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Our personality is always distinct and describes how we show ourselves to the world. Some people are outgoing and confident whilst others are shy and reserved. Personality is a mixture of both inherited characteristics from our ancestors, and traits developed as a result of what we have experienced in our lives – particularly as children. Our personality might also explain how we interpret what has happened to us, and why when two people are placed in an identical situation, one may seem resilient whilst the other sensitive.
Personality disorder is a blanket term which describes a condition in people who seem unable to regulate their thoughts, feelings and behaviours which in turn leads them to act in negative, harmful or destructive ways. The condition can lead to problems for individuals, their families and society as a whole. Mind, a leading charity concerned with mental illness estimates that more than 10% of the population may suffer from some severity of a personality disorder, with this figure rising to around 50% in prison and psychiatric hospital inmates.
What is personality disorder?
Personality disorder is not an illness or condition you are born with, but is about how a person develops while growing up. Often, a personality ‘trait’ which may have evolved as a coping mechanism for some early difficulty now causes repeated problems in life – particularly within relationships. These issues can be with family and friends, work and health professionals and frequently with all of them.
Personality disorder is an officially classified somewhat controversial medical condition, and a diagnosis can only be made by a psychiatrist or suitably qualified psychologist.
The Diagnostic and Statistical Manual of Mental Disorders, which aims to standardise medical classifications, lists 10 personality disorders. Each usually involves some aspect of a person being unable to regulate and control their feelings then ‘acting out’ with actions towards themselves or others.
There are 10 main disorders which are classed in three ‘clusters’ by DSM IV of behaviour types, which are:
- Cluster A personality disorders: these are disorders in which odd or eccentric behaviour is considered to be central. For example in schizotypal, schizoid and paranoid personality disorders.
- Cluster B personality disorders: this group includes personality disorders in which dramatic and erratic emotional responses are common. Borderline, antisocial, histrionic and narcissistic personality disorders belong in this cluster.
- Cluster C personality disorders: personality disorders which are classified as belonging to cluster C are those in which anxious and fearful behaviour are central – including avoidant, dependent and obsessive compulsive personality disorders.
Who suffers from personality disorders?
Personality disorder is a controversial diagnosis which covers a wide range of people. Many sufferers are distressed by the label while others will never receive an official diagnosis. Historically this might be because it was considered an untreatable condition but this stance is now being rethought.
Individuals who commonly suffer from personality disorders include:
- people who seem unable to manage their lives and relationships
- those who seek psychiatric services long term
The Home Office pressed for changes to Mental Health legislation in 1996 to address the impact of inadequate support for sufferers and to allow a move away from the ‘diagnosis of exclusion’ (diagnosis of a medical condition which is reached through process of elimination). Since entering into the noughties, the Government have been attempting to break the stigma of such conditions with optimistic programmes, increased research and new attitudes in society. Sufferers are now more likely to have diagnosable ‘mental illnesses’ such as depression, eating disorders, panic attacks and drug abuse.
Symptoms of a personality disorder
Personality disorders usually reveal themselves as destructive ways of acting, feeling and interacting with others which generally can’t be revised or regulated. Often the person seems unable to take responsibility for how they act which may be destructive to themselves or others. These repeated, apparently unstoppable patterns often cause inconvenience or chaos in the lives of the sufferer themselves and those around them.
What causes personality disorders?
Research undertaken by Personality Disorder UK has shown that often there has been significant trauma in childhood and/or adolescence. This can range from one event to repeated inability to get long-term healthy responses to emotional needs in earlier life in order to learn how to manage themselves. Some have encountered events that have triggered earlier difficulties. These may have interrupted the development of normal relationships and/or the person’s ability to take responsibility for themselves, nurture and protect themselves and regulate their own emotional responses.
As mentioned above, there are 10 diagnosable personality disorders which fall into three ‘clusters’. Many people do not find these categories useful, as most people with severe problems have a mixture of them and diagnosis does not always help in deciding on treatment. Terms such as ‘complex post traumatic stress disorder (PTSD)’ or ‘attachment disorder’ are more likely to be given to allow a wider view of the person.
What are the personality disorders?
