Personality disorders treated with the depth and honesty they require.
Personality disorders are among the most complex, most frequently misdiagnosed, and most inadequately treated conditions in outpatient psychiatry. At Wave Psychiatric Group, our board-certified psychiatrists approach personality pathology with the clinical rigor, the psychotherapeutic depth, and the honest communication that this work demands.
Personality disorders are characterized by enduring patterns of inner experience and behavior — in cognition, affect, interpersonal functioning, and impulse control — that deviate markedly from the expectations of the person's culture, are pervasive and inflexible across situations, are stable over time and traceable to at least early adulthood, and lead to clinically significant distress or functional impairment.
What this means in practice is that personality disorders are not acute conditions that come and go like depressive episodes or anxiety attacks. They are deeply ingrained patterns in the way a person perceives themselves, relates to others, and navigates the world — patterns that typically developed in response to early experiences and that have become structural features of the person's psychology over time. This is what makes them clinically challenging and what makes superficial or symptom-focused treatment approaches insufficient.
Personality disorders are also among the most stigmatized conditions in psychiatry — particularly borderline personality disorder, which has historically been treated with therapeutic nihilism that the evidence does not support. People with personality disorders are not difficult patients to be managed. They are people with genuine suffering, genuine strengths, and genuine capacity for change — who need clinicians willing to engage with the full complexity of their presentation rather than defaulting to a label that closes rather than opens the clinical conversation.
It is also important to understand that personality disorders exist on a continuum with normal personality variation and that the boundary between a personality disorder and a severe characterological presentation without a formal diagnosis is often less clinically meaningful than whether the pattern is causing suffering and whether the person wants help with it. Our psychiatrists are interested in the clinical reality of the person in front of them — not in the diagnostic label alone.
Understanding personality disorders
The diagnostic challenge
Wave treats the full range of personality pathology in adults. The presentations we most commonly see include the following.
Borderline personality disorder
BPD is characterized by pervasive instability in mood, self-image, and interpersonal relationships — alongside intense fears of abandonment, impulsivity, chronic feelings of emptiness, and in some patients self-harming behavior or suicidal ideation. It is one of the most prevalent and most clinically significant personality disorders in outpatient psychiatric practice. Despite its historical reputation as difficult to treat, BPD has a meaningful evidence base for specific psychotherapeutic interventions — particularly Dialectical Behavior Therapy and Mentalization-Based Treatment — and a meaningful proportion of patients show significant improvement over time with appropriate treatment.
Narcissistic personality disorder
NPD is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy — alongside, in many presentations, a fragile underlying self-esteem that is highly reactive to perceived slights or failures. Narcissistic personality pathology exists on a spectrum from subclinical traits to the full disorder, and it frequently presents in the context of depression or anxiety triggered by a significant narcissistic injury — a career setback, a relationship failure, or a life transition that has disrupted the person's sense of specialness or entitlement. Psychodynamic approaches that work at the level of underlying self-esteem regulation and the defenses that protect against it are the most clinically meaningful for this presentation.
Avoidant personality disorder
Avoidant personality disorder involves a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation — producing significant restriction in occupational and social functioning driven by the anticipation of criticism, rejection, or humiliation. It exists on a continuum with generalized social anxiety disorder and shares significant overlap with it — though avoidant personality disorder tends to be more pervasive, more characterologically entrenched, and more resistant to symptom-focused interventions alone.
Obsessive-compulsive personality disorder
OCPD — distinct from OCD, as discussed on our OCD page — involves a pervasive preoccupation with orderliness, perfectionism, and control that impairs flexibility, openness, and efficiency. Unlike OCD, where obsessions and compulsions are ego-dystonic and experienced as intrusive, OCPD traits are ego-syntonic — experienced as the right way to be, even when they cause significant interpersonal and occupational difficulties. OCPD frequently presents in the context of work-related stress, relationship conflict, or the functional consequences of perfectionism that has become impairing.
Dependent personality disorder
Dependent personality disorder involves an excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation — producing significant difficulties in self-direction, decision-making, and the capacity to function independently. It frequently co-occurs with depression and anxiety and may not present explicitly as a personality concern but as a pattern of relationship difficulties, chronic low self-esteem, and inability to function without significant support from others.
Personality disorders present diagnostic challenges in multiple directions — and getting the diagnosis right matters both because it shapes treatment and because a personality disorder diagnosis, incorrectly applied, can carry significant stigma and lead to therapeutic nihilism that is unwarranted.
The most clinically consequential diagnostic challenges involving personality disorders include the following.
Borderline personality disorder and bipolar disorder
As discussed at length on our Bipolar Disorder page, BPD and bipolar disorder are among the most commonly confused diagnoses in outpatient psychiatry. The emotional dysregulation, impulsivity, and mood instability of BPD are frequently misidentified as bipolar disorder — leading to years of mood stabilizer treatment that addresses the symptoms incompletely while the underlying psychological and relational dimensions of the presentation go unaddressed. Distinguishing between them requires careful attention to the nature, timing, and triggers of mood shifts — and a thorough developmental and relational history that many rapid psychiatric evaluations do not provide.
Personality disorders and trauma
Complex trauma and personality disorders — particularly BPD — have overlapping presentations and deeply intertwined etiologies. Many patients with BPD carry significant developmental trauma histories that are central to understanding how their personality pathology developed. In some patients, what presents as a personality disorder is more accurately understood as the psychological sequelae of complex trauma — a distinction that has treatment implications, as trauma-focused approaches may be more central to recovery than characterological work per se. Our psychiatrists hold both possibilities in mind and assess the relative contribution of trauma and personality in every relevant presentation.
