Personality Disorder

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What is Personality?

It’s difficult to pin down exactly what we mean by the word ‘personality’. It seems obvious when we use it in everyday conversations, but it is hard to define. We generally refer to personality types, characteristics and traits as a way of describing ourselves and other people. In mental health, the word ‘personality’ refers to the collection of characteristics and traits that we have developed as we have grown up and which make each of us individual. These include attitudes, values, desires, wishes, ways of thinking, feelings, and behaviours. The general consensus is that our personality is reasonably stable and consistent but with occasional fluctuations and sufficient flexibility to adapt to different situations, demands, and roles.

What is a Personality Disorder?

A personality disorder can occur when parts of your personality develop in ways that make it difficult for you to live with yourself and with other people. Alternatively, when suffering from a personality disorder it is common to not be able to learn from experiences and not to be able to recognise your role in a problem. You may find that you can’t seem to change the parts of your personality that constantly contribute to problems. Difficult traits may emerge during childhood, adolescence and early adulthood with the latter two stages often being especially turbulent.

You may find it difficult to make and keep close relationships. Alternatively, you might become overly reliant and dependent on others with whom you share a close relationship. You might find it hard to get on with people at work or school. There may be regular conflict with friends and family and you may find listening to others difficult. It can become hard to understand yourself and manage your feelings, thoughts and behaviour. You may frequently find yourself in trouble and feel like you are doing the wrong thing or making the wrong choices. If you have a personality disorder life is often a lot more chaotic and you may often feel especially isolated .

You are more likely to have other mental health problems such as anxiety or depression. You may find it difficult to trust yourself and others, have emotional outbursts, or act impulsively. It is not uncommon to rely on unhelpful behaviour patterns such as self-harm, substance misuse and other addictive behaviours to cope with a personality disorder.

Do I need to get Help with my Personality Difficulties?

People with personality based difficulties are frequently misunderstood by themselves and others. You can often blame yourself for your own difficulties and others can feel like you are attention-seeking, manipulative, selfish or are not trying hard enough to change things. You may be perceived as irresponsible, reckless, or not a nice person to be around. Traditionally, personality difficulties have generally not had enough support from mental health services. You might have initially sought help for a common mental health problem such as anxiety and depression; however, during assessment and treatment it could have emerged that the nature of your difficulties was more complex.

What are the main symptoms of Personality disorders?

Personality disorders are a complex range of disorders therefore we can only give a brief description as guidance here. You need to discuss your concerns with a psychiatrist or psychologist specialising in this area before coming to a conclusion about your own or another person’s personality based difficulties.

The essential features of a personality disorder are struggles in personality both in terms of how you understand yourself and your identity and extensive interpersonal difficulties. In order to be diagnosed with a personality disorder you need to experience significant impairments in how you see yourself and your capacity for self-direction. There tends to be a pattern of broken, intense, sometimes controlling and conflictual relationships. Alternatively, there can also be a notable absence of intimate relationships. There is likely to be evidence of a cluster of problematic personality traits, these can include risk-taking, impulsive, compulsive, anxious disposition, depressive responses, avoidance of intimacy, empathy issues, unusual cognitive and perceptual experiences, lack of insight and rigidity.

In addition these clusters of traits need to be relatively stable across time and consistent across situations. That is to say that they may not be better explained as a natural result of the individual’s developmental stage or socio-cultural environment. Finally it is important that the difficulties are not solely due to the direct physiological effects of a substance misuse or a general medical condition (e.g. head injury or trauma).

Treatment

If you think you are suffering from personality difficulties that interfere with your daily life, it may be best to consider longer term psychological therapy. Therapy may be particularly important if the problems persist despite all your best efforts. There are a number of evidenced based approaches such as Mentalization Based Treatment (MBT), Dialectical Behavioural Therapy (DBT) and Schema Therapy that are considered to be helpful treatments for personality difficulties. These approaches focus on emotional regulation, distress tolerance and developing a broader range of coping strategies to reduce risk and unhelpful behaviour patterns. This helps you develop an understanding of any underlying developmental trauma and build a stronger sense of identity and self-worth.

Although medication is not recommended for treating a personality disorder itself, medication may be prescribed to treat associated problems such as depression, anxiety or psychotic symptoms. Medication should not be used as a long-term treatment but can help to stabilise distressing symptoms and make engaging regularly with psychological help more manageable.

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