The so-called Axis II disorders consist of a series of socially deviant prototypical formulations of disorders, without a known etiology. The usefulness of these diagnoses has been challenged from the start of their inception in DSM-III. Usefulness has to be understood in terms of administration, research, education and last nut not least treatment. The criticism focused on the imprecise boundaries between disorder and non-disorder, the well-known problem of co-morbidity, the dimensional and not categorical nature of personality variations and the overlap with axis-I disorders. A major problem is however the absence of treatment tools implicit in the diagnostic formulations. This has undoubtedly promoted certain pessimism with respect to the treatment of patients with personality disorders, a pessimism that is not corroborated by prospective studies. For instance a majority of patients diagnosed with borderline personality disorder achieve a remission over a period of 4-6 years. These data counteracted the marginalization in healthcare systems of individuals with severe personality disorders. Along with this the expectations about effectiveness of treatment have changed with the introduction of dialectical behavior therapy and psychodynamically oriented interventions. In the case of borderline personality disorders new treatment procedures have been outlined by e.g. Fonagy, who focuses on the role of mentalization in the psychological treatment. In this presentation the nature and effectiveness of the different psychotherapeutic treatment procedures will be compared and illustrated with some patient vignettes.