Personality Disorders: A Help Guide
Before approaching a personality 'disorder', it's important to understand what a 'personality' is. Your personality is composed of the way you think, feel, and act.
Of course we all have different sides to our personality. The way we act with a colleague is not the way we act with a loved one. And we all can behave in ways that are slightly out of character if we experience a traumatic event or life challenge. But in general, by the time we get to our 20s we all have consistent marked patterns of being and relating that allow us to get through our days.
A person with a personality disorder, however, will have thoughts, feelings, and behaviours that consistently make their life difficult. These ways of being in the world are things that they can't seem to change no matter how hard they try. Most often this is because their personality is outside of the norm and makes it difficult for them to maintain relationships with others, or sees them often upsetting others.
In summary, a personality disorder is a pattern of difficult behaviour that is persistent, inescapable and long-term, and that constantly complicates life and relationships.
At one point research suggested that up to 20% of people might have a personality disorder, but more recent research suggests it's only 5%. The clearer truth is that it's not really certain how many people have personality disorders. For starters, many people who would qualify for a diagnosis don't see themselves as having something wrong with them and don't seek help. Then there is the changing criteria the mental health community applies to diagnosis, which also makes a statistic difficult.
There is substantial controversy around personality disorders.
Many mental health professionals find the label of a personality disorder unhelpful for the clients they work with. Or they feel that personalities are too individual and too composed of personal life experience to be distilled down to a diagnosed 'disorder'.
The word disorder itself is limiting, focussing on what is wrong with someone, instead of looking at their strengths and resilience. And, of course, it raises the question of what is 'ordered'? This itself is something that changes according to cultures and the present norms of society.
On the other hand, a label can be useful. It is a good shorthand for doctors and healthcare workers to communicate with. And some people find being offered a diagnosis a great relief if they have suffered for a long time with behaviour they can't control or understand. It can feel like a platform to work from.
Perhaps the important thing to remember is that a diagnosis is not all of who you are. It cannot describe your wealth of experiences, or predict the strengths you'll develop in the future. And also, mental health diagnoses are by no means an exact science. A personality disorder is not an illness that can be identified across all sufferers in a microscope, but really just a term to describe a group of people with similar behaviour patterns.
The main symptom of all personality disorders is a marked way of thinking and behaving that does not match what is seen as the norm in your culture. These differences will cause you constant difficulty with relating to others and with fitting in to society, and mean you often upset others despite yourself.
When looking at symptoms of personality disorders, most people will recongise themselves in some way. But it's important not to jump to conclusions or self-diagnose. The difference is that for people with a personality disorder, these behaviours are not occassional when they are upset, a new behaviour they have resorted to because of a challening circumstance they are facing, or behaviours they exhibit because they are still a teenager learning who they are.
Instead, for people with personality disorders, the behaviours listed are consisent and long term. They become clearly evident by early adulthood (when our personalities tend to settle). The symptoms are also things they can't change about themselves no matter how hard they try. Or, they are behaviours that are so natural and ingrained in the person that they even struggle to understand why others have a problem with them.
There are ten diagnosable personality disorders, and it is possible to have symptoms of more than one.
The ten disorders are organised into three groups that are called 'clusters'. Each cluster is like an umbrella for several disorders that share certain traits or symptoms. The clusters and their main traits are:
- Cluster A, Odd or Eccentric
- Cluster B- Dramatic, Emotional, or Erratic
- Cluster C- Anxious or Fearful
If one was to imagine what it was like to have a personality disorder, it would be like these summaries below (for more detailed descriptions, see the links to our personality disorder articles at the end of this guide):
Cluster A personality disorders and their symptoms are:
Paranoid personality disorder - Your life is ruled by a strong suspicion that you can't trust anyone because everyone just wants to exploit and deceive you. Despite no proof, you are sure that the people you know are not to be trusted, especially sexual partners. Even if what others say sounds friendly it must be hostile or a way to secretly belittle you. In fact you are sure that conspiracy theories are all true. You fight for your rights often. And you don't forgive, instead you hold grudges.
