Personality Disorder

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What is Personality?

It’s not easy 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 our self and other people. In mental health, the word ‘personality’ refers to the collection of characteristics or traits that have developed as we grow up and which make each of us an individual. These include attitudes, values, desires, wishes and ways of thinking, feelings and behaving. The general notion is that our personality is reasonably stable and consistent, but with expected fluctuations and flexibility to adapt to different situations, demands and roles.

What is a Personality Disorder?

Parts of your personality can develop in ways that make it difficult for you to live with yourself and with other people. You don’t seem to be able to learn from the things that happen to you and you may not recognise your role in the problem. You find that you can’t seem to change the bits 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 or you might become overly reliant and dependent on close others. You might find it hard to get on with people at work, education, and activities. There may be regular conflict with friends and family and listening to others can be difficult. It can be hard to understand yourself and manage your feelings, thoughts and behaviour finding yourself frequently in trouble and feeling like your are doing the wrong thing or making the wrong choices. Life is generally a lot more difficult sometimes being chaotic or feeling especially isolated when you have a personality disorder.

You are more likely to have other mental health problems such as anxiety, depression, find it difficult to trust yourself and others, have emotional outbursts, act impulsively and rely on unhelpful behaviour patterns such as self-harm, substance misuse and other addictive behaviour to cope with confusion and distress.

Do I need to get Help with my Personality Difficulties?

People with Personality based difficulties are often 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 or bothered to change things. You could be seen as irresponsible, reckless at times and just not a nice person to be around and maybe even bad. Similarly, personality difficulties have generally not had enough help from mental health services. You may initially seek help for a common mental health problem such as anxiety and depression. However, during assessment and treatment it could emerge that the nature of your difficulties is more complex.

What are the main symptoms of Personality disorders?

This is 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 self-identity combined with extensive interpersonal difficulties. To be diagnosed with a personality disorder you need to experience significant impairments in how you see yourself and your capacity for self-direction. In terms of relationships there tends to be a pattern of broken, intense, sometimes controlling and conflictual relationships, but sometimes there can also be a notable absence of intimate relationships. There is likely to be evidence of a cluster of problematic personality traits for example 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 cluster of traits need to be relatively stable across time and consistent across situations and are not better understood as expected based on the individual’s developmental stage or socio-cultural environment. Finally 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 interferes with your daily life and contributes to a repetition of problems despite all your best efforts, you may need to consider longer term psychological therapy. 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 approaches to treat personality difficulties. These approaches especially focus on emotional regulation, distress tolerance and developing a broader range of coping strategies to reduce risk and unhelpful behaviour patterns, developing an understanding of any underlying developmental trauma and building 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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