In general, someone with a personality disorder, (of which there are 10 different types), will differ significantly from an average person, in terms of how they think, perceive, feel and/or relate to others…
To be diagnosed with a personality disorder, an individual must present with a few*, (more than one or two), of the symptoms that are highlighted in any particular personality disorders diagnostic criteria.
*(In terms of why a personality disorder will not be diagnosed in someone with only one or two ‘symptoms’, it is simply because, this is how a personality disorder- something which impacts daily living for those diagnosed- is distinguished from being merely a ‘character trait‘).
It is possible to meet the diagnostic criteria for more than one type of personality disorder, too, if you have symptoms which overlap, and, in this instance, the individual will likely be diagnosed with a ‘mixed’ personality disorder.
The ten recognised personality disorders, and, some of the symptoms which constitute their diagnostic criteria, are as follows…
(Note: they are categorised into 3 ‘clusters‘- A, B, & C, and, 3 groups within those clusters-
A= ‘Suspicious‘- finding it difficult to relate to other people. you might be viewed by others as ‘odd’ or ‘eccentric’,
B= ‘Emotional & Impulsive’– finding it difficult to control emotions. You might be viewed as ‘unpredictable’ by others,
& C= ‘Anxious’– having strong feelings of fear/anxiety. You might appear ‘withdrawn’ to other people)…
Types of Personality Disorders & their symptoms:
Cluster A Personality Disorders
‘Suspicious’
(1-3):
1) Paranoid personality disorder
Characterised by…
‘A pattern of distrust and suspicion of others without adequate reason to be suspicious.’
Symptoms:
- Finding it hard to confide in people, even friends and family
- Finding it very difficult to trust other people, believing they will use you or take advantage of you
- Having difficulty relaxing
- Reading threats and danger (which others don’t see) into everyday situations, innocent remarks, or casual looks from others.
2) Schizoid personality disorder
Characterised by…
‘A lack of interest in social relationships.’
Symptoms:
- Finding it difficult to form close relationships with other people
- Choosing to live life without interference from others
- Preferring to be alone with your own thoughts
- Not experiencing pleasure from many activities
- Having little interest in sex or intimacy
- Having difficulty relating to others/being ’emotionally cold’ towards others.
3) Schizotypal personality disorder
Characterised by…
‘A consistent pattern of intense discomfort with close relationships and social interactions.’
Symptoms:
- Experiencing distorted thoughts or perceptions
- Finding making close relationships extremely difficult
- Thinking and expressing yourself in ways that others find ‘odd’, e.g., by using unusual words or phrases
- Believing that you can read minds or that you have special powers such as a ‘sixth sense’
- Feeling anxious and tense with others who do not share these beliefs
- Feeling very anxious and paranoid in social situations/finding it hard to relate to others.
Cluster B Personality Disorders
‘Emotional & Impulsive’
(4-7):
4) Antisocial personality disorder (ASPD)
Characterised by…
‘Impulsive, irresponsible and often criminal behaviour.’
Symptoms:
- Putting yourself in dangerous or risky situations, often without thinking about the consequences for yourself or other people
- Behaving dangerously and, sometimes, illegally
- Behaving in ways that are unpleasant for others
- Feeling very easily bored and acting on impulse – e.g., you may find it difficult to hold down a job for long
- Behaving aggressively and getting into fights easily
- Doing things even though they may hurt people – to get what you want, putting your needs and desires above other people’s
- Having problems with empathy – e.g., you may not feel or show any sense of guilt if you have mistreated others
5) Borderline personality disorder (BPD)/‘Emotionally unstable personality disorder’.
Characterised by…
‘inability to manage emotions.’
Symptoms:
- Having extreme reactions to feeling abandoned
- Forming unstable relationships
- Getting confused feelings about who you are/your identity, & how you view yourself
- Being impulsive in ways that could be damaging, for example, spending lots of money very quickly, substance abuse, and reckless driving
- Self-harming, and/or having suicidal thoughts and behaviours
- Experiencing long-lasting feelings of emptiness and/or feeling abandoned
- Finding it difficult to control emotions and anger
- Experiencing overwhelming mood swings and intense emotions/’black and white thinking’, where everything is either really good or really bad, never just ‘neutral.’
