Which personality disorder is most difficult to cure?


The four ‘Cluster B‘ personality disorders are considered the most difficult to treat.

  • Borderline personality disorder
  • Narcissistic Personality Disorder
  • Antisocial Personality Disorder
  • Histrionic Personality Disorder

However, in recent years, Borderline Personality Disorder and Narcissistic Personality Disorder have been better understood and found to be much more responsive to treatment than previously thought.

The most common and effective treatments for each disorder are:

  1. Borderline personality disorder: Dialectical Behavioral Therapy and Mentalization-Based Treatment.
  2. Narcissistic Personality Disorder: Psychodynamic and Schema Therapy.
  3. Antisocial Personality Disorder: Schema Therapy.
  4. Histrionic Personality Disorder: Psychodynamic Therapy

But thing is…don’t people have to first admit there is an issue, then seek treatment? Most whom I have met with on the above list I think there is absolutely nothing wrong with them and it’s always everyone else. They also never see that they are the drama. So, someone may question that how exactly we can treat someone?

  1. Who thinks they are “fine” and
  2.  Goes on to continue the pattern of destruction? For themselves and everyone around them?

Please remember that all the disorders are a continuum, so yes, there will be those who refuse to accept their problem, but others as soon as they realize that the real reason why their life repeatedly takes the same turns towards chaos, is because of their own disorder, will be only too willing and anxious to gain therapy and change for the better.

I can’t imagine why anyone would want to live with disorders like Borderline personality disorder (BPD) and narcissistic personality disorder (NPD).

10% of people with BPD commit suicide and people with NPD become more suicidal as they reach upper middle age as they reflect on a unhappy life.

Narcissistic personality disorder:

Not all people with Narcissistic personality disorder intentionally seek supply, seek to hurt others, or want to fool or get one over on people. It’s a spectrum like autism or even depression.

It is surprising that Narcissistic Personality Disorder (NPD) is now being thought of as a “treatable” disorder. Typically people with that Cluster B disorder do not believe there is anything wrong with them and therefore do not seek treatment even when their loved ones suggest it. People with Narcissistic Personality Disorder think everyone else has the problems and rarely seek help.

They usually turn any suggestions of that kind around and against the person who suggested it. It is also said that person’s diagnosed with NPD that agree to “see a professional” usually pretend to be getting well (their use of charm and manipulation can sometimes fool even the most discerning psychologist or psychiatrist) and then revert back to their old ways once they are deemed “cured.” They were never cured at all, they just “faked it” to continue on their path of endless supply until the well went dry so they could move on to the next victim.

Anyhow, there is hope for those out there that may be fed up with their life with NPD and want to take a new and more fulfilling path.

I suggested therapy to my NPD friend (before I knew that’s what he was) and he absolutely refused therapy he said he talked to his dad and therapy didn’t do anything for his dad so it would not do anything for him.

The bad news is most narcissists and psychopaths will never accept they have a problem, and they’ll never want to be treated.

Psychopaths don’t even feel that something’s wrong, and narcissists only think that people who don’t consent to being eviscerated are evil

Borderline personality disorder:

With Borderline personality disorder, we do know something is wrong with us. It’s just very hard to accept that you have a personality disorder and some people can’t reach the point of acceptance.

But they will be in the mental health system for some reason, depression, substance abuse, eating disorder. A good clinician can make an initial diagnosis of borderline and follow up with psychological testing to confirm. You can’t cure personality disorders, but the most difficult and most challenging personality disorder to have is BPD.

Response of BPD patient:

I’m 32, and I only found out about my Borderline personality disorder (BPD) diagnoses 8 months ago. The best way I can frame it (from my own experience) is that, one simply doesn’t know until they know. For me, I was in a horrible place and sought therapy. I thought I was depressed. It’s like you know/understand the things you feel/do can’t be normal as your friends don’t seem to be struggling at the same levels as you.

In my case, I thought it was stress, or work, anxiety, or someone/something else making you think the way I was thinking. In retrospect it was cycles of the same patters for years.

You can’t simply think like a neurotypical when you aren’t one to begin with and it’s because what you’re going through is quite literally all you’ve known. You’ve grown with your emotional dysregulation. It becomes you, and you. It’s normal.

You simply can’t understand what you/who you are, until you the onion begins to peel. And even as the onion peels it only becomes more confusing. I expend massive amounts of energy simply trying to manage my thoughts, my reactions, others perception of me. It’s going to take years to sort out.

As a psychologist:

As a psychologist, I always thought the folks caught up in paranoia were the hardest to counsel because they are unable to trust even their therapist. Without that bond, they don’t open up or trust enough to make progress out of the paranoia.

I certainly pray that there is hope for people living with borderline personality disorder (BPD) and the other cluster B’s.

From my observation of a loved one with BPD, it’s a cruel condition to suffer, in it’s worst form. It takes over their life completely and without treatment the results are awful for them and the people around them.

Early diagnosis is necessary:

Much earlier diagnosis is needed too. In my people with BPD case, she wasn’t diagnosed until last year, by which time she had experienced some truly awful consequences which certainly wouldn’t have befallen her if she was at least in treatment and aware ten years earlier. Now she has to not only work on the original condition, which I understand requires a lot of effort.

Also the considerable fallout from various self-sabotaging events, and also come terms with either self-forgiveness and acceptance for her treatment of friends and loved ones. So there is some hope of reconciliation or moving on totally and starting afresh. So, yes, I hope treatment can be effective for people with BPD.

Anti-social personality disorder:

It amazes me that there should be a treatment for anti-social personality disorder (ASPD). First of all, those people usually don’t even go into therapy because they don’t feel anything’s wrong with them. On the contrary, they feel superior to most of the “pathetic worms” that in their eyes populate the Earth. Second, they have no empathy and no conscience. Both things that can be recovered when they are buried under trauma, but can’t be learned when they are not there.

On the other hand, many ASPDs are expert in faking human emotions; so I suspect that they’re faking “getting better” through therapy as well.

I suspect that (as with most mental disorders), there are varying degrees of severity when it comes to ASPD. The milder cases may have some success in treatment. Although chances are many of these people will have to be forced into it through the criminal justice system (as a condition of parole).

There are some interesting brain scan differences in Post-traumatic stress disorder (PTSD), narcissistic personality disorder (NPD) and I believe sociopaths. There is much we don’t know about the brain and health. Maybe cognitive behavior therapy or working with the cranial bones or nervous system etc may help. Or at least if early interventions in childhood may lessen symptoms.


It’s my guess, but the easiest to treat would be Borderlines, followed by Narcissists, then maybe Sociopaths. The first two might see great strides in their treatment if they work a program. The last one might struggle with this because of past trauma and anger issues. And you’re not going to change a psychopath. Their brain is built a certain way, so unless you can get in there and fix the amygdala and certain portions of the brain for them to be more neurotypical that’s not going to happen. I am assuming you can only give them a code of ethics. A plan to follow to stay out of bad behavior.

Essentially, how a person wants to behave is up to them… neurotypical or cluster B, it doesn’t matter the treatment if a person does not want to grow or change, it’s not going to happen.

But if they do seek help they can get it if they work with a trained therapist and do the work.

I am sure we have all dealt with certain cluster B’s that can be wonderful people provided we don’t get too enmeshed with them, like with a malignant narcissist or a sociopath.

I believe communication and working together is a foundation of building a better future, not by manipulation or self-gains. We build it for everyone to be safe and happiness, and yes, hopefully wealth.

Let’s end suffering and manipulation now, and start giving hope and happiness day by day. So we achieve our goals.

These are just my opinions. Good luck to all who seek therapy.

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