The personality disorder category has a complicated history, and clinicians should be honest about that. For decades, a diagnosis like borderline personality disorder was handed out with a kind of therapeutic resignation, the assumption being that the pattern was fixed, the prognosis poor, and the patient difficult. That changed substantially when Marsha Linehan developed Dialectical Behavior Therapy (DBT) in the 1980s and 1990s: the first treatment to produce strong controlled-trial evidence for borderline personality disorder, and one that shifted how clinicians understood what was possible. Longitudinal research since then has reinforced the point. The old fatalism was wrong. Personality patterns are more changeable than the field once believed, and that is a meaningful revision.
People with a personality disorder often arrive at treatment because of what the pattern has cost them: repeated relationship ruptures, job losses, a persistent sense that something is wrong without being able to name what it is. The pattern itself can be difficult to see from the inside. Others around a person frequently notice it first. Most people seek help during a crisis, focused on what is immediately painful, and the longer history takes shape over the course of early treatment. That process of recognition is not always comfortable, but it is where the work begins.
The primary treatment for personality disorders is psychotherapy, usually over a longer course than therapy for most other conditions. Evidence-based approaches include DBT, mentalization-based therapy, and transference-focused psychotherapy, each developed with specific personality presentations in mind. The relevant material often has to come up in the therapy relationship itself, not just be reported about it, which is part of why time matters. Medication does not treat the underlying personality pattern. It can reduce specific symptoms that make therapy harder to engage, such as mood instability, anxiety, or brief perceptual disturbances, but the core work happens in sessions.
Working with Dr. Sharpe on a personality disorder means a gradual process oriented first toward building an accurate picture of the person’s history, relationships, and the patterns generating difficulty. There are no shortcuts and no false reassurances. Change tends to arrive incrementally: a slightly different reaction in a familiar situation, a relationship that holds where it would not have before. People who sustain the effort frequently find that the shifts, accumulated over time, are more substantial than they expected.
Frequently Asked Questions
What’s the difference between a personality trait and a personality disorder?
Everyone has personality traits, habitual ways of thinking, relating, and responding to stress. A personality disorder is diagnosed when those patterns are rigid, cause significant distress, and consistently impair functioning across different areas of life. The distinction is not severity alone but inflexibility: a trait bends to context; a personality disorder tends not to.
Can a personality disorder be cured?
“Cure” is not the right frame, but meaningful change is possible and well-documented. Longitudinal research shows personality patterns are more changeable than the field once believed. Many people who complete a full course of evidence-based therapy find that the patterns generating difficulty become less disruptive, relationships become more stable, and functioning improves substantially, sometimes more than they anticipated going in.
Is borderline personality disorder really treatable?
Yes. Dialectical Behavior Therapy, developed by Marsha Linehan in the 1980s and 1990s, was the first treatment to produce strong controlled-trial evidence for borderline personality disorder. Other approaches including mentalization-based therapy have since added to that evidence base. The old clinical pessimism about BPD has been directly contradicted by outcome data, and effective treatment exists for people willing to engage the work.
What is DBT (Dialectical Behavior Therapy)?
DBT is a structured psychotherapy developed specifically for people with borderline personality disorder and later applied to related conditions. It combines cognitive-behavioral techniques with mindfulness-based strategies and focuses on four skill areas: emotional regulation, distress tolerance, interpersonal effectiveness, and the ability to observe experience without immediately reacting to it. Standard DBT involves both individual sessions and skills-training groups.
Why does treatment for personality disorders take so long?
The patterns in question developed over years and show up most clearly in relationships, including the therapy relationship itself. That material has to arise in treatment, not just be reported about. Progress tends to be incremental rather than sudden, and the relevant history takes time to understand accurately. Medication can reduce specific symptoms that interfere with therapy but does not address the underlying pattern, which is why sustained engagement in psychotherapy is the core of treatment.