
Reviewed
Transactional Analysis
Eric Berne · 1958
Reviewed population: Adults with diagnosed personality disorders receiving a three-month inpatient programme based on transactional analysis (STIP-TA).
Horn et al. compared 67 propensity-matched patient pairs receiving STIP-TA or other specialized psychotherapy. Psychiatric symptoms and functioning improved in both groups; the STIP-TA programme showed larger symptom improvements through follow-up. Assignment was not randomized, so residual confounding remains. Findings concern this inpatient treatment package, not isolated transactional-analysis techniques or every PD subtype.
Reviewed
Assessment not yet completed (12)
No completed assessment or source check for this topic is recorded yet.
Character-Analytic Vegetotherapy
Wilhelm Reich · 1933
Compassion-Focused Therapy
Paul Gilbert · 2005
Compassionate Mind Training
Paul Gilbert · 2005
Internal Family Systems
Richard Schwartz · 1995
Interpersonal Process Group Therapy
Irvin Yalom · 1970
Lacanian Psychoanalysis
Jacques Lacan · 1953
Multimodal Therapy
Arnold Lazarus · 1976
NeuroAffective Relational Model
Laurence Heller · 2012
Process Group Therapy
Irvin Yalom · 1970
Psychoanalysis
Sigmund Freud · 1895
Rational Emotive Behavior Therapy
Albert Ellis · 1955
Relational Psychoanalysis
Stephen Mitchell / Lewis Aron · 1988
Cases Featuring Associated Approaches
These teaching cases share approach links with this topic. They may illustrate a different presenting concern.
Reading This Page
Why are these approaches listed with Personality Disorders?
The catalogue associates 24 approaches and 0 frameworks with this topic. These links support learning and comparison; association alone is not a treatment recommendation or evidence of effectiveness.
How should I read the evidence assessments?
Assessments are specific to the population and scope stated on each card. They include a rationale, source links, and a review date. An overall review of an approach does not automatically apply to this condition, and a randomized-study label does not by itself mean that a study found benefit.
What does "Assessment not yet completed" mean?
A condition-specific assessment has not been recorded. Approaches with checked sources appear in a separate assessment-pending group; a checked source can support, oppose, or discuss an intervention without recommending it. Neither pending group means that no research exists or that the approach is ineffective. Frameworks are shown separately.
Sources and Review Scope
Source links and dates on assessment cards apply to the stated population and rationale. The clinical overview and prevalence text above are separate authored content; an approach's evidence label does not verify those statements. Recorded narrative notes and citations remain available on individual modality pages, with their review status identified. The bibliography provides further reading.