Understanding personality disorders

Dr Deborah J Lee, Dr Fox Online Pharmacy, tells us everything we need to know about personality disorders, including how they are diagnosed and treated

What is a personality disorder?

We all have a personality. I’m gregarious, out-going, talkative, and love being with other people. My brother is shy, quiet, never says ‘Boo’ to a goose, and hates other people’s company. Yes, we have the same parents and had the same upbringing.  In fact, we get on well, perhaps as they say, because opposites attract!

But some people have such extremes of personality they can’t get on well with other people, known as a ‘personality disorder.’ This means they find it difficult to make long term relationships, and often seem to find themselves in the midst of some kind of social upset.  This is because they exhibit extreme traits of personality – that is, extreme thoughts, emotions, and behaviours – which don’t adhere to societal norms, and as a consequence often have an unhappy time.

To make matters worse, people with a personality disorder,  often have no idea that their personality dysfunction is the core of the problem, and vociferously blame everybody else.

The diagnosis of a personality disorder deserves sympathy, after all this is not anybody’s fault – it is a medical diagnosis –  and more importantly – once the diagnosis is made, it can be treated.

People with a personality disorder often feel anxious, angry, or distressed, and may self-harm, or harm others. There is frequently a link with drugs or alcohol dependency.

Certain types of personality disorders are often linked to crime. In a recent 2017 medical study of prison inmates, 87.3% of women and 83.3% of men had a personality disorder – most commonly ‘dependent’, ‘borderline’ and ‘antisocial’ personality disorders.

How common are personality disorders?

According to the Royal College of Psychiatrists –

• At any one time, up to 1 in 20 people in the UK may have a personality disorder.
• They are usually diagnosed in early adulthood, over the age of 18.
• They tend to improve in mid-life.

Who makes the diagnosis?

A diagnosis of a personality disorder is usually made by a Consultant Psychiatrist, or another mental health professional.

How to diagnose a personality disorder

If you answer ‘Yes’ to some of the questions on the list below, the chances are you could have a personality disorder. However, most of us have some have some of these issues, some of the time, so do not jump to conclusions.

• Do you find it hard to make friendships and keep them?
• Do you find it hard to make relationships with work colleagues?
• Are you repeatedly falling out with friends and family?
• Do you find unfortunate things keep happening to you?
• Do you find it hard to control your feelings and emotions?
• Do you keep being told you never listen?

Different types of personality disorder

Personality disorders are divided according to clusters of symptoms –

• Cluster A – Odd or eccentric
• Cluster B – Dramatic or emotional
• Cluster C – Anxious or fearful

It’s important to realise that we all have some of these traits quite normally in our personalities – it’s only when these traits are severe, destructive, and causing harm, that it can be labelled as true, personality disorder.

Below is a list of some of the most common types of personality disorder.

• Cluster A

Paranoid – You feel suspicious that everyone is out to get you, even when it is made clear they are not, constantly feeling others are being unkind to you, bearing grudges against people, having nasty behaviour.

Schizoid – You dislike other people, prefer your own company, have no emotions, feel little remorse, and live in a rich, fantasy world.

• Cluster B

Antisocial – You don’t care about other people’s emotions and find it hard to develop intense relationships. You tend to be impulsive, angry, and aggressive. This can lead to you committing crimes for which you feel no remorse. You don’t learn from your previous negative experiences.

Borderline – You find it hard to control your emotions and tend to be impulsive,    sometimes harming yourself, and making suicide attempts. You find it hard to have meaningful relationships. You may feel paranoid and depressed.

Histrionic – You are very self-centred, often over-dramatising events. You tend to be preoccupied with your appearance and can be overtly seductive. Your emotions can be very on and off, quickly up and down.

Narcissistic – You have an overwhelming sense of your own importance. You have inner, unshakeable goals of your own brilliance and success. You often crave affection from others but find it hard to return these affections. This means you regularly take advantage of other people and often do not return favours.

• Cluster C

Obsessive-compulsive  – You are a worrier, you always stick to the details, you are a perfectionist and always like to make sure everything runs smoothly. You are rigid in your outlook and prefer routines. You have high moral standards and can be judgemental. You don’t like criticism.

Dependent – You always rely on others to do things for you. You are usually passive and feel hopeless and despondent. Others quickly abandon you.  You find it hard to cope with the daily chores of life.

Why do some people have personality disorders?

Why some people develop a personality disorder is not known. There may be a genetic tendency but undoubtedly, your upbringing, social environment, and life events, all have an impact on your personality. Traumatic life events such as emotional or physical abuse, bullying, bereavement, parental drug or alcohol dependency, all have an influence.

A personality disorder may also be triggered by life events, such a money worries, a break-up with a spouse, the death of a loved one, or any stressful, untoward, life event.

How can a personality disorder be treated?

There should not be any stigma. A personality disorder is a mental health diagnosis just like any other and deserves recognition, respect, and empathy.

See your GP, discuss the situation, ask for a proper assessment and a diagnosis. Take your partner with you. They need to understand the condition and what they can do to help you.

You may be referred to the Community Mental Health Team or referred directly to see a Psychiatrist. Your appointment will involve a detailed assessment to make a formal diagnosis.

Treatments for a personality disorder include ‘talking treatments’, and/or medication.

Talking treatments

It’s perfectly possible for people with personality disorders to develop insight into their condition and to learn to control thoughts and emotions and modify their behaviour. The way to do this is by using some form of talking therapy. Options include –

• Cognitive Behavioural Therapy (CBT) – This type of treatment aims to explore your thoughts, feelings, and emotions, challenge your behaviour, and teach you coping skills.

• Cognitive analytical therapy – This is a type of interpersonal therapy which aims to help people think about situations differently and work out how to improve your everyday decisions.

• Psychotherapy – In Psychotherapy the therapist seeks to get you to talk about your feelings and emotions. They will try to get you to understand the underlying effects of any previous trauma and help you to heal from it. 

• Treatment in a therapeutic community – This treatment involves admission to a specialised unit to treat drug or substance abuse. Attending these longer-term programs can be highly beneficial and lead to long term behaviour change.

Medication

Various types of medication can be used to treat people with personality disorder. Anxiety or depression often accompany personality disorders and may need treatment. Serotonin Reuptake Inhibitors (SSRIs) are often used in people with borderline personality, histrionic, or narcissistic disorders. Antipsychotic drugs are sometimes used in low doses for those with paranoid or schizoid personality disorders. Sedatives may be needed for anyone suffering from an acute mental health crisis.

A psychiatric hospital admission is rarely indicated and only used as a last resort option, because the vast majority of mental health conditions are managed in the community.

Final thoughts

Mental Health awareness is topical right now. The diagnosis of a personality disorder is not often recognised or discussed in the media, yet personality disorders are common and cause much heartache. Making a diagnosis and getting the right help is vitally important. If this is something you hadn’t considered, or you think a family member or close friend might be suffering from a personality disorder, encourage them to see their GP and ask for help.

For more information

• Mind – Personality Disorders
• http://personalitydisorder.org.uk/
• The Samaritans