Those who are unhappiest with their personality and thus tend to seek help independently are most commonly those in cluster B. Antisocial personality disorder, which belongs in this cluster, used to be known as ‘psychopathic’ and is extremely high among prison inmates with rates as high as 50% according to online resource Personality Disorder. In contrast, individuals suffering from a disorder which belongs in cluster A will rarely seek help, with sufferers of paranoid personality disorder often being extremely suspicious of medical services and assistance, sometimes leading them to file complaints. Those in cluster C are very often too shy and fearful to seek help and treatment.
Cluster A personality disorders (odd or eccentric disorders)
- Paranoid personality disorder: by nature sufferers will experience a distrust of others as well as irrational suspicions.
- Schizoid personality disorder: defined by a disinterest in engaging in social relationships and spending time with others. Also often unable to find pleasure in enjoyable activities and will spend time contemplating ones own mental and emotional state.
- Schizotypal personality disorder: typical characteristics include odd behaviour or thinking.
Cluster B personality disorders (dramatic, emotional or erratic disorders)
- Antisocial personality disorder: characterised by an ignorance of the entitlements of others, the absence of empathy, and (generally) a pattern of consistent criminal activity.
- Borderline personality disorder: extreme ‘black and white’ thinking and long term unstable emotions – particularly when involving relationships, identity and behaviour. These feeling can lead to both self-harm and impulsive behaviour.
- Histrionic personality disorder: attention seeking behaviour that often includes inappropriate seductive conduct and superficial or inflated emotions.
- Narcissistic personality disorder: characterised by the consistent need for praise and admiration and a belief that they are special and ‘entitled’. Extreme jealousy, arrogance and a lack of empathy are also usually present.
Cluster C personality disorders (anxious or fearful disorders)
- Avoidant personality disorder: feeling socially inhibited and inadequate is common, as is extreme sensitivity to any form of criticism or evaluation that may be interpreted as negative.
- Dependent personality disorder: an extreme psychological dependence upon others.
- Obsessive-compulsive personality disorder: this is not the same as obsessive-compulsive disorder, and is characterised by conforming to rules and moral codes on a severe and unyielding basis. Excessive orderliness is also usually present.
Until guidelines changed in 2002, nurses and doctors were trained to avoid the diagnosis of personality disorders unless they had no alternative option. In the event that a diagnosis was made, the sufferer was then commonly ‘written off’ and excluded from treatment and services. This is where the term ‘diagnosis of exclusion’ originates from.
Living with a personality disorder
Within the last five years, huge strides have been made in the acceptance and treatment of personality disorders. New types of treatment including group work, mulitsystemic therapy (MST) and mentalized based therapy (MBT) have all been implemented to help support and improve the lives of people suffering. Many such people have self-medicated with alcohol and drugs in the past and a new acceptance in the National Health Service is leading the way to new ways of looking at the problem. Support groups and better literature plus an increased understanding are making managing some of the disorders easier for relatives too.
Treatment for personality disorders
Counselling and psychotherapy for personality disorders
The form of treatment offered and indeed the overall success will really be dependent upon both the severity of the condition and also potentially what is available in the local area.
Generally treatment will involve a course of therapy lasting at least six months – sometimes longer if there are others issues.
A specially trained counsellor or psychotherapist will aim to help individuals learn to regulate their thoughts and emotions and generally to understand themselves better.
Often, sufferers find that their personality disorder improves as they age, suggesting perhaps that as they grow older they gain more life experience and develop more of an understanding of how to manage and live with both their own responses and interactions with others.
Interaction with others is something that many sufferers will struggle with, and is an area which counselling/psychotherapy will also endeavour to address. Without knowing it or doing it deliberately, people diagnosable with personality disorder can stir up emotions in others. A professional could help them to work through this, usually through suitable supervision and by providing an opportunity to ‘offload’ in a safe environment.
Specifically, psychotherapy and cognitive behavioural therapy (CBT) are considered to be among the most effective treatment methods, whilst group therapy has also been shown to help.
Being in a group situation will differ from real life because any disagreements or upset will occur in a controlled environment where professionals and other patients can help you to overcome and learn from any issues that arise.