Personality Disorders

It is thought that around 5-10% of people have a Personality Disorder (PD) of some kind, affecting men and women equally. With borderline personality disorder, it is estimated that around 2% of people are affected, with around 75% of them being women. Personality disorders tend to affect the 25-44 age group more significantly more than any other. In institutions like prison, personality disorder is alarmingly common, between 50-65% of the prison population.

What is a personality disorder?

A personality disorder is a disorder which affects the way that a person relates to themselves, other people, the environment around them and how they manage their feelings. It can be very difficult to diagnose as people have very different personalities and it can be hard to distinguish what is ‘normal’ and what is ‘abnormal’. To be diagnosed with PD, these symptoms, mentioned above, must cause disability or distress to the person’s life or to the lives of others. It must also be inconsistent with the norms of their social and cultural background. In the past, PD has been deemed untreatable but nowadays there are treatments used which can be effective.

Personality disorders can be categorised into three groups:

1. Cluster A: Suspicious – divided into three subtypes:
   1. Paranoid – This is characterised by a suspicion of others, a fear of rejection and a tendency to hold grudges.
   2. Schizoid – People would be uninterested in forming relationships, tend to socially isolate themselves, seen by others as ‘loners’ and seem to live in a fantasy world.
   3. Schizotypal – This can come with hallucinations and delusions, sufferers often have an ‘odd’ way of thinking, seen by others as eccentric.
2. Cluster B: Emotional & Impulsive – divided into four subtypes:
   1. Antisocial (this type is closely linked with crime) – Characterised by disregard for the feelings of others (and themselves), people with this type tend to be very impulsive, finding it difficult to form relationships and are prone to outbursts of rage, frustration and aggression.
   2. Borderline– People with this type tend to display poor impulse- control, whether it be with emotions, spending, eating, sexual conduct or substance use, tending to form relationships quickly but losing them easily. Low self- esteem is a trait of this disorder, coupled with depression and high rates of self- harm.
   3. Histrionic– This is displayed but the constant need to be centre of attention, constantly seeking excitement. Relationships tend to be formed quickly but are often shallow. Often emotions are strong but change very quickly.
   4. Narcissistic– Again, people with this form tend to crave attention. They tend to feel very important and dream often of success and power. They often take advantage of others for their own personal gain.
3. Cluster C: Anxious – divided into three subtypes:
   1. Obsessive Compulsive – The sufferer tends to be over cautious which then makes it difficult to make decisions, also tending to worry about the smallest details. People with this form have (in their view) high moral standards and are very sensitive to criticism.
   2. Avoidant– Characterised by very low self- esteem and insecurity causing an intense fear of being judged by others. This can often cause people to be socially withdrawn. This fear of not being accepted or being judged can lead to a great difficulty in forming relationships, though this may be the one thing that the sufferer craves.
   3. Dependent – Often, with this form, the person would rely on others to make decisions for them, eventually; this causes the person with the disorder to put their own needs behind the needs of others, thus becoming dependent on others. Feelings of incompetence and abandonment are common.

What causes PDs?

As with most mental health problems, the exact cause of personality disorders are unknown, though it is widely accepted that the cause is a combination of genetic factors, environmental factors and brain abnormalities. There are also reasonably strong links to childhood trauma – an alarmingly high number of people with PD have had experiences of sexual, physical or emotional abuse or neglect (especially with borderline personality disorder). Strong links are also found in PD and substance abuse.

Treatment Available

Personality disorders can range from mild to severe and because of this the treatment varies greatly.

Sometimes, because a PD is often coupled with another mental illness such as depression and anxiety, or some types of PD can be linked to schizophrenia, medication, such as antipsychotics or antidepressants are used.

Talking therapy is the most widely used method to treat people with PD’s. Often this therapy is done in groups, this helps people learn to interact properly with others and also recognise the benefits of socialising and spending time with others. Reflective psychotherapy can be very effective, simply reflecting on ones behaviours and looking at the feelings that these behaviours cause. Cognitive Behavioural Therapy (CBT) can also very effective in the treatment of personality disorders, it encourages people to explore their feelings, thoughts and behaviours and attempts to teach them how to approach these, and the situations that they may encounter, in a different way. It works on the basis that how a person thinks affects how they feel and what they do. It often helps people break vicious cycles.

Medication can be particularly useful when other conditions such as depression and anxiety are also present

If you are concerned that you or someone you know may require help and advice please call the Via Clinic on 01372 363939