Personality disorder

The Royal College of Psychiatrists has begun a piece of work to better understand:

• how people are affected by this diagnosis
• the impact it can have on the quality of their care and lives
• the harms caused by negative stereotypes, prejudice and discrimination
• barriers to accessing healthcare and other forms of support.

Information on our website will continue to evolve in light of this work. The insights and experiences of patients, families and carers will be an important part of this.

Patients and carers have also played a key role in developing the information below. It has been written with people with a diagnosis of personality disorder and the people who know them best. This information outlines:

• current thinking about the kinds of difficulties experienced by people who have a diagnosis of personality disorder
• why these difficulties develop
• the forms of support that may be available to people with this diagnosis
• how friends and families might help someone who has personality difficulties or who has been diagnosed with personality disorder. 

There are many reasons why personality disorder is a controversial diagnosis. However, we want to provide information to those who have been given this diagnosis.

We all have different patterns of thoughts, feelings and behaviours, which can be described as personality traits. For example, one person might be described as ‘fussy’, ‘creative’ and ‘quiet’. Another person might be described as ‘laid back’, ‘confident’ and ‘forgetful’. We would describe these people as having different ‘personalities’.

Everyone’s personality is unique. Our personalities are not only shaped by the world around us but also shape the way we view the world. They affect how we act and think, what we believe and how we relate to others.

How our personalities develop can be strongly influenced by our:

• childhoods
• environments
• experiences in early life.

For some people some of these early experiences are difficult or traumatic. This can further impact how their personalities develop.

For everyone, personality traits exist on a scale. For example, we all feel emotional, get jealous, or want to be liked by others at times. However, some people feel these things more intensely than others.

Being told you have a ‘disordered’ personality can be upsetting and hurtful. But it does not mean there is something wrong with who you are.

Personality disorder is a diagnosis that can be given to people whose personality traits:

• make it extremely difficult for them to manage their emotions and feelings about themselves, others and the world around them
• who have significant problems coping day to day, and in their relationships.

Why do we need to make a diagnosis?

A diagnosis is when a healthcare professional works out what issues someone is having by looking at:

• the symptoms they are experiencing
• and other difficulties they may be having.

The issues are given a name, called a diagnosis. This diagnosis allows the healthcare professional to give the person evidence-based care and treatment that has been shown to be effective through research and clinical practice.

We understand the limits of the personality disorder diagnosis. However, we discuss it in this resource because we know that it allows doctors to direct people to specific and evidence-based forms of support and treatment. It also allows people to access the right services for them. Without a diagnosis, this wouldn’t be possible.

Diagnosis also helps new treatments to be developed. For example, some talking therapies have been developed to treat people with certain diagnoses.

Many people would like personality disorder to be given a new name.

Many people with a personality disorder diagnosis have past experiences of trauma. Because of this, some people find it more acceptable to describe the difficulties they experience as complex post-traumatic stress disorder (complex PTSD). Complex PTSD is a separate medical diagnosis. Someone could be diagnosed with both complex PTSD and personality disorder.

Some people find it more appropriate to describe these difficulties as ‘complex emotional needs’, especially if they don’t consider themselves to have had traumatic life experiences.

This resource will use the term personality disorder. This is because it is the term currently used by the majority of healthcare professionals. It is also most familiar to the general public. We will use other terms, such as borderline personality disorder (BPD), later on in this resource only when referring to research.

Now, personality disorders are organised by severity and how someone presents with one or more of five personality traits. This new classification of personality disorders was created with the hope that it would be less rigid and stigmatising.

Using these new criteria, someone might be diagnosed with, for example:

'Moderate personality disorder with negative affectivity specifier.’

The person making the diagnosis might also add ‘borderline pattern’ onto this diagnosis. This is used to show that someone might benefit from the treatments that research has shown work well for people who have received a borderline personality disorder diagnosis in the past.

Most people have personality traits that can cause them problems from time to time. This doesn’t mean that they would be given a personality disorder diagnosis. For example, many of us feel easily rejected or act in ways that other people see as ‘eccentric’. However, a personality disorder diagnosis might be considered if these experiences:

• start to cause someone significant distress or
• interfere with their ability to live their life.

Feelings about diagnosis

How people feel about having a diagnosis of personality disorder will depend on whether receiving the diagnosis has helped them get the help they need or made it more difficult. It can also be heavily affected by their experiences of:

• prejudice
• discrimination
• and exclusion related to the diagnosis.

Professionals can help to support someone who is being given a diagnosis, by:

• taking these things into account
• exploring alternative diagnoses
• making time for diagnostic counselling.

