Personality disorders are a group of conditions characterised by an inability to get on with other people and learn from experience. People with a personality disorder may find that their beliefs and attitudes are different from those of most other people. Others may find their behaviour unusual, unexpected or perhaps offensive.
Personality disorders usually become apparent in adolescence or early adulthood, although they can start in childhood. People with a personality disorder may find it difficult to start or maintain relationships, or to work effectively with others. As a result, many may feel hurt, distressed, alienated and alone.
Personality disorders affect how a person thinks and behaves, making it hard for them to live a normal life. People diagnosed with personality disorder may be very inflexible – they may have a narrow range of attitudes, behaviours and coping mechanisms which they can’t change easily, if at all. They may not understand why they need to change, as they do not feel they have a problem.
Personality disorder is a controversial diagnosis. They are very deep-rooted, so hard to treat, but people can be helped to manage their difficulties. There are no accurate figures, but an estimated 10% of the general population have some kind of personality disorder. The risk of suicide in someone with a personality disorder is about three times higher than average. People who think they may be suffering from a personality disorder should consult a GP.
People with personality disorders may find it difficult to:
- make or keep relationships
- get on with people at work
- get on with friends and family
- keep out of trouble
- control their feelings or behaviour.
Personality disorders in children or adolescents are sometimes called conduct disorders. However most conduct disorders in children do not necessarily lead to personality disorders in adulthood.
There are several different types of personality disorders, which are categorised under three main ‘clusters’:
Cluster A: Suspicious
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder
Cluster B: Emotional and impulsive
- anti-social personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
Cluster C: Anxious
- avoidant personality disorder
- dependent personality disorder
- obsessive compulsive personality disorder
There is a widespread belief that all people with a personality disorder are very dangerous and can harm other people. This is not true. Some people with anti-social or psychopathic personality disorder may be dangerous. But people diagnosed with borderline or paranoid personality disorder are more likely to harm or even kill themselves.
People with personality disorder are likely to have experienced great trauma in their childhood, and often have multiple and complex needs because of their difficulties fitting in with ordinary life and expectations.
People with personality disorder may also have other mental health problems, such as depression, anxiety, panic disorders, eating disorders, self-harm, substance misuse, and bi-polar disorder.
It can be very difficult to diagnose personality disorders if other mental health problems are masking the personality disorder. Sometimes people with similar symptoms – people with PTSD or Asperger’s syndrome – are misdiagnosed as having a personality disorder.
Causes of personality disorders
The causes of personality disorders are not fully known. Possible causes include trauma in early childhood such as abuse, violence, inadequate parenting and neglect. Neurological and genetic factors may also play a part.
Treatments and self management strategies
Very little research has been undertaken into treatments for personality disorder. What we do know is that most forms of personality disorder can be managed, but no single treatment or management strategy will be effective in all cases.
Personality disorders may be difficult to treat because they involve lifelong, pervasive attitudes and behaviours and because people with personality disorders often have other mental health problems. When a treatment is seen to fail it is often the patient who is blamed for not fitting the programme rather than the service admitting that it has not met the individual’s needs.
In the UK treatment for personality disorders varies considerably, depending to a large extent on whether people are in a general NHS setting, an inpatient psychiatric unit, special hospital or in the prison system. The availability of appropriate resources including qualified staff, therapeutic environments and management support for innovative treatments is also a major issue.
Medication (pharmacological treatments)
Personality disorder is not strictly a mental health problem. Medication is often used, but mainly to control other, associated symptoms. Short-term treatments may include anxiolytic or neuroleptic drugs, which are given for short periods or at times of severe stress
Long-term treatments may involve the use of neuroleptics, which can be helpful in cases of paranoid and schizotypal personality disorders. However it is possible that the medication is mainly controlling risk and stress, rather than having any long term impact on the personality disorder itself.
Cognitive therapies and self-management approaches are also proving successful in helping people live with personality disorder.
This treatment emphasises personality structure and development. It aims to help people understand their feelings and to find better coping mechanisms. This approach has had limited success and is likely to be less successful for those with addiction and/or antisocial personality disorder.
Cognitive and behavioural therapy
Cognitive and behavioural therapies such as cognitive therapy, dialectical behaviour therapy, interpersonal psychotherapy and cognitive analytic therapy can also be helpful. Most cognitive behavioural approaches address specific aspects of thoughts, feelings, behaviour or attitude, and do not claim to treat the entire personality disorder of the person. Research suggests that there are some short term benefits to these approaches but more research is required into the long term benefits.
The therapeutic community (TC) approach involves living in a therapeutic community for several months. Engagement in therapy is voluntary and responsibility for the day to day running of the TC is shared between patients and staff. Members of the TC are encouraged to talk about their feelings, and particularly their feelings about each others’ behaviour. This encourages them to think about the affect of their own behaviour on other people. The results of TC are still be researched.
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