Psychiatria pre prax 1/2001

Treatment of personal disorders

Treatment of personality disorders is considered to be very difficult. Small doses of neuroleptics are used for behavior disturbances, antidepressants for anxiety and phobias, thymoprophylactics for reduction of anger and impulsiveness. Traditional approach to the treatment of personality disorders – psychoanalysis – deals more with description of structure of particular personality disorder than with specific therapeutic strategies. Kernberg has designed complex patterns for borderline personality disorder, Kohut did the same with narcissistic personality disorder. The most common approach for treatment of people suffering from personality disorder has been dynamic group psychotherapy. Short term group program is insufficient for a personality change, long term one is, however, scarce. According to CBT concepts patients suffering from personality disorders have established relatively firm, global, negative opinion of themselves, other people and the world during their childhood. Given this some patterns of behavior have developed excessively, some not at all. Management of patients suffering from personality disorders is more complex and treatment longer (from 1 to 3 years) comparing to CBT of patients with anxiety disorders. Therapeutic relationship can be used in therapy as a representation of other relations. Emphasis is given to patient´s development and his childhood. Structure of a session is more variable. The most important approaches are directed towards patient´s change in dysfunctional conviction of himself, other people and the world and towards modification of compensatory behavioral patterns.

Keywords: personality disorders, stigmatization, pharmacotherapy, psychoanalysis, group psychotherapy, cognitive behavioral therapy, basic schemas, related schemas, maladaptive patterns of behavior, cognitive restructure, practice of abilities, therapeutic relationship.