Reading through all of the threads on personality disorders that have popped up lately has brought some questions to mind. ISTM that the personality disorders grouped under Cluster B in the DSM-IV-TR are considered extremely difficult, if not impossible, to treat successfully. Several posters on this board have claimed that the majority of therapists refuse to even see those with Antisocial Personality disorder, BPD, etc. Is this a true statement or an exaggeration?
On the other hand, Cluster C or “anxious” personality disorders appear to be thought of as much more treatable. Posters on this board have pointed to cognitive behavioral therapy as an effective treatment for those with avoidant personality disorder(btw the wiki article on this disorder reads like a nightmare to me) and obsessive-compulsive personality disorder.
I know next to nothing about this whole field so am I just off the mark completely?
Well, I think you’re right about cluster B’s being the hardest and perhaps scariest to treat. But I’m not sure about the cluster C’s being that much more easier to treat. The disorders in that group appear to be more disparate than the ones in cluster B (in my non-professional opinion). Histronic and narcissistic PDs are pretty much the same thing in my mind, except that histronics tend to be attention-whores with their emotional neediness while narcissistics tend to be attention-whores with their perceived (and real) accomplishments.
I can’t imagine it would be that easy working with someone with Obsessive Compulsive Personality Disorder, because they are typically certain that they are right, you are wrong. I work with someone with traits of this disorder, and you can literally argue with her all day long about how irrational her choices are and she will have a serious excuse, no matter how nonsensical, ready. However, avoidants tend to have the opposite schema. In their minds, they are wrong, very wrong, while you and everyone else in the world are right. So I’d imagine it would easier working with the latter rather than the former because the latter knows they are “messed up” and would be amenable to getting help. Many avoidants actually want to be hospitalized, because they feel that they are so fundamentally wrong. (It’s my opinion they would prefer this because hospitalization would validate their “wrongness” and give them permission to be excuse themselves from society, but who am I to judge?) I can’t think of any other PD that would have such a belief system. Of course, that doesn’t mean they’re necessarily easier to “treat”, but I could see how you could have a more productive doctor-patient relationship with an avoidant than with someone with OCPD. Avoidants also tend to be social phobics, so there are drugs available to help them overcome this major obstacle. There isn’t a drug for treating OCPD, as far as I know.
I don’t know nuttin’ about dependent PD.
Another thing to keep in mind: people with cluster B’s tend to get better with age, while people with other clusters tend to worsen with time. So in that respect, it might be better to have a cluster B PD.