Schizoid personality disorder - You are not one for the company of others, preferring to be alone. Emotions are too hard for you to understand and you don't feel them often yourself, you don't understand why you should care what others think of you, and sex is not something you care for. People call you cold. They might say that you flaunt social conventions. You don't understand why it matters. Besides, you are busy. You have a very rich world inside your head, many thoughts and imaginative streams, and you prefer to engage with this than others.
Schizotypal personality disorder - You really have great difficulty understanding others and having relationships, in fact relationships make you feel really uncomfortable and anxious. When you do try to communicate you are told your ideas and behaviour is odd, or that you apparently get things wrong. You might dress in a way that is unusual too. Emotions are hard for you to understand, and yours never seem to match what other expect. You might be very superstitious, or interested in the paranormal, or you might also see and hear things others don't. It's possible that the TV talks to you, or that you are sure there are messages just for you in the things around you. Sometimes you worry that people are out to get you.
Cluster B personality disorders and their symptoms are:
Borderline personality disorder - You can make friends or romantic connections easily, but you seem too sensitive for the world, with far bigger emotions and impulses than others. It's as if you lack the emotional boundaries and 'skin' that others seem to have. This means you have outbursts and upsets that make it difficult to sustain relationships and leave others upset with you, while you are left feeling bad all the time. Sometimes it all feels too much and you self-harm or threaten suicide. Sometimes you just don't know who the real you is, and you feel terribly empty all the time. Your biggest fear, and what you work so hard to avoid, is being abandoned.
Histrionic personality disorder - You really need life to be exciting, and you need everyone to like you, no matter what it takes. A lot of effort in your life is put into your appearance, and you do tend to go for a seductive look, even if others tell you its inappropriate. You have been told you are too dramatic, not totally in touch with reality, and too emotional, although your emotions don't last long. If you like someone, you will do what they suggest without questioning the wisdom of it. You are often accused of being selfish.
Antisocial personality disorder – Rules are for everyone else but you. You don't understand why everyone else is so emotional and uptight, in fact you very easily get frustrated and angry with others and their opinions. You are told you are too impulsive, but for you, life is there for you to do whatever you want, when you want. You never feel guilty or learn any lessons, and you have committed crimes or used agression if it suited you. Close relationships are rarely a part of your life, and you rarely hold down a job.
Narcissistic personality disorder - All that matters to you is your desire for power. You want success, no matter what it takes, and won't let others stand in your way. If you have to take advantage of others to get where you are going, you rarely feel bad about it. It's just the nature of the game, and you are the born winner. Your hobby is taking other people's attention and getting them to do what you want. You don't ever feel you have to return the favour or owe someone. And you are not into emotions or people who want to be emotional.
Cluster C Personality Disorders
Avoidant personality disorder - You find relationships and people terribly difficult because all they do is hurt you, or make you feel bad. It worries you. You worry a lot, actually. All you want is to be liked and accepted, so why is everyone always so horrible to you? It must be something about you that is unacceptable. These sorts of thoughts rule your days. In the end you tend to avoid any real intimacy because it's just too hard and nobody really likes you anyway.
Dependent personality disorder - Your life is ruled by the idea that you need others to survive and must do what it takes to hold on to people, doing what they want. In fact you'll do whatever they say you should do. Because the thing you are sure of is that you just can't cope by yourself, you aren't strong enough, and you can't take care of yourself. But what haunts you is that everyone wants to abandon you, you are sure of it. You are passive and feel entirely hopeless.
Obsessive compulsive disorder (anankastic personality disorder) - You need everything to be just right or it is very upsetting. You check things often to make sure they are right, are obsessed with details, and you have routines you need to follow. Your biggest fear is doing the wrong thing, and you worry excessively over it. You find new situations very challenging, and really hate it when others criticise you, although you have actually often been accused of being critical of others.