- Having paranoid thoughts when you’re stressed
6) Histrionic personality disorder
Characterised by…
‘Extreme dependence on being noticed/on seeking approval, to such an extent that day-to-day living is effected because of it.’
Symptoms:
- Feeling very uncomfortable if you are not the centre of attention
- Feeling that you have to entertain people
- Constantly seeking, or feeling dependent on, the approval of others
- Making rash decisions
- Flirting or behaving/dressing provocatively to ensure that you remain the centre of attention
- Getting a reputation for being dramatic and overemotional
- Being easily influenced by others.
7) Narcissistic personality disorder
Characterised by…
‘An unreasonably high sense of self-importance.’
Symptoms:
- Believing that there are ‘special’ reasons that make you different, better or more deserving than others
- Having a fragile self-esteem/being overly reliant on others to recognise your worth and your needs
- Feeling upset if others ignore you and don’t give you what you feel you deserve
- Resenting other people’s successes
- Putting your own needs above other people’s, and demanding that they do too
- Being seen as selfish and dismissive or unaware of other people’s needs.
Cluster C Personality Disorders
‘Anxious’
(8-10):
8) Avoidant personality disorder*
Characterised by…
‘Chronic feelings of inadequacy.’
Symptoms:
- Avoiding work or social activities that mean you must be with others
- Expecting disapproval and criticism and being very sensitive to it
- Worrying constantly about being ‘found out’ and rejected
- Worrying about being ridiculed or shamed by others
- Avoiding relationships, friendships and intimacy because you fear rejection
- Feeling lonely and isolated, and inferior to others
- Being reluctant to try new activities in case you embarrass yourself.
*(Avoidant personality disorder can often get mistaken for social anxiety disorder, and vice versa. There are, however, stark differences between the two, most notably in their severity- symptoms of avoidant personality disorder are much more extreme compared to those of social anxiety disorder, particularly in terms of ones self-esteem and insecurities. For example, someone with AVPD is more likely to believe that they are completely socially inept, unworthy, or unable to have normal interactions. While a person with social anxiety may struggle with these same insecurities, it will be to a lesser extent. They are more likely to feel slightly insecure or self-conscious rather than entirely inadequate or inferior. Because of the extremity of their symptoms then, people with AVPD are more likely to avoid all social settings, making them more likely to become isolated and have fewer close relationships).
9) Dependent personality disorder
Characterised by…
‘A pervasive psychological dependence on other people.’
Symptoms:
- Feeling needy, ‘weak’ and unable to make decisions or function day-to-day without help or support from others
- Allowing, or requiring, others to assume responsibility for many areas of your life
- Agreeing to things you feel are wrong or you dislike to avoid being alone or losing someone’s support
- Being very afraid of being left to fend for yourself
- Having low self-confidence
- Seeing other people as being much more capable than you are.
10) Obsessive compulsive personality disorder (OCPD)*
Characterised by…
‘An extensive preoccupation with perfectionism, organisation and control.’
Symptoms:
- Needing to keep everything in order and under control
- Setting unrealistically high standards for yourself and others
- Thinking yours is the best way of doing things
- Worrying about yourself, and/or others, making mistakes
- Feeling very anxious if things aren’t ‘perfect’.
*(Although OCPD sounds very similar to OCD, the difference is that, whereas OCD symptoms often fluctuate over time depending on an individuals levels of anxiety, OCPD traits tend to be persistent over time. Someone with OCD will often feel anxious and distressed due to their symptoms, symptoms which impact upon their behaviour so driven are they be their obsessions/compulsions, whereas someone with OCPD will likely lack the awareness that they even have a ‘problem’, for, orderliness and perfectionism are just elements of their personality- they believe that their obsessive traits actually serve a purpose).
