Pharmacotherapy of personality disorders: what we know and what we have to search for

Abstract

Pharmacotherapy for personality disorders is in the early stage of development because the evidence base for effective drug treatment is insufficient, biased toward borderline personality disorder and rampant with methodological issues. In this paper, we reviewed randomized, placebo-controlled trials of drugs efficacy in patients with personality disorders published between 1990 and 2016. Overwhelming majority of studies focused on borderline personality disorder (BPD), and the accumulation of evidence resulted in 7 meta-analyses, which are interpreted into better strategies for evidence-based practice. Little research attention was given to schizotypal (SPTD) and antisocial (ASPD) personality disorders, with only indirect treatment efficacy evidence for the obsessive-compulsive (OCPD) and avoidant (AvPD) personality disorders. Some avenues for future efficacy research are indicated. respectively on a fair (level B) and minimal (level C) research-based evidence level. The main symptomatic targets of pharmacotherapy in personality disorders, according to WFSBP guidelines, are affective dysregulation, cognitive-perceptual symptoms, impulsivity and anger. The effects of pharmacotherapy in these patients can also be useful to increase response to combined psychosocial interventions.