From untreatable to treatable: On how our views on personality disorders changed during the last three decades

Arnoud Arntz
Professor of Clinical Psychology, University of Amsterdam

KEYNOTE LECTURE/OPENING CEREMONY-11.10.2019 // 20:00 - 21:00

The last three decades have shown a remarkable change in how we view personality disorders. Before 1990, the dominant view was that personality was formed during childhood and adolescence, after which change was not really possible. A similar idea dominated the view on personality disorders that were believed to be unchangeable, and therefore basically untreatable. A diagnosis of a personality disorder was thus like a death sentence, and the whole concept of personality disorders raised resistance among clinicians who disliked the idea of diagnoses with such stigmatic effects. Three decades later, the situation has drastically changed. First, contradicting the general idea that personality is unchangeable and also untenable after adolescence, there is so much empirical evidence that personality changes up to high ages, Moreover, the average change is towards better adaptation, which indicates that learning mechanisms play a role. Second, personality disorders also tend to change over time, probably thru similar mechanisms. Third, specialized psychotherapies like Dialectical Behavior Therapy, Schema Therapy, and specific forms of CBT, can create impressive changes in personality pathology and in associated problems. Fourth, we no longer think that a personality disorder rules the individual’s complete personality. In other words, people with a diagnosis of a personality disorder have non-pathological aspects in their personality, and differ in this respect. Moreover, they can also have comorbid personality disorders, even seemingly contradicting combinations that were formerly difficult to understand, such as avoidant and borderline personality disorder. Modern views, such as schema theory, are capable to explain such phenomena and are therefore gaining popularity. We now know that personality disorders are generally treatable, and further innovations attempt to reduce the treatment length (which is quite long), the scope of treatment (to include societal functioning, quality of life and happiness), and develop better ways to match patients to specific treatments (personalized treatment).

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