‘Getting Better’:
In terms of how personality disorders can be treated, experts are divided over whether medicine is helpful in treatment or not. No medicine is currently licensed for treatment, but there is, however, evidence that medicine might be helpful for treating certain problems* in certain people.
*(‘Problems’ meaning another associated mental health condition, such as Depression, Anxiety, or Psychosis)…
Some GP’s will prescribe mood stabilisers, or antipsychotics, in order to help their patient(s) to manage their mood swings, to alleviate psychotic symptoms, and/or to reduce impulsive behaviour.
The best treatment for personality disorders, though, is said to be, not medication, but talking therapies, of which there are many (both group and one-to-one) options available- something to suit everyone’s needs- as I will highlight below…
1) CBT (Cognitive behavioural therapy)
CBT, most commonly used to treat Depression and Anxiety, is based on the idea that; how we think about situations can affect the way we feel and behave, for, our thoughts, feelings, physical sensations and actions, are all interconnected… An example- if you interpret a situation negatively, you might experience negative emotions, and those bad feelings might lead you to behave in a certain way, thus meaning, in other words, that your negative thoughts and feelings ‘trap’ you in a negative cycle. CBT, then, aims to help you to deal with the negative thoughts that can arise from seemingly ‘overwhelming’ problems, by encouraging you to break your problems down into smaller parts, so that you can deal with them in a more positive way, changing negative patterns (by analysing your thoughts and behaviours to work out if they’re unrealistic/unhelpful), and thus improving the way you feel. CBT does this by looking for practical ways to improve your state of mind on a daily basis.
If CBT is recommended, you’ll usually have a session with a therapist once a week, or once every two weeks. The course of treatment usually lasts for between 6 and 20 sessions, with each session lasting for between 30 to 60 minutes.
2) DBT (Dialectical behaviour therapy)
Whereas CBT focuses heavily on changing your thoughts, DBT focuses on accepting and changing your behaviour.
Specifically developed for Borderline personality disorder, DBT is centered around the idea that; two different beliefs or thoughts that seem to be the opposite of each other, can both be simultaneously true. In DBT, these opposing ideas are acceptance (understanding and accepting yourself/your feelings, however difficult), and change (changing your behaviour/making positive changes in your life). DBT teaches us that these two goals are both achievable at the same time.
A full course of dialectical behavior therapy typically takes around 6 months to complete in, weekly one-to-one sessions, usually lasting for around 45-60 minutes each.
3) MBT (Mentalisation-based therapy)
Like DBT, MBT was specifically developed for treating Borderline personality disorder (BPD), and is best summed up as “thinking about thinking”. It is being able to understand your own mental state, and that of other people, and how this effects your behaviour.
An ability to mentalise, which is what MBT offers, translates to; experiencing a more stable sense of who you are, being able to make sense of other people quicker, being less likely to let emotions get the better of you, and, when emotions do get the better of you, being able to regain your composure quicker.
MBT treatment programmes can last for 12 to 18 months, with individual mentalisation-based therapy sessions lasting for 60 minutes per week, and group sessions lasting for between 75 and 90 minutes per week.
4) CAT (Cognitive analytic therapy)
CAT mainly focuses on relationship patterns, and is based on the idea that our early life experiences influence the way we relate to other people and how we treat ourselves. This means that sometimes patterns of behaviour, or our expectations of other people’s behaviour, can develop into unhealthy/unhelpful repeating patterns. During therapy you will explore how you manage your relationships and cope with feelings or difficult situations. This will involve identifying patterns of thinking, feeling, and behaving. By looking at these patterns more closely, with a CA therapist, you will; clarify which ones are helpful or unhelpful, understand how these patterns have developed, discover what makes you keep repeating them, and, finally, find alternative, more effective coping mechanisms to stop negative experiences/feelings from recurring, the aim of this being to minimise the distress you experience within your relationships with others and with yourself.
CAT usually takes place weekly, with appointments lasting for 50 minutes. Commonly between 16 and 24 sessions of CAT will be needed.