It is also important to recognise that some of the traits that can lead to a diagnosis of personality disorder can also be seen as strengths. Some people feel that their experiences make them:

• creative
• determined
• adaptable
• sensitive to other people’s feelings.

People with a personality disorder diagnosis can also be extremely passionate about things they feel are important. They can use this passion to have a positive impact on the world around them.

“For me, being super sensitive to other people’s emotions can make me very empathetic and good at understanding other people’s feelings.” Ellie

What if I was diagnosed under the old categories?

Over time the new categories will start to be used instead. These new categories do not match the old categories exactly.

For example, if someone was once diagnosed with ‘paranoid personality disorder’ there is not one of the five new personality traits that ‘matches’ this old diagnosis.

However, the difficulties that might have led to a diagnosis of paranoid personality disorder can now be described using a combination of the five personality traits. 

It is estimated that around 4.4% of people in the UK have a diagnosable personality disorder. This means that they don’t necessarily have a diagnosis, but might meet the criteria of a diagnosis of personality disorder if they were assessed.

Life experiences

Adverse childhood experiences (ACEs) are difficult experiences that happen in childhood. They include, but are not limited to:

• experiencing abuse or neglect
• living with someone with a substance use disorder
• being exposed to domestic violence
• living with someone with a severe mental illness
• the death or other loss of a parent.

ACEs do not mean that someone will definitely go on to be diagnosed with personality disorder or any other condition. However, there is a strong association between personality disorder and ACEs.

Children trust and rely on their primary caregivers (parents or guardians) to protect and care for them. If, as a child, you were abused, neglected or mistreated by a primary caregiver, it might affect the way you experience relationships as an adult.

Some studies also look at ‘adverse community environments’. These include things like:

• poverty
• discrimination
• a lack of opportunities
• poor housing.

Some people will experience a combination of these factors.

There are a huge number of life events that people can find difficult. Experiences that aren’t mentioned here can still have a profound effect on someone’s life and the development of their personality.

Experiences later in life can also lead to the sorts of difficulties related to personality disorder becoming more prominent. For example:

• physical illness
• relationship breakdowns
• experiencing conflict.

Genetics

How genetics are involved in personality disorders is unclear. The balance between life experiences and genetics is very complicated.

There is no ‘personality disorder gene’. However, some academics think that genetics plays a role in how difficult experiences affect different people.

There are many different pathways that lead to people being diagnosed with and receiving support for personality disorder. This will depend on:

• how you are coping and what led to you seeking help
• any pre-existing social or health problems you might be having
• where you live and the services available to you.

If you are struggling with some of the issues described earlier in this resource, you might be offered an assessment with your community mental health service.

Having an assessment

If you have an assessment, you should be asked about:

• your living situation, employment and relationships
• your thoughts and feelings
• any harmful behaviours that you want to address
• any challenges you have had getting help in the past
• what has worked well for you and helped you to cope in the past.

A personality disorder diagnosis might be considered as part of this assessment. Understanding someone’s story and the difficulties they might have experienced getting the help they need will make it easier for the team to make a positive difference.

A diagnosis of personality disorder should be made with careful consideration. This diagnosis should be made through a shared agreement between the person making the diagnosis and the person receiving it.

During the assessment and in future appointments you might explore different support options, such as:

• self-help
• psychological therapies
• social care
• support with education, training or work
• medication
• physical health care
• peer support.

The person assessing you should work with you to develop a plan for your treatment and care, called a ‘care plan’. This plan should also help you to cope better with any difficulties you might have in between appointments. This is sometimes referred to as a ‘crisis and contingency plan’.

If you receive a diagnosis of personality disorder

For a diagnosis of a personality disorder to be helpful, it should be made in a collaborative way between you and your clinician. This means the clinician should explain:

• why they think this diagnosis might be helpful
• what it means
• what support is available for the problems you are experiencing.

Finding out more about your diagnosis

When finding out more about your diagnosis, focus on sources of information that are:

• reliable
• evidence-based
• and recent.

You might also find it helpful to get information from:

• charities that work with and for people with mental illnesses
• other people who have received a personality disorder diagnosis.

Recovery Colleges have groups where you can meet and speak to other people diagnosed with personality disorder in a balanced environment. This will be supported by mental health professionals and lived experience practitioners.

You can find other useful sources of information and support at the end of this resource.

What if I don’t agree with my diagnosis?

A diagnosis of personality disorder should only be made following a thorough assessment by someone with appropriate skills and knowledge. It is not a diagnosis that should be made quickly, or without careful consideration.

If you have been given a personality disorder diagnosis and feel that it does not represent your experiences, ask for an appointment with your psychiatrist to review it. If you don’t have a psychiatrist, you can ask your GP to request an assessment by a psychiatrist.