It's really not known exactly what causes someone to have a personality disorder. It is generally thought, though, that it is a combination of genetics, brain anomalies, and childhood experiences or social disadvantages that affected the way a person developed.
Again, it's very important not to self-diagnose a personality disorder for either yourself or others, even if it seems you or they have all the symptoms. We all have moods and act out of character now and then, and this doesn't a personality disorder make. As well, personalities are varied and complex things, and a disorder must be diagnosed very carefully only with thorough information and a diligent approach. After all, it's a serious thing that can really affect your sense of self if you do receive a diagnosis.
For this reason, if you do feel you or a loved one might have a personality disorder, it's important to see a mental health professional with substantial experience diagnosing them, not just any therapist and definitely not just a regular doctor. And if you feel you have been given a diagnosis incorrectly, there is nothing wrong with seeking a second opinion.
Because personality disorders are an integral part of the way someone act, thinks, and responds to others, they do not go away. They are life long conditions. But the good news is that most personality disorders respond to treatment and support (read more on this below) and can be managed. Some personality disorders even naturally lessen their effect with time, in particular those that involve impulsvity, such as borderline personality disorder. Sufferers do report that when they reach their 30s or 40s symptoms can be less severe. Of course this is not the case for all personality disorders.
Like with many and even more so than many psychological health conditions, personality disorders tend to be misunderstood. This is not helped by the portrayals of personality disorders by the media, who tend to focus on worse case and rare scenarios, or create fictional characters that are far from the truth about people with personality disorders.
It seems that some personality disorders are more accepted than others, such as obsessive compulsive disorder versus the often misunderstood (and misnamed) borderline personality disorder. And other personality disorders, such as antisocial personality disorder, can leave one ostracised by society.
There is even stigma within the mental health community itself. Clients and users report not being taken seriously by some mental health practitioners, or even being refused treatment. There are charities now working to turn this tide and make mental health services more available and useful to those living with a personality disorder.
If you face stigma trying to find the help you need, the important thing is not to give up. Try elsewhere, or contact one of the charities in the resource section below for advice and guidance.
Personality disorders are not an exact science that can be spotted by examining blood or cells. They are terms created by mental health professionals to describe groups of people with similar behaviours.
Because of this, a diagnosis depends on the expertise and discretion of mental health professionals who specialise in personality disorders. They will observe your behaviour and ask you many questions about your life, your relationships, and your history. This will then be compared to criteria taken from the manual that is considered appropriate in your country – in the UK, this is the World Health Organisation's (WHO) guide to Mental and Behavioural Disorders called the ICD-10 and also the guidelines put forth put forth by the National National Institute for Health and Care Excellence (NICE). NICE works to maintain a set of specific, concise statements that healthcare professionals can refer to to maintain quality standards for patient care. You can visit their website for more information.
Some UK specialists might also refer to the America's well known (and also controversial) reference the Diagnostic and Statistical Manual of Mental Disorders (DSM).
In the past there was quite a negative attitude towards personality disorders, and the belief persisted that they were untreatable. But it's now widely acknowledged that most personality orders can benefit from treatment.
Medication can be helpful for some personality disorders, only in that it can help with some symptoms. Antidepressants might be prescribed for depression and anxiety, and antipsychotics might help people who have a Cluster A personality disorder. But medication cannot 'cure' a personality disorder.
What has been found to be helpful is psychological talking therapy. These seem especially useful for those with Cluster B personality disorders like borderline personality disorder. It's not a short-term solution by any means, and often involves weekly sessions over the course of months or often years. But it provides support, helps you understand yourself better , and helps you recognise your patterns and learn to make better choices in life.
Talking therapies that can help with certain personality disorders include:
Cognitive behavioural therapy – a talk psychotherapy that helps you recognise how your thoughts, feelings, and actions work together.
