What is a personality disorder (PD)?
Our 'personality' is the collection of ways that we think, feel and behave that makes us all individuals
A person's personality has different parts (or 'traits'), such as openness, sociability, confidence, impulsivity, introversion among many others. Most of these personality traits are present in everyone to some degree. It is the unique variation in degrees and combinations of personality traits that make us who we are.
Our personality develops from both our inherited genes and our life experiences, particularly in childhood.
Most of the time, our personality allows us to get on reasonably well with other people, but for some of us, this isn't true.
If you have a personality disorder. parts of your personality make it hard for you to live with yourself and/or other people.
You may have a personality disorder if you experience severe difficulties over a long period of time in several of these areas:
making or keeping relationships and friendships
getting on with people at work or with friends and family
keeping out of trouble
controlling your feelings or behaviour
You often feel unhappy or distressed and/or find that you upset or harm other people.
How common is PD?
Probably about 1 in 10 people has a PD, but many will not be severe.
Personality disorders tend to fall into three groups according to the aspect of personality which seems to cause the main problems:
Cluster A: 'Suspicious' - includes
You are suspicious of other people - you feel that they are being nasty to you.
You are sensitive to rejection and tend to hold grudges
You don't have strong emotions, don't like contact with other people and prefer your own company.
You have a rich fantasy world.
You have odd ideas and difficulties with thinking. Other people see you as eccentric.
You may see or hear strange things.
Cluster B: 'Emotional and Impulsive' - includes
You don't care about the feelings of others, get easily frustrated, fight, commit crimes and find it hard to have close relationships.
You do things on the spur of the moment, don't feel guilty and don't learn from unpleasant experiences.
Borderline, or Emotionally Unstable
You do things without thinking, find it hard to control your emotions, and feel empty.
You feel bad about yourself and often self-harm.
You make relationships quickly, but easily lose them.
You often feel paranoid or depressed and, when, stressed, may hear noises or voices,
You over-dramatise events and tend to be self-centered.
Your emotions are strong, but change quickly.
You worry a lot about your appearance and crave excitement.
You feel very important and dream of succes, power and status
You crave attention, tend to exploit others and ask for favours that you don't return.
Cluster C: 'Anxious' - includes
Obsessive-Compulsive (aka Anankastic)
You are perfectonist, worry about detail and are perhaps rigid.
You are cautious and find it hard to make decisions.
You have high moral standards, tend to judge other people and worry about doing the wrong thing.
You are sensitive to criticism and may have obessional thoughts and behaviours.
Avoidant or Anxious
You are very anxious and tense, you worry a lot, feel insecure and inferior.
You want to be liked and accepted, and are sensitive to criticism.
You rely on others to make decisions for you and do what other want you to do.
You find it hard to cope with daily tasks, feel hopeless and incompetent , and easily feel abandoned by others.
Psychologists and psychiatrists can help. You can learn to control aspects of your emotions and behaviour which cause these problems.
Our personalities tend to stay constant over a long period of time, so the treatment will often be long-term. The mainstay of treatment are talking therapies, of which there are different types, but drug treatments can also help.
Counselling and dynamic psychotherapy, cognitive and behavioural therapy (CBT), cognitive analytical therapy (CAT), mentalisation-based therapy (MBT) and dialectical behaviour therapy (DBT).
Treatment in a therapeutic community
A place where you can attend (or sometimes stay) for several weeks or months, Most of the work is done in groups. You learn from being with other people in a unit. It differs from 'real life' in that any disagreements or upsets happen in a safe place. The staff and other patients help you get through such problems and learn from them.
It has been difficult to study the benefits of medications in personality disorder, which means evidence for their effects is limited. Most drug trials are based on borderline personality disorder.
Antipsychotic drugs can reduce the suspiciousness of the Cluster A disorders. They can also help with borderline disorder if people feel paranoid, or are hearing noises and voices.
Antidepressants can help with the mood and emotional difficulties of people with Cluster B disorders, for example in reducing aggressive, impulsive and self-harming behaviours. They can also reduce anxiety in Cluster C disorders.
Mood stabilisers such as lithium, carbamazepine and sodium valproate may also reduce impulsiveness and aggression.
How effective is treatment?
The evidence is weak because treatments are usually quite complicated, so it is hard to know what part actually worked. The studies are also usually small and rather too short, and the ways of measuring improvement are poor. However, there is growing evidence to show that symptoms of borderline personality disorder can improve and even resolve over time.