If your psychiatrist has made the diagnosis and you are not sure about it, you can ask for another psychiatrist to give a second opinion. NHS trusts usually have a system for providing this. You could also ask your GP if they can request a second opinion for you. You do not have a legal right to a second opinion, but it is usually possible to get one.

Can someone be diagnosed with personality disorder and another condition?

It is possible for someone to have a diagnosis of personality disorder, and a diagnosis of one or more mental illnesses. Some people are first diagnosed with other mental illnesses before a diagnosis of personality disorder is found to better describe their problems. The opposite can also happen.

With the right help and support, people with a personality disorder diagnosis can improve and lead fulfilling lives. They can also find ways to cope with some of the challenges they face. However, some people might experience more persistent difficulties.

The types of treatment you receive will depend on:

• what you need
• what you want
• what will be helpful to you
• what is available to you
• what is safe for you to take part in and whether you are engaging in any high-risk behaviours.

Most people receive treatment from community mental health services. Some services have a dedicated personality disorder service. Other services work in close collaboration with a psychotherapy department.

Depending on the level of support you need, you might receive help and support from:

• psychiatrists
• psychologists
• nurses
• occupational therapists
• social workers
• lived experience practitioners (also known as peer support workers)
• support workers.

All of these people can help to support you with different parts of your life.

What kind of support should I get?

Most of the research into treatments for personality disorder focuses on what was previously called borderline personality disorder (BPD). This is partly because people with problems associated with BPD are more likely to experience distress and seek help.

This makes it hard to offer information about treatments for other kinds of personality disorder in this resource. But this does not mean that these treatments won’t work for you. The treatment you receive should be based on:

• your individual needs
• the challenges you are facing.

We will talk about BPD in the following section where it relates to research into different treatments.

Creating a formulation

A diagnosis is a way of describing the challenges that someone is having. A formulation is a way of understanding the ‘full picture’ of the person.

If you have a diagnosis of personality disorder, a formulation can help the people supporting you to understand what is happening in your life and relationships. Together you can use it to understand what help you need.

There are different ways to create a formulation, but in general formulations look at:

• The challenges you are having now and how they affect you.
• Why these challenges came about – For example, factors in your life that might have impacted you, threats you faced and how you understood them.
• Why these challenges continue – For example, how coping mechanisms might impact your progress. Or how other difficulties in your life might keep the problems going.
• Strengths you have – For example, supportive relationships, skills and belief systems.

You will use these things to:

• understand your own situation better
• make more sense of the problems you are facing
• think about how you can react in more helpful ways to difficult situations.
  

Psychological therapies

There are lots of different psychological therapies that are used to help people who have a personality disorder diagnosis. The kind of psychological therapy you have, how often you have it, and how long you have it for will depend on your unique situation and what is locally available.

It is quite likely that you will have to wait to receive psychological therapy, which can be very frustrating. During this time, you may want to prepare so that the psychological therapy can be done as safely as possible and have a greater impact. For example, if you have housing needs, these might need to be addressed before you start receiving psychological therapy in order for the therapy to be helpful.

Dialectical Behavioural Therapy (DBT)

DBT is aimed at people who have a diagnosis of BPD and who self-harm, or who have attempted suicide.

In DBT self-harming behaviours are understood to be something people use to manage difficult emotions. This is also known as self-regulation. These behaviours have both a harmful and a helpful aspect to them.

DBT can help you to develop alternative behaviours. These can either prevent difficult emotions from building up or help you to cope with them in a safer way.

DBT uses the principles of cognitive behavioural therapy (CBT) and mindfulness. In DBT your therapist will help you to:

1. start by identifying and aiming to reduce self-harming behaviours
2. then aim to reduce other behaviours that might interfere with your therapy
3. finally aim to reduce behaviours that might interfere with your quality of life.

DBT is structured around four modules:

• Distress tolerance – This means learning to handle pain and distress in ways that are helpful.
• Emotional regulation – This means identifying your feelings and understanding why they happen.
• Interpersonal effectiveness – This means:
  • building and maintaining relationships
  • resolving conflicts
  • and getting your wants and needs met.
• Mindfulness – This means becoming aware of your thoughts and feelings in a non-judgemental way.

DBT is delivered in a group and individually. You will have one group and one individual session per week for 12 months. If you have less serious harmful behaviours, you might have DBT for only six months as part of a wider treatment and care programme.

You can also access self-help materials and workbooks for DBT online.

