Despite the advancements in the development of pharmacological interventions for personality disorders (PDs), clinicians should be relatively cautious about the potential benefits of using pharmacological agents for the treatment of PDs when facing therapeutic decisions for individual patients. The pharmacological management of PDs is considerably complex; frequent treatment drop-out, non-compliance, and adverse effects illustrate why having a good therapeutic relationship with patients is a particularly important factor for the success of pharmacological treatment of PDs. Results from clinical trials for PDs may not be generalizable for individual patients in the community. PDs are heterogeneous conditions associated with many psychiatric disorders. Yet, clinical trials frequently include highly selected populations that do not necessarily correspond to typical patients with PDs found in community settings. Considering that PDsfrequently co-occur with other psychiatric diagnoses, a promising approach to future research in PDs should consider the development of treatment algorithms based on co-occurring disorders. This approach is likely to resonate with prescribing physicians trained to evaluate patients systematically for the presence or absence of specific disorders. For instance, this approach has been increasingly studied in gambling disorder, with promising findings reported thus far.

Pharmacological management of personality disorders (PD) is controversial and some guidelines state medications are not to be used. Yet prescribing medications is endemic in practice. This chapter reviews recent evidence regarding the use of medication for PD patients; and novel approaches highlighting possible neuropathological mechanisms and a clinical approach to psychopharmacological management.