Personality disorders and mood or anxiety disorders
Personality disorders frequently co-occur with depression, anxiety, and other major conditions — and the personality pathology shapes the presentation, course, and treatment response of those conditions in clinically important ways. A patient with avoidant personality disorder and generalized anxiety disorder requires a different treatment approach than a patient with GAD alone. A patient with OCPD and major depression has a different prognosis and treatment trajectory than a patient with uncomplicated depression. Recognizing the personality dimension of a psychiatric presentation — even when it does not rise to the level of a formal diagnosis — is part of what comprehensive psychiatric evaluation provides.
Personality disorders we treat
Our approach to personality disorder treatment
Treatment of personality disorders at Wave is individualized, long-term in orientation, and honest about both what we offer and what exceeds our scope.
Psychodynamic psychotherapy
Psychodynamic psychotherapy is the treatment with the broadest evidence base and the deepest clinical fit for personality disorder treatment. It works at the level of the underlying structures that generate personality pathology — the defensive patterns, relational templates, and self-experience that have become organized around early experiences and that produce suffering across the full range of a person's life. This is not a quick process. Meaningful characterological change takes time, requires a stable and consistent therapeutic relationship, and asks patients to engage with dimensions of their psychology that are often outside of awareness and that can be difficult to look at directly.
Medication management
Medications do not treat personality disorders directly — there are no FDA-approved medications for any personality disorder — but they play a meaningful adjunctive role in managing the psychiatric symptoms and comorbid conditions that co-occur with personality pathology. Low-dose antipsychotics have evidence for the cognitive-perceptual symptoms and affective instability of BPD. Mood stabilizers have evidence for impulsivity and affective dysregulation. Antidepressants address co-occurring depression and anxiety. Our psychiatrists prescribe judiciously and with clear communication about what medication can and cannot address in the context of personality disorder.
Referral for specialized personality disorder therapy
Several of the most evidence-based treatments for personality disorders — particularly DBT for BPD — require specialized training and a structured therapeutic format that our practice does not provide. When a patient's clinical presentation calls for these approaches, we refer to therapists in our Los Angeles clinical network with specific expertise in personality disorder treatment — maintaining communication with the treating therapist and continuing to provide psychiatric medication management and oversight within a collaborative care arrangement.
A note on therapeutic nihilism
It is worth addressing directly something that many patients with personality disorders have encountered in psychiatric and therapeutic settings — the implicit or explicit message that their condition is not really treatable, that they are too difficult to work with, or that their prognosis is poor.
This is not the clinical reality, and it is not the position of Wave's psychiatrists.
Personality disorders — including BPD, the most stigmatized — respond to evidence-based treatment. Longitudinal studies show meaningful improvement in personality disorder symptoms over time, particularly with appropriate psychotherapeutic intervention. The notion that personality disorders are static and untreatable is inconsistent with the evidence and with clinical experience. It reflects historical biases in psychiatric training and practice that have caused significant harm to the patients who received that message.
Our psychiatrists approach personality disorder with the same interest, investment, and clinical seriousness they bring to every presentation. We do not find these patients difficult. We find the work meaningful, clinically engaging, and — when the therapeutic relationship and the treatment approach are right — genuinely capable of producing significant and lasting change.
Insurance and fees
Wave Psychiatric Group accepts Aetna, Optum / UnitedHealthcare Behavioral Health, Meritain Health, Oxford Health Plans, ComPsych, UC SHIP, and others for diagnostic assessment appointments. Self-pay rates are also available.
Call us at 323-688-6380 or complete our intake form and our team will verify your benefits before your first appointment.
Frequently Asked Questions
How is a personality disorder different from a mood disorder?
Mood disorders — depression, bipolar disorder, anxiety disorders — are episodic conditions that represent a change from the person's baseline. Personality disorders are enduring patterns of experience and behavior that are stable over time and that represent the person's characteristic way of being in the world rather than a departure from it. The distinction matters clinically because the treatment approaches differ — episodic conditions are primarily addressed with medication and symptom-focused psychotherapy, while personality disorders require longer-term, characterologically oriented work. Many people have both, and recognizing the personality dimension of a presentation — even when a mood disorder is the presenting complaint — is an important part of comprehensive psychiatric evaluation.
Can personality disorders be treated with medication alone?
No. Medications play an adjunctive role in managing specific symptoms and comorbid conditions associated with personality disorders, but they do not address the underlying characterological patterns that define the disorder. Psychotherapy — particularly psychodynamic approaches — is the treatment with the strongest evidence base for meaningful and durable change in personality pathology. A treatment plan that consists only of medication management for a personality disorder is not meeting the clinical need.
Is BPD a life sentence?
No. Longitudinal research on BPD has consistently shown that a significant proportion of patients experience meaningful symptom reduction over time — particularly with appropriate treatment. The dramatic, crisis-driven aspects of BPD — self-harm, suicidal behavior, intense relational instability — tend to improve significantly over years, particularly with DBT and other evidence-based treatments. The deeper characterological dimensions — chronic emptiness, identity disturbance, difficulties with self-direction — are more persistent but also respond to long-term psychotherapeutic work. BPD is not a life sentence. It is a serious condition that requires serious treatment and time — but the prognosis with appropriate care is meaningfully better than its reputation suggests.
How do I know if I have a personality disorder or just a difficult personality?
This is a question worth taking seriously, and the answer is a matter of clinical evaluation rather than self-assessment. Personality disorders are diagnosed when enduring patterns of inner experience and behavior cause clinically significant distress or functional impairment — in relationships, at work, or in the person's own subjective experience. If you have noticed persistent patterns in the way you relate to others, regulate your emotions, or experience yourself that are causing you or the people around you significant difficulty, a psychiatric evaluation is the appropriate next step. The goal is not to apply a label but to understand the pattern clearly enough to address it effectively.