People who have trouble handling everyday stresses and a pattern of difficulty dealing with others may have a personality disorder.
In this article the personality disorders will be explained, and what possibly causes the disorders. It will be clarified, how someone can access a treatment and support. And also it will include the indications of how to help someone with personality disorder, which could be treated as a guidance for family and friends.
Personality disorders are categorised by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) as mental illnesses and clearly defines them. Having difficulty coping with normal stress and trouble creating relationships with family, friends, and co-workers may be signals of a personality disorder. However, people who struggle with a personality disorder often don’t enjoy social activities and may not see themselves as contributing to their problems. While everyone has its own unique features, the personality disorders also share some common characteristics.
What are Personality Disorders?
Personality is the way of thinking, feeling and behaving that makes a person unique from other people. An individual’s personality is effected by experiences, environment and inherited characteristics. However, a person’s personality typically stays the same over time. Although, a personality disorder is a way of thinking, feeling and behaving, that diverges from the expectations of the culture, causes distress or problems functioning, and lasts over time.
Although personality disorders may be responsive to treatment, the challenge is getting the individual with a personality disorder to admit that he has a problem and then agree to treatment. One of the reason for this, could be that there is still lots of stigma and shame regarding the mental illnesses.
There are 10 different types of personality disorders. Long-term patterns of behaviour and inner experiences that differs significantly from what is expected are personality disorders. However, the pattern of experience and behaviour starts by late adolescence or early adulthood and causes distress or problems in functioning. Nonetheless, without treatment, personality disorders can be long-lasting. Personality disorders affect at least two of these areas:
- Way of thinking about oneself and others
- Way of responding emotionally
- Way of relating to other people
- Way of controlling one’s behavior
How to Identify Someone with a Personality Disorder?
As mentioned above, the first signs of personality disorder generally appear in late adolescence or early adulthood. Even though children are not formally diagnosed with these disorders, some feature of the disorder can be identified in childhood.
Although the disorders grouped within each cluster have comparable symptoms and traits, one person may not have the exact same symptoms as another person with the same disorder, nor to the same degree. It is important to note that people with one personality disorder usually have symptoms of at least one additional disorder. So it is important not to attempt a diagnosis if one is not a mental health professional. People are usually unaware of their differences because they recognise their own distorted thought processes, emotional responses, and behaviours as normal.
Individuals with personality disorders are disposed to comorbid diagnoses like substance abuse disorder, anxiety, and depression.
What are the categories of personality disorders?
Subsequently, psychiatrists are using a system of diagnosis, which identifies 10 types of personality disorders, and these are divided into 3 categories:
- Cluster A: Odd, suspicious or eccentric behaviour
- Paranoid personality disorder
- Schizoid personality disorder
- Antisocial personality disorder
- Cluster B: Dramatic, emotional or erratic behaviour
- Borderline personality disorder (BPD)
- Histrionic personality disorder
- Narcissistic personality disorder
- Cluster C: Anxious fearful behaviour
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive compulsive personality disorder (OCPD)
Above all, the understanding of what it means to experience a personality disorder is frequently developing. Although it is a controversial diagnosis. Certainly, people have very different views about these terms, and not everyone agrees with using them for many different reasons. However one of the main reason why people don’t agree with it, is because they don’t agree with labelling/ boxing people.
Nonetheless it is important to remember is that the feelings and behaviours associated with personality disorders are very difficult to live with. While you understand your diagnosis, and whether terms you prefer to use, you deserve understanding and support.
What types of Personality Disorders are there?
Paranoid personality disorder:
A pattern of being suspicious of others and seeing them as mean or spiteful. Therefore, the individual with paranoid personality disorder shows distrust toward others that usually begins by early adulthood. While the DSM defines the disorder as “a pattern of distrust and suspiciousness such that other’s motives are interpreted as malevolent.” They perceive a lot of unintentional insults and may be very unforgiving.
The thoughts, feelings and experiences associated with paranoia:
- It is hard to confide in people, even family and friends.
- It is difficult to trust people.
- It is very difficult to relax.
- Read threats and danger (which others don’t see) into everyday situations.
Schizoid personality disorder:
According to DSM, it is a pattern of detachment from social relationships and a restricted range of emotional expression. As a result, a person with schizoid personality disorder typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others. But many people with schizoid personality disorder are able to function well. Unlike in schizophrenia, people would not usually have psychotic symptoms.
The thoughts and feelings associated with this diagnosis:
- It is difficult to form close relationships with other people.
- Live life without interference from others.
- Prefer to be alone with one’s thoughts.
- Not enjoying many activities.
