One of the cardinal assumptions in psychiatry and psychology has long been that individuals who have personality disorders will be the way they are for their lifetime and that treatment offers little real hope of change. In fact, the official diagnostic nomenclature used in modern psychiatry (the DSM-IV of the American Psychiatric Association), describes these disorders as "inflexible" and "stable over time." Results from a landmark longitudinal study, which has followed a large number of young adults over time, now call into question the assumption that personality disorders never change.
The Longitudinal Study of Personality Disorders, under the direction of Professor Mark F. Lenzenweger at Binghamton University, State University of New York, has recently discovered that individuals who have personality disorder symptoms will show significant declines in their symptoms with the passage of time. "On average, our subjects showed a decline of 1.4 personality disorder features per year," noted Lenzenweger.
What is particularly fascinating about this finding is that the change is not explained by exposure to conventional treatments or the presence of another form of mental disorder, such as anxiety, depression, or other illnesses. The subjects in the study were examined carefully for personality disorder features at three time points over a four year period and a complex statistical procedure known as growth curve analysis helped to detect the changes that were happening in the subjects. The nature of the study design helped to assure that any observed change in the personality disorder features was not due to artifacts or shortcomings that plague other studies.
Personality disorders are conditions that reflect serious disturbances in social and occupational functioning and the nature of the disturbance is part and parcel of a person's personality. The personality disorders do not represent episodic disturbances, unlike other forms of mental illness such as schizophrenia, bipolar illness, or major depression. They are relatively common among the public, with approximately 10% of the population affected (a fact also discovered previoulsy in Lenzenweger's laboratory), and they make up a large proportion of those individuals seen for treatment by practicing mental health professionals. "Although the disorders are common, with 1 in 10 people affected, the good news is that we now know the disorders can change with time," states Lenzenweger. The recent emergence of specialized treatments for the personality disorders coupled with these new findings creates new hope for those affected with the conditions.
Common personality disorders are borderline personality disorder, which is characterized by unstable personal relations as well as self-destructive and impulsive behavior. Narcissistic personality disorder is characterized by grandiose self-importance and disregard for others. There are ten well-defined personality disorders according to the American Psychiatric Association.
The report by Lenzenweger and his colleagues, Matthew Johnson (Binghamton University) and John B. Willett (Harvard), will appear in this month's Archives of General Psychiatry. The study was sponsored, in part, by the National Institute of Mental Health (NIMH).
For additional comments from scholars not connected with the study:
John F. Clarkin, PhD (Cornell Medical College) 914-997-5911 jclarkin@mail.med.cornell.edu
Kenneth Levy, PhD (Pennsylvania State University) 814-865-5848 klevy@psu.edu
Drew Westen, PhD (Emory University) 404-727-7407 dwesten@emory.edu