A personality disorder is a long-standing, pervasive, rigid pattern of thought, feeling and behaviour that interferes with functioning and causes unhappiness for the person suffering and often the people around them. Personality disorders are also conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others. Changes in how a person feels and distorted beliefs about other people can lead to odd behaviour, which can be distressing and may upset others.
Common features include:
- being overwhelmed by negative feelings such as distress, anxiety, worthlessness or anger
- avoiding other people and feeling empty and emotionally disconnected
- difficulty managing negative feelings without self-harming (for example, abusing drugs and alcohol, or taking overdoses) or, in rare cases, threatening other people
- difficulty maintaining stable and close relationships, especially with partners, children and professional carers
- sometimes, periods of losing contact with reality
Symptoms typically get worse with stress.
People with personality disorders often experience other mental health problems, especially depression and substance misuse.
When and why personality disorders occur
Personality disorders typically emerge in adolescence and continue into adulthood. They may be mild, moderate or severe, and people may have periods of “remission” where they function well. Personality disorders may be associated with genetic and family factors. Experiences of distress or fear during childhood, such as neglect or abuse, are common.
- a) Paranoid Personality Disorder: This personality disorder is marked by a suspicion of people in almost all situations, with no reason. They feel that everyone is against them and are constantly scanning the environment for proof of their suspicions. This suspicion has drastic effects on emotional adjustment and interferes with relationships.
- b) Schizotypal Personality Disorder: In schizotypal personality disorder, a person’s speech, behaviour, thinking and/or perceptions are disturbed in an odd way, but not disturbed enough to be diagnosed as schizophrenic.
- c) Schizoid Personality Disorder: This disorder involves a severely restricted range of emotions that is most associated with a social detachment. A person with this disorder has little or no interest in relationships and are distant from their families, rarely marry, and have no close friends. In some cases the ability to experience positive emotions at all is restricted. They are totally absorbed with themselves.
- d) Borderline Personality Disorder: Borderline personality disorder is characterized by an unstable sense of self, a needy dependency on relationships with others in order to achieve a sense of identity; distrust of other people, a suspicion of people and an expectancy that they will be abandoned or victimized, an ambivalence towards people, impulsive, unpredictability in actions, self-destructive behaviour, manipulative behaviours, and difficulty in controlling anger, often existing in a state of perpetual grief and anger.
- e) Histrionic Personality Disorder: The main feature of this disorder is self-dramatization – an exaggerated display of emotion. These emotional outbursts are manipulative and are aimed at attracting attention and sympathy. Due to this excessive drama, their interpersonal relationships are fragile.
- f) Narcissistic Personality Disorder: This disorder is characterized by a grandiose sense of self-importance, which is often combined with periods of feelings of insecurity and inferiority. They brag of their achievements and predict great successes for themselves in their future, and expect the attention and adoration that would be given someone as gifted as they think they are. This self-love, however, is accompanied by a fragile self-esteem, which causes the individual to constantly check how he or she is regarded by others and to react to criticism with rage and despair. These people are poorly equipped for relationships with others, as they demand a great deal from others and give little in return, showing a lack of empathy. As well, they choose their friends based on what they can get from them.
- g) Avoidant Personality Disorder: This disorder is marked by social withdrawal. This withdrawal is due to a fear of rejection. The person is hypersensitive to any possibility of rejection, humiliation or shame. They want to be loved and accepted, but they think that they will not, therefore causing then to avoid relationships unless they are constantly reassured of the others affection. They have low self-esteem and are depressed.
- h) Dependent Personality Disorder: This disorder involves a dependence on others. These people are fearful and incapable of making decisions on their own. Underneath this dependency exists a fear of abandonment.
- i) Obsessive compulsive personality disorder: The defining characteristics of this disorder are excessive preoccupation with orderliness, perfectionism, and control. They are very interested in efficiency – organizing, following rules, and making lists and schedules. They become so obsessed with this that they cease to be efficient, as they never get anything really important done. They are generally stiff and formal in their dealings with others, and they cannot really take any genuine pleasure in anything. Often obsessive compulsive personalities tend to be workaholics.
Many people recover from personality disorders over time. Psychological or medical treatment is sometimes helpful; sometimes support is all that is needed. This depends on the severity of the disorder and whether there are ongoing problems.
Treating a personality disorder
Treatment for most personality disorders usually involves a course of psychological therapy. This normally lasts at least six months, often longer, depending on the severity of the condition and other co-existing problems.
Psychotherapy is a treatment that involves discussion of thoughts, emotions and behaviours with a trained professional. The aim of all psychological therapies is to improve people’s ability to regulate their thoughts and emotions.
Some therapies focus on dysfunctional thoughts, while others focus on self-reflection and being aware of how your own mind works. Some therapies, especially group therapies, help people understand social relationships better.
Psychological therapies can be effective for many personality disorders. However, they should only be delivered by a trained professional who has experience of working with personality disorders and other clinical conditions. This is because personality disorders are serious conditions that can be associated with high-risk behaviours, such as self-harm.
As well as listening and discussing important issues with you, the psychotherapist can suggest strategies to resolve problems and, if necessary, can help you change your attitudes and behaviour.
A range of different psychotherapies are used to treat personality disorders. They can be broadly classified into three types of therapy, outlined below.
Psychodynamic (reflective) psychotherapy
Psychodynamic psychotherapy is based on the idea that many adult patterns of behaviour are related to negative early childhood experiences. These experiences cause patterns of distorted thinking and beliefs that may have been understandable in childhood, but do not work in adult life. The goal of therapy is to explore these distortions, understand how they arose, and find effective ways to overcome their influence on your thinking and behaviour.
Both individual and group psychodynamic therapy may be helpful for personality disorders, especially borderline personality disorder (BPD). A particular form, called metallization-based therapy, is recommended for BPD.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is based on the theory that how we think about a situation affects how we act. In turn, our actions can affect how we think and feel. Therefore, it is necessary to change both the act of thinking (cognition) and behaviour at the same time.
A type of CBT called dialectical behaviour therapy (DBT) has proved successful in helping people reduce impulsive self-harming behaviours, especially in BPD. DBT is designed to help you cope better with emotional instability, while at the same time encouraging you to behave in a more positive way.
Interpersonal therapy (IPT) is based on the theory that our relationships with other people and the outside world in general have a powerful effect on our mental health.
Several personality disorders may be associated with feelings of low self-esteem, anxiety and self-doubt, caused by problems interacting with people.
During IPT, the therapist will explore any negative issues associated with your interpersonal relationships and how these issues can be resolved.
Therapeutic communities (TCs) are a form of group therapy, in which the experience of having a personality disorder is explored in depth. TCs are an intensive form of therapy.
The minimum type of TC is one day a week, but others are 9am-5pm, five days a week. They have been shown to be effective for mild to moderate personality disorders, but require a high level of commitment.
No medication is currently licensed for the treatment of any personality disorder. However, medications may be prescribed to treat associated problems, such as depression, anxiety or psychotic symptoms.
For example, if you have moderate to severe symptoms of depression that make it difficult to approach your therapy with confidence or enthusiasm, you may be prescribed a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
Some people, especially those with BPD, have found mood-stabilising medication helpful.