- No interest in sex or intimacy.
- It is difficult to emotionally relate with others.
Schizotypal personality disorder:
Is marked by a pattern of difficulty with relationships that is accompanied by cognitive and perceptual distortions and eccentric behaviours. In other words, people with schizotypal personality disorder feel very uncomfortable in close relationships. Also they may have odd beliefs and strange behaviour or speech, or may have excessive social anxiety. Individuals with this disorder are so highly superstitious they are basically dysfunctional.
The thoughts, feelings and experiences associated with schizotypal personality disorder:
- It is extremely difficult to make close relationships.
- Experience distorted thoughts or perceptions.
- The belief of the ability to read minds.
- Expressing oneself in an ‘odd’ way.
- Feel anxious and tense with others.
- Feel very anxious and paranoid in social situations.
Antisocial personality disorder:
This disorder entails a pattern of disregarding or violating the rights of others. For instance, a person with antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively. Consequently males with antisocial behaviour tend to break the law, disregard rules of conduct, and be manipulative and reckless, says Dr. Oldham.
The thoughts and experiences associated with antisocial personality disorder:
- Behave in ways that are unpleasant for others.
- Behave dangerously and sometimes illegally
- Feel very easily bored and act on impulse.
- Behave aggressively and get into fights easily.
- Do things even though they may hurt others.
- Have problems with empathy.
- Have had a diagnosis of conduct disorder before the age of 15.
But, it is important to note, that this diagnosis includes “psychopathy’ and ‘sociopathy’. However these terms are no longer used in the Mental Health Act.
Borderline personality disorder (BPD):
Is defined by a pattern of instability in interpersonal relationships, intense emotions, poor self-image and impulsivity. As a result, a person with borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness. Not only do these individuals lack a solid sense of identity, they also have difficulty forming and keeping relationships. Borderline personality disorder is also known as emotionally unstable personality disorder (EUPD).
The thoughts and feelings associated with borderline personality disorder:
- Feeling worried about being abandoned.
- Have very strong emotions that can change quickly.
- Not having a strong sense of who they are or what they from life.
- Find it hard to make a keep stable relationships.
- Act impulsively and do things that could harm them.
- Have suicidal thoughts.
- Self-harm.
- Feel empty and lonely most of the time.
- Struggle to control anger.
- Find it hard to trust people.
- Experience other mental health problems, like anxiety, depression, eating problems, addictions, post-traumatic stress disorder.
To clarify, BPD is currently the most commonly diagnosed personality disorder.
Histrionic personality disorder:
With this disorder, the person shows a pattern of excessive emotion and attention-seeking behaviours, which as a result may involve a sensitive sense of dramatization and inappropriate sexual or provocative behaviours. Someone with this disorder may be uncomfortable when they are not the centre of attention, or have rapidly shifting or exaggerated emotions.
However, majority of people enjoy being given compliments and positive feedback about their actions. But if someone depend very profoundly on being noticed, or are seeking approval so much that this affects their everyday life, they might get a diagnosis of histrionic personality disorder.
The thoughts, feelings and experience associated with histrionic personality disorder:
- Be easily influenced by others.
- Get reputation for being dramatic and overemotional.
- The need to entertain people.
- Feel very uncomfortable when not in the centre of attention.
- Constantly seek and feel dependant on, the approval of others.
- Make rash decisions.
- Flirt or behave/dress provocatively to remain the centre of attention.
Narcissistic personality disorder:
Narcissistic personality disorder involves a pattern of grandiose behaviours with an exaggerated sense of self-importance, also a sense of entitlement or take advantage of others, a pattern of need for appreciation and lack of empathy for others. For example, the person tends to believe he or she is special and unique and requires excessive admiration from others.
On the other hand it is human nature to be aware of our own needs, to express them, and to want others to be aware of our abilities and achievements. These are good traits. However, if these thoughts, feelings and behaviours are very extreme and cause problems in relating to others, then someone may have a narcissistic personality disorder.
The thoughts and experience associated with narcissistic personality disorder:
- Be seen as selfish and dismissive of other people’s needs.
- Feel upset if others ignore them or don’t give them what they feel they deserve.
- Put your own need above other, and demand they do too.
- Resent other people’s successes.
- Believe that there are special reasons that make them better and more deserving than others.
- Have a fragile self-esteem, so they rely on others to recognise their worth.
Avoidant personality disorder:
Consequently, this disorder involves a pattern of behaviour with heightened social inhibition, which is often accompanied by a fear of rejection of others. In addition, a pattern of extreme shyness, feelings of inadequacy and great sensitivity to criticism. People with avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially incompetent.
