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Lenzenweger study: Personality disorders may change

Personality disorder symptoms are supposed to be stable, enduring and persistent across the life span.

However, the work of Mark Lenzenweger, Binghamton University professor of psychology, as well as research performed at Harvard University, shows evidence that such disabling psychiatric conditions are flexible and appreciable change is possible over time.

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 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 Lenzenweger’s direction, 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,” said 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 four years.

A complex statistical procedure known as growth curve analysis helped detect changes in the subjects. The nature of the study design helped ensure 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 percent of the population affected (a fact also discovered previously 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 one in 10 people affected, the good news is that we now know the disorders can change with time,” said 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; and, narcissistic personality disorder, which is characterized by grandiose self-importance and disregard for others. There are 10 well defined personality disorders, according to the American Psychiatric Association.

The report by Lenzenweger and his colleagues, Matthew Johnson, assistant professor of psychology at Binghamton University, and John B. Willett at Harvard, will appear in this month’s Archives of General Psychiatry. The study was sponsored, in part, by the National Institute of Mental Health.

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