5) Schema-focused cognitive therapy
Another BPD focused therapy, Schema-focused cognitive therapy operates on the presumption that when our basic childhood needs (such as needs for safety, acceptance, and love) are met inadequately, we develop unhealthy ways of interpreting and interacting with the world (maladaptive early schemas). Such ‘schemas’ are deeply held patterns of thinking and behavior that are closely related to our sense of self and view of the world.
Schema theory proposes that schemas are triggered when events happening in our current life resemble those from our past that were related to the formation of the schema. If we have developed unhealthy schemas because of difficult experiences in our childhood, we will, the schema theory suggests, resort to unhealthy ways of thinking now. Though, schema-focused cognitive therapy hopes to avoid this from happening now, by working with patients on ways of processing emotions and unhealthy coping styles that are the result of unhealthy schemas- schemas that could be causing BPD symptoms to ‘flare up’…
Like MBT, Schema-focused cognitive therapy usually lasts for a minimum of 12 months (though, it can go on for up to 24 months- 2 years), and it includes a combination of individual and group therapy sessions on a weekly basis, usually for one hour each.
6) Psychodynamic therapy
Psychodynamic therapy is focused less on the patient-therapist relationship, and is, instead, focused more on the patients relationship with the external world.
In psychodynamic therapy, you will learn how your past has shaped your present, so that you can move mindfully into the future.
With help from a therapist, You will be encouraged to analyse and resolve your current difficulties and change your behaviour in current relationships, through deep exploration and analysis of earlier experiences and emotions. The purpose of this is to place the focus on recognising, acknowledging, understanding, expressing, and overcoming negative and contradictory feelings and repressed emotions, so as to help you to improve your present experiences and relationships.
Short-term psychodynamic therapy will typically consist of 25-30 sessions, over a period of 6-8 months, whilst long-term therapy may last for a year or more, spanning over 50 sessions.
7) IPT (Interpersonal therapy)
IPT focuses on relieving symptoms by improving interpersonal functioning. It addresses current problems and relationships- and problems in relationships- rather than childhood or developmental issues.
The idea is that poor relationships with people in your life can leave you feeling depressed.
IPT is very much a ‘short-term’ therapy, typically involving a total of just 12 to 16 sessions.
8) Art therapy
Art therapy is a form of psychotherapy in which art is used as a medium/as the main mode of expression and communication, in order to address emotional issues which may be confusing and distressing/difficult to verbalise with spoken word…
With support from a therapist, you will use art materials to express your feelings and/or experiences. Your therapist will help you to explore the ‘hidden meaning’ of your art.
Art therapy is rarely used on its own, but more as a ‘complimentary’ therapy, to be used alongside a more conventional, talking therapy…
9) Therapeutic Community
For some people, attending therapy sessions once a week will not be enough to help them manage their systems. In cases such as these, which are more ‘extreme’, they might be encouraged to attend a ‘Therapeutic Community’- a structured environment, usually residential , where people with similar needs come together to interact and take part in therapy, usually for around 1 to 4 days a week, as an inpatient.
10) Hospital
For more urgent treatment- if someone is in crisis/at risk of suicide- hospitalisation might be required. This, although a rarity, can sometimes be imposed against the patients will if they are deemed unable to make appropriate decisions about their safety. In the event of this happening, they would be detained under the mental health act and admitted to hospital until their symptoms improve.
Cause(s) of Personality Disorders:
In the same way that experts are divided over the treatment of personality disorders, so too are many experts divided over the cause of them, too. Whilst the cause of an individuals personality disorder will be unique to them, and will vary massively from person-to-person based on the experiences they have had, most researchers believe that there are three factors that have the biggest influence on the development of personality disorders. These factors are…
1) Environment and social circumstances
The environment and social circumstances we grow up in, and the quality of care we receive, can affect the way our personality develops. You may experience difficulties associated with personality disorders if you’ve experienced:
- An unstable or chaotic family life, such as living with a parent who is an alcoholic or who struggles to manage a mental health problem
- Little or no support from your caregiver
- A lack of support or bad experiences during your school life, peer group or wider community, such as bullying or exclusion
- Poverty or discrimination
- Some form of dislocation, such as migration from abroad.