The thoughts, feelings and behaviours associated with avoidant personality disorder:
- Constant worry about being rejected.
- Worry about being shamed by others.
- Avoid work or social activities.
- Expect disapproval and criticism and be very sensitive to it.
- Avoid relationships, and intimacy because of the fear of refection.
- Feel lonely and isolated, and inferior to others.
- Be reluctant to try new activities in case they embarrass themselves.
Dependent personality disorder:
A person with a dependent personality disorder exhibits a pattern of behaviour, which is marked by extreme neediness or clinginess, that is accompanied by fears of separation. For Instance, people with dependent personality disorder may have trouble making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.
However, it is normal to need other people to care for us or give us comfort sometimes. A healthy balance involves being able to both depend on others as well as being independent from others. While, if feelings and thoughts about needing others become so devastating that they impact someone life and relationships, they may get a diagnosis of dependent personality disorder.
The thoughts and behaviours associated with dependant personality disorder:
- Allow and require others to assume responsibility for many areas of their life.
- Agree to things that feel wrong, in order to avoid being alone.
- Feel needy, weak and unable to make decisions or function in everyday life, without help from others.
- Being afraid of being left alone.
- See other people as being much more capable that themselves.
Obsessive compulsive personality disorder (OCPD):
A person with anankastic (obsessive-compulsive) personality disorder displays a pattern of preoccupation with orderliness, perfection and control. For example, a person with obsessive-compulsive personality disorder may be excessively focused on details or schedules, may work disproportionately not allowing time for leisure and friends, or may be inflexible in their morality and values. However it is important to note that this is NOT the same as obsessive compulsive disorder, which describes a form of behaviour rather than a type of personality.
Nevertheless, similarly to OCD, OCPD involves problems with perfectionism the need for control, and significant difficulty being flexible in how you think about things.
The thoughts and behaviours associated with obsessive compulsive personality disorder:
- Need to keep everything in order and under control.
- Set unrealistically high standards for themselves and others.
- Think their way is the best way of doing things.
- Worry about them or others making mistakes.
- Feel very anxious if things aren’t ‘perfect’.
Can Personality Disorders Be Treated or Cured and If So How?
Personality disorders involves unique treatment challenges. However, people with personality disorders who are inspired to change, can make great steps and benefit from therapeutic involvements. Moreover, most personality disorders are ego-syntonic, which means they are compatible with a person’s self- concept. Similarly, there is little or no motivation to change behaviour, and the behaviour is not perceived as dysfunctional. The characteristic nature of personality disorders also makes them treatment-resistant. That is to say, these maladaptive ways of thinking and behaving are foundational, and are now understood to reflect brains that developed anomalously.
Certainly, some types of psychotherapy are effective for treating personality disorders. An individual can gain awareness and knowledge about the disorder and what is contributing to symptoms, and can talk about thoughts, feelings and behaviours during psychotherapy. Nonetheless the process of psychotherapy can help a person understand the effects of their behaviour on others and learn to manage and to cope with symptoms and to reduce behaviours triggering problems with functioning and relationships. However the type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s situations.
Commonly used types of psychotherapy include:
- Psychoanalytic/psycho-dynamic therapy
- Dialectical behavior therapy
- Cognitive behavioral therapy
- Group therapy
- Psycho-education (teaching the individual and family members about the illness,
treatment and ways of coping)
However, it is important to note there are no medications to treat personality disorders. But on the other hand medication, such as antidepressants, anti-anxiety medication or mood stabilizing medication, may be sometimes helpful in treating some symptoms. Although, more severe or long lasting symptoms may require a team approach involving a primary care doctor, a psychiatrist, a psychotherapist, social worker and family members.
In addition to actively participating in a treatment plan, some self-care and coping strategies can be helpful for people with personality disorders.
- Learn about the condition, because knowledge and understanding can help empower and motivate.
- Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety.
- Avoid drugs and alcohol, because alcohol and illegal drugs can worsen symptoms or interact with medications.
- Get routine medical care, but don’t neglect regular care from your family doctor.
- Join a support group, of others with personality disorders.
- Write in a journal, in order to to express your emotions.
- Try relaxation and stress management techniques such as yoga and meditation.
- Stay connected with family and friends; avoid becoming isolated
Conversely just because a disorder cannot be “cured” does not mean an individual will not live a rewarding life and make contributions to society. Those who struggle to do so can be supported with empathy and encouragement. Conversations with an individual who may be distressed with a personality disorder are most successful when they are future-focused and centered on behavioral choices and consequences, rather than on what the person “should” do or why they behave as they do.
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