Current Practice in Psychotherapy of Personality Disorders

Given the epidemiological relevance and the growing insights into biopsychosocial mechanisms and etiological pathways, this paper describes the current practice in psychotherapy as treatment of choice for patients with personality disorders.The main focus is on borderline, antisocial, narcissistic and avoidant personality disorders. Borderline personality disorder (BPD) is clinically the most relevant, i.e. the most prevalent and most disabling condition, for which several transtheoretical psychotherapeutic approaches have been developed.Their effectiveness has empirically been validated with encouraging results. These evidence-based psychotherapies are dialectical behaviour therapy (DBT), mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), and schema therapy (ST). All of them converge in general principles necessary for a successful treatment. Likewise, general guidelines can be established for antisocial, narcissistic and avoidant personality disorders taking into account their specific features. However, there is less evidence for the effectiveness of psychotherapy for these disorders than for BPD. Finally, future challenges with regard to psychotherapy research, clinical management and implementation of evidence-based treatments in everyday practice are discussed.