The pessimism which was once associated with personality disorder and its intractability, is no longer fully justified. There is a growing body of research – particularly with the most commonly encountered personality disorder diagnoses, antisocial and borderline – that suggests positive change over time. When followed up for long periods of time, the majority of personality disordered individuals show fewer symptoms and experience less distress over the course of a decade or so, many of them no longer meeting the diagnostic criteria at follow up.
It is important to consider quite what it is that changes over time. Current thinking suggests that dysfunctional personality should be divided broadly into two types of trait:
The research suggests that there is very little change in core characteristics, but improvements do occur in the secondary characteristics. So, for example, antisocial and psychopathic individuals show little change in empathy deficits or callousness, but do show improvements in behavioural controls, taking increasing responsibility, reduced impulsivity, and setting more realistic life goals. Borderline individuals remain emotionally sensitive, but are less prone to being overwhelmed by intense emotional states, or engaging in repetitive self harming behaviour. Narcissistic individuals remain aloof, arrogant and contemptuous, but are less prone to erupt into a rage when challenged, less driven to demonstrate their superiority by engaging in self-destructive behaviours. (See chapter four for more information on traits). That is, we would suggest that although there are minimal shifts in core beliefs about the self, the world and other people, there can be more significant improvements in the expressive acts and interpersonal strategies.