Personality
Disorders
Psychotherapy is the treatment. No medication is FDA-approved for any personality disorder — which doesn't mean medication has no role, but it does mean the role should be defined, targeted, and regularly reviewed rather than accumulated.
What are personality disorders?
Personality disorder treatment is primarily psychotherapy — dialectical behaviour therapy, mentalization-based therapy, transference-focused therapy — with pharmacotherapy targeting specific symptoms and co-occurring conditions such as depression, anxiety, sleep disruption, and impulsivity. No medication holds an FDA indication for any personality disorder. Dr. Farkas coordinates with specialized therapists and prescribes conservatively to preserve long-term stability.
Personality disorders describe enduring patterns of thinking, feeling, and relating that are long-standing rather than episodic, and that cause real distress and difficulty in relationships and work. That word — enduring — is what distinguishes them from a depressive episode or an anxiety disorder, and it's also what makes accurate diagnosis matter: treating a long-standing pattern as though it were an acute episode produces years of medication changes that never quite land.
On treatment, the evidence is consistent and worth stating plainly. The main treatment is psychotherapy, and no medication is approved specifically for treating borderline personality disorder — or any personality disorder. Structured, disorder-specific therapies have the strongest evidence: dialectical behaviour therapy, mentalization-based therapy, transference-focused therapy, and good psychiatric management.
That leaves a real question about what a psychiatrist is for here, and the answer is specific. Co-occurring conditions — major depression, anxiety disorders, PTSD, ADHD, bipolar disorder, substance use — are common, genuinely treatable, and frequently under-treated because everything gets attributed to the personality disorder. Sleep disruption and impulsivity can be targeted. And someone has to hold the medication list.
That last part matters more than it sounds. UK NICE guidance for borderline personality disorder is explicit that drug treatment should not be used specifically for the disorder or its individual symptoms, that short-term sedative use in a crisis should not exceed about a week, and that polypharmacy should be avoided with ineffective treatments discontinued. Prescribing practice, as Psychiatric News notes, has changed only marginally — which is why so many patients arrive on regimens nobody can fully account for.
Diagnosis is also frequently wrong in one particular direction. Borderline personality disorder and bipolar disorder are confused constantly, and the distinguishing feature is usually timescale: mood shifts over hours in response to interpersonal events look different from sustained episodes lasting days to weeks. Getting that wrong means either mood stabilisers that don't help, or a treatable bipolar illness left unmanaged.
Dr. Farkas brings MD/PhD neuroscience training, NIH research center experience, and board-certified psychiatric practice to this work — and treats the diagnosis as a clinical description, not a verdict on character.
What an evaluation addresses
Conditions as classified in the DSM-5-TR. This page is educational and is not a diagnostic tool.
How Dr. Farkas approaches personality disorders
Psychotherapy-first, conservatively prescribed, and coordinated with the people doing the therapy.
What to expect from your first appointment
A new patient evaluation with Dr. Farkas runs 30–60 minutes. It covers your history in enough depth to distinguish long-standing patterns from episodic illness, what treatment you've had and how it went, every current medication and what it was started for, and what you want from psychiatric care alongside therapy.
You'll leave with a clear account of what's being treated and why, a medication list that makes sense, and coordination with your therapist if you have one. Telehealth is available throughout South Carolina and New York. In-person appointments are available at the Bluffton, SC office.
Related Conditions
Call or text 988 (Suicide & Crisis Lifeline). Text HOME to 741741 for the Crisis Text Line. Call 911 or go to your nearest emergency room if you are in immediate danger.
Medical disclaimer: This page is for educational purposes and does not constitute medical advice. No doctor–patient relationship is established through website use. No medication is FDA-approved for the treatment of any personality disorder; any prescribing decision requires individual evaluation by a physician. Individual results vary; no specific outcome is guaranteed. Telehealth visits are conducted on a HIPAA-compliant platform. Gabriella I. Farkas, MD PhD, is a board-certified psychiatrist licensed in South Carolina and New York.
Psychiatric care that works
with your therapist
30–60 minutes. A medication list that makes sense. Co-occurring conditions treated properly.
Personality disorder treatment is primarily psychotherapy — dialectical behavior therapy (DBT), mentalization-based therapy (MBT), transference-focused therapy — with pharmacotherapy targeting specific symptoms and co-occurring conditions like depression, anxiety, sleep disruption, and impulsivity. Dr. Farkas coordinates with specialized DBT therapists and prescribes conservatively to preserve long-term stability.
Key Takeaways
- Psychotherapy is the main treatment for personality disorders, including DBT, mentalization-based therapy, and transference-focused therapy.
- No medication is FDA-approved for any personality disorder.
- Medication targets specific symptoms such as depression, anxiety, sleep problems, mood swings, or impulsivity.
- Co-occurring conditions like PTSD, depression, and substance use are common and often need direct treatment.
Frequently Asked Questions
Can medication treat personality disorders?
Medication targets specific symptoms — depression, anxiety, sleep, mood instability, impulsivity — rather than the personality structure itself. Psychotherapy, particularly DBT for borderline personality disorder, is the treatment of choice.
What is DBT?
Dialectical Behavior Therapy — a structured psychotherapy developed for borderline personality disorder that combines skill training in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness with individual therapy. Strong evidence for reducing self-harm and hospitalization.
Are co-occurring conditions common?
Yes — depression, anxiety, PTSD, eating disorders, and substance use commonly co-occur with personality disorders and often need direct treatment alongside psychotherapy.