2) Early life experiences
Our experiences growing up can affect our personality in later life. If you had a difficult childhood, you might have developed certain beliefs about the way people think or act, and how relationships work. This can lead to you developing certain strategies for coping which may have been necessary when you were a child, but which aren’t always helpful in your adult life.
Examples of traumatic childhood experiences that increase the likelihood of personality disorders developing include:
- Neglect
- Losing a parent or experiencing a sudden bereavement
- Emotional, physical, or sexual abuse
- Being involved in a major incident/accident
- Frequently feeling afraid, upset, unsupported or invalidated*
*(A quote I read recently, which sums up the above point:
‘When I was a little kid, I cried alone in my room waiting for someone to come and hug me, but no one ever did. So I prayed to God to get sick or in an accident so that I could get some attention…’)
The above two factors- environment & social circumstances, and early life experiences- centre on the belief that personality disorders are a ‘learned’ behaviour in response to some sort of trauma. As such, episodes must be triggered by something- something which takes one back to that traumatic experience- in order to arise.
In contrast, the third and final, somewhat ‘controversial’ factor for the development of personality disorders…
3) Genetic factors
Some elements of our personality are likely to be genetic, since we are all born with different temperaments. The difficulty with determining if genetic factors have a part to play in the development of personality disorders, however, is that, there is ultimately no way of knowing whether similarities in temperament and behaviour have been handed down the generations genetically, or rather, through the behaviour children were modelled as they grew up (i.e., through the previous 2 factors outlined- early life experiences and environmental/social circumstances)… It’s like the chicken and egg debate, isn’t it. What came first, the personality disorder or the person? I tend to believe the former to be the case- I believe that personality disorders are ‘learned’ as opposed to ‘inherited.’ Research backs this up, too, suggesting, for example, that BPD is more common in an individual with a borderline or narcissistic parent, this being due to the behaviour they have grown up around/the behaviour their parents displayed, rather than due to the personality they were born with…
My experience:
To conclude, because, writing this post has caused me to reflect on my own experiences…
Although not diagnosed, (I probably should make an appointment with my GP), I, as I can quite easily identify now, having done all this research for this post, have ‘mixed’ personality disorder- a combination of both emotional & Impulsive (cluster A), AND Anxious (cluster C) personality disorders.
Cluster A: Borderline Personality Disorder-
I experience strong emotions, mood swings, and feelings that I find difficult to cope with (feelings which are, primarily, ones of distress and anxiety), as well as frequent problems with my identity and how I view myself…
Cluster C: Avoidant personality disorder-
I have a very strong fear of being judged negatively, find criticism difficult, worry a lot, and have extremely low self-esteem, with these factors all causing me to feel uncomfortable in social situations…
&, another
Cluster C: Obsessive-Compulsive personality disorder-
I feel anxious if things are disorganised, unplanned, or not exactly ‘right’, for I hold myself, and everything that I do, to a ridiculously high standard. As such, I am often very cautious and ‘obsess’/ruminate over the smallest of details, details which, most people, wouldn’t even think twice about…
And so, based on all of this, I am going to take some time to work on myself, to…
not shy away from facing certain things, but to lean into them- it’s the only way that I can heal.
Knowing that I have a personality disorder/personality disorders, and that they are best treated with therapy, this is what I am going to focus on- engaging in therapy.
I am already taking anti-depressants (Sertraline) for low mood which, if I’m being entirely honest, doesn’t seem to be having an effect on me anymore, despite my dosage having doubled since last year. What I need is therapy, to work through my difficulties, rather than constantly trying to block them out.
For, I don’t want to feel numb all the time.
I just want to feel ‘normal‘ (whatever ‘normal’ is).
I just want to feel…
alive.
That’s all I want…
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