Dialectical behavioural therapy – this is created to deal with borderline personality disorder, and involves looking at the connection between your thoughts and actions as well as learning useful techniques that come from ancient Eastern philosophy.
Psychodynamic therapy - this sort of talk therapy looks at the ways your childhood experiences have created distorted thinking in your adult life and created patterns of behaviour that, while they might have worked as a child, are no longer working for you now.
Interpersonal therapy – this form of therapy directly focuses on your relationships with others, which is often the main thing people with personality disorders struggle with.
It's a sad fact that many people with personality disorders never seek help. The nature of some personality disorders either mean the person thinks they are above help, or are too paranoid to seek or trust help.
Some personality disorders, left untreated, do change in some cases with time. Disorders that involve impulsiveness, such as borderline personality disorder, may start to be more manageble in your mid 30s or 40s. Of course treatment is still recommended, because it still makes life much easier to have support.
And not all personality disorders improve with time. Some, like schizotypal personality disorder, can worsen, espeically without treatment. It can then turn into schizophrenia, a more challenging disorder.
Because of the stigma attached to having a personality disorder, few well-known people admit to having one (although conjecture abounds). But Kim Basinger has spoken openly about her struggles with avoidant personality disorder, and Leonardo DiCaprio has claimed he has obsessive compulsive disorder. In America well-known football coach Jerry Sandusky famously claimed he had histrionic personality disorder in a court case.
It can be overwhelming if someone in your family or close to you suffers a personality disorder. You can feel like you can't rely on them to behave in ways you understand, or you might even feel threatened by their inconsistent choices.
It can be helpful if you can try to remain curious about what it's like for the other person to live with the viewpoint and personality they have. Compassion for what they experience, depending on the disorder in question, can help the person feel more relaxed around you.
Do educate yourself about their condition, but only to try to undertand your loved one better, not to use information against them or to assume they exactly fit what youhave read. We are all, diagnosis aside, individuals with our own experience. Don't forget to listen to their view of their experiences, and to ask them questions.
You don't have to agree with the things a person with a personality disorder thinks or feels. But it can be helpful to validate that they have such thoughts or feelings over telling them they are wrong. It's better to say, “I appreciate you feel that way” instead of, for example, '”feeling that way makes no sense”.
Do be realistic about your expectations. Lkife can be very hard on a person with a challenging personality, and if you are hoping they will one day wake up different, not only might you be disappointed, but it might make them feel even worse. Likewise nobody wants to feel like notihng but a letdown, and if you see your loved one as entirely untreatalbe or say things like 'you will neer change' it can leave them feeling very defeated and defective, or even inhuman. A better tactic might be to focus on what progress there actually is over what progress you hope for.
Byt again, this depends on the disorder, and it's of course important to take care of your own wellbeing. If you are dealing with someone with serious personality difficulties who might be a danger, you might need to remove yourself and seek help as soon as possible.
Even if you just feel emotionally affected by your experience with your loved one's behaviour, it can be a good idea to seek support. A counsellor or psychotherapist, or a support group consisting of others who have gone through what you are experiencing, can help you set firm boundaries and understand what you are dealing with better.
Emergence - an organisation that supports everyone affected by personality disorders in the UK, including those who have them, their friends and families, and professionals dealing wtih personality disorders in the work place.
Hearing Voices Network - An organisation committed to helping people who hear voices.
Rethink UK - providing advice to those with mental health conditions
Together UK - a charity helping people with mental health issues lead independent lives
Useful Telephone Numbers
Samaritans: 08457 90 90 90
Saneline: 0300 304 7000
Counselling and Therapeutic Services and Organisations
There are many trained personality disorder psychotherapists who will be able to help you.
Counselling and psychotherapy clinics - search through online directories for one in your area. Harley Therapy is one such private practice in London, UK that can assist with personality disorder treatment. Most workplace insurances now cover visits to a therapist, enquire with human resources at your organisation.
The NHS - an alternate to a private practice in the UK is seeing your GP and asking for a referral to a specialist.
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