Heritability, Cures and Recovery: Is There Any Hope for a Personality Disorder?

Reader’s Question

I attend a support group for the adult children of parents with Borderline Personality Disorder. Members of the group are in two camps regarding whether or not a person can “recover” from a personality disorder. I’m in the camp that says “No, its not possible to cure personality disorders.” To me, that’s like “recovering” from being born without eyes. From what I’ve read, the brains of individuals with personality disorders have some kind of bad wiring that prevents them from perceiving other people and reality accurately, plus they have “no emotional skin” which makes their perceptions and reactions exaggerated. My mom has BPD, and I buy the “bad wiring” theory.

The other camp says “Yes, it is possible to be cured of a personality disorder.”

In your opinion, can personality disordered individuals truly be cured or do they simply learn how to self-monitor enough that their disordered behaviors and distorted perceptions don’t damage their kids quite as much?

Are there any recent research papers or statements from the American Psychiatric Association or from NIMH that discuss this? And, are the Cluster B personality disorders genetically heritable?

Our Clinical Psychologist’s Reply

Personality disordered individuals are by no means a homogeneous group. There is a great deal of variability both in the the nature and the extent of various personality disturbances.

By definition, a person has a personality “disorder” as opposed to a collection of problem personality “traits” when there is an “enduring” pattern of dysfunction that is inflexible and pervades across a broad range of interpersonal functioning. That said, with appropriate intervention, individuals with personality disturbances can and do learn to increase their range of adaptive functioning and to overcome the most problematic ways they are predisposed to perceive and relate to their environment.

Although there is evidence of some genetic predisposition to certain personality disorders, and a biological basis for some temperamental traits that contribute to personality formation, there is definitely no evidence that all personality disorders are strictly biologically-rooted. (There’s also no evidence that they’re strictly trauma-rooted as some once thought.) Further, even though certain temperamental aspects of personality will most likely endure for a lifetime, that fact does not preclude a person’s ability to enhance other, more adaptive traits in their personality, to learn different coping skills, to alter beliefs, and to restructure to some extent the overall makeup of their personality. Besides that, advances are being made daily in the psychopharmacological treatment of various aspects of personality disturbance (e.g., employing medications to enhance impulse control and decrease emotional lability in Borderline Personalities), and these advances are changing our understanding of the underpinnings of the various personality disorders.

So, the issues are not quite as black or white as the debate among your group attendees seems to suggest. Our knowledge of personality dysfunction and how to treat it is really in its infancy. In time, the prognosis for individuals and families affected by personality disorders is likely to improve considerably.