Expert Telehealth Care for Personality Disorders in New York
Personality disorders affect an estimated 9–15% of the general population — making them far more common than most people realize. Despite this prevalence, personality disorders are among the most frequently misdiagnosed and least understood psychiatric conditions. Many individuals spend years receiving treatment for depression, anxiety, or other conditions without ever having the underlying personality disorder properly identified and addressed.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides thorough telehealth evaluation, accurate diagnosis, and personalized medication management for personality disorders for adolescents and adults across New York State — with a strong emphasis on coordinated care connecting patients to the specialized therapy that produces lasting change.
What Are Personality Disorders?
Personality disorders are a group of mental health conditions characterized by enduring, inflexible patterns of inner experience and behavior that deviate significantly from cultural expectations, span many areas of life, remain stable over time, and cause significant distress or impairment. These patterns typically emerge in adolescence or early adulthood and affect how a person thinks about themselves and others, how they manage their emotions, how they behave in relationships, and how they respond to the world.
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The DSM-5 organizes personality disorders into three clusters:
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Cluster A — Odd/Eccentric: Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder
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Cluster B — Dramatic/Emotional/Erratic: Antisocial Personality Disorder, Borderline Personality Disorder (BPD), Histrionic Personality Disorder, Narcissistic Personality Disorder (NPD)
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Cluster C — Anxious/Fearful: Avoidant Personality Disorder, Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder (OCPD)
What Are The Signs And Symptoms of Personality Disorders?
Symptoms vary significantly by specific disorder. Common presentations across personality disorder categories include:
Borderline Personality Disorder (BPD) — Most Frequently Treated
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Frantic efforts to avoid real or imagined abandonment
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Intense, unstable relationships alternating between idealization and devaluation
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Unstable self-image or chronic identity confusion
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Impulsive, self-damaging behaviors — spending, substance use, risky sexual behavior, reckless driving
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Recurrent self-harm or suicidal behavior
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Intense emotional reactivity — mood shifts lasting hours to days
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Chronic feelings of inner emptiness
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Inappropriate, intense anger or difficulty controlling anger
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Transient paranoia or dissociative symptoms under stress
Common Features Across Personality Disorders
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Persistent relationship difficulties — patterns that repeat across different relationships and contexts
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Difficulty understanding or empathizing with others' perspectives
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Emotional dysregulation — intense, rapidly shifting, or inappropriate emotional responses
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Rigid, inflexible thinking and behavioral patterns
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Chronic sense of emptiness, shame, or — in some disorders — grandiosity
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Significant distress or impairment in work, relationships, or daily life
How Are Personality Disorders Diagnosed?
Diagnosing personality disorders requires a comprehensive evaluation reviewing a person's long-term patterns of thinking, feeling, and behaving — not just current episodic symptoms. Because personality disorders frequently co-occur with depression, anxiety, PTSD, and substance use disorders, careful differential diagnosis is essential. At Strong Enough Mental Health, Salvatore takes a thorough, unhurried approach to evaluating personality in the context of a person's full clinical picture.
What Are Possible Treatments For Personality Disorders?
Medication for Personality Disorders
There are currently no FDA-approved medications that directly treat personality disorders themselves. However, medications can significantly reduce specific associated symptoms — mood instability, impulsivity, anxiety, depression, and psychotic features — that interfere with daily functioning and quality of life, and that make therapeutic work more accessible.
Mood Stabilizers — For Emotional Dysregulation and Impulsivity
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Lamotrigine (Lamictal) — Multiple studies support its use in BPD for reducing emotional dysregulation, impulsivity, and self-harm behaviors
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Valproate/Divalproex (Depakote) — Reduces impulsivity and affective instability in BPD and other cluster B presentations
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Lithium — Used for mood instability and impulsive aggression
Low-dose atypical antipsychotics can reduce impulsivity, aggression, emotional dysregulation, and transient paranoid or dissociative symptoms associated with personality disorders — particularly BPD and cluster A presentations.
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Quetiapine (Seroquel)
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Aripiprazole (Abilify)
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Olanzapine (Zyprexa)
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Risperidone (Risperdal)
Atypical Antipsychotics — For Impulsivity, Paranoia, and Cognitive-Perceptual Symptoms
Antidepressants — For Co-occurring Depression and Anxiety
SSRIs and SNRIs are frequently used to manage co-occurring depression and anxiety in individuals with personality disorders. Some evidence suggests they may also help reduce impulsivity and emotional reactivity in certain presentations.
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Fluoxetine (Prozac) — Some evidence for reducing anger and impulsive aggression in BPD
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Sertraline (Zoloft)
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Venlafaxine (Effexor)