Mentalisation Based Therapy (MBT)

MBT is aimed at people who have a diagnosis of borderline personality disorder (BPD). It tries to help people with a diagnosis of BPD to:

• make personal attachments
• and to understand the thoughts, feelings and wishes of themselves and others.

MBT encourages you to explore how you think and feel about yourself and others, and how this affects how you act. MBT can be given individually and in a group, and is recommended to be given for 18 months.

Schema Focused Therapy (SFT)

SFT focuses on the idea that everyone has negative patterns of thought (known as schemas). These are learned in early childhood, and facing adversity early on can make them more likely to develop. SFT believes that these schemas cause us to resort to unhealthy ways of thinking and behaving.

In SFT you will focus on finding out what your schemas are by linking them to past and current events. You will work to develop healthier responses to these schemas.

Psychodynamic therapy

Psychodynamic therapy is based on the idea that we have an unconscious part of our mind. This contains powerful feelings and fantasies that inform:

• our relationships
• how we view ourselves and our place in the world.

These are heavily determined by our early experiences in life.

Therapists in psychodynamic therapy work to understand:

• how you have been affected by your past
• how unconscious thoughts and feelings can have an impact on your thoughts, behaviours and relationships.

Psychodynamic therapy is a term that groups together a number of different therapies with similar practices. How psychodynamic therapy is given will vary a lot between therapists.

Group psychotherapy

Most types of therapy can be done in groups. Group therapy can offer you the experience of acceptance and understanding from others. It can also offer you the opportunity to communicate with others with similar experiences. It can be very helpful for learning how to develop healthy relationships, and a sense of belonging, power and agency.

Art therapy

In art therapy you will use creative techniques like painting or sculpture to help you to express yourself. Art therapy is used in some specialist personality disorder services and in wider mental health services. Art therapy will often use the techniques of other therapies, such as psychodynamic, MBT and DBT.

Other forms of art therapy that use drama or music work in a similar way but are less widely available.

Therapeutic communities

Therapeutic communities are a type of service, rather than a type of therapy. These services can use therapy techniques such as psychodynamic therapy, DBT or art therapy.

In therapeutic communities, staff are not considered to ‘hold all the wellness’ and patients are not considered to ‘hold all the illness’. Therapeutic communities provide a network of close relationships. This can help you to manage difficult emotions and behaviours within this new and positive network. Staff work to organise and hold the group together.

Therapeutic communities are widely used in:

• community-based residential placements
• rehabilitation placements for addiction
• prisons.

Nidotherapy

Nidotherapy aims to understand a person’s views, aspirations and how they interact with the world. In nidotherapy, changes are made to your environment to help treat your ‘symptoms’. This makes it different from other therapies, which start with considering how you react to your environment, rather than changing the environment itself.

Systems Training for Emotional Predictability and Problem Solving (STEPPS)

STEPPS is weekly group psychotherapy that lasts for 20 weeks. It is aimed at people with a diagnosis of BPD, and is based on the principles of CBT. In STEPPS you learn skills to help regulate your emotions.

Why is psychological therapy helpful to people with a personality disorder diagnosis?

Psychological therapy helps in a number of different ways. Some therapies, such as DBT and STEPPS emphasise learning and developing skills. Other therapies place more of an emphasis on self-awareness and meaning, such art therapy, MBT, psychodynamic and SFT.

However, all psychological therapies are thought to be helpful because they offer people a consistent, coherent, curious and respectful relationship with their therapist. Psychological therapy can also provide you with helpful coping strategies.

After you complete a course of therapy, you might be encouraged to take a break. This can allow you to practice some of the skills you learnt and use them in your daily life. This phase of embedding new skills is one of the most important phases of any therapy.

What challenges might I have with psychological therapy?

Like any other treatment, psychological therapies can sometimes make people feel worse. As your relationship with your therapist or group develops you will come to depend on them and be vulnerable with them. If you have had negative experiences with being vulnerable with others, therapy can feel very frightening. It is quite common for people to become unwell or face a crisis during therapy.

Services should understand this and will try to prepare you for therapy. They can make arrangements to prevent a crisis from happening or to manage it when it does.

Many psychological therapies focus on the relationship between the therapist and the person receiving therapy. This can make behaviour like self-harming, eating disorders, or addictions worse. When this happens, other therapies might be used first to help reduce these behaviours.

When might I not be given psychological therapy?

In some cases, a therapist might feel that it isn’t appropriate or safe for you to have psychological therapy. If this happens your service should still work with you to find ways to support you and improve your quality of life. This should happen whether or not you are likely to be able to have therapy in the future. If you disagree with this decision, you can request a second opinion.

If you need a therapist with specific skills to match your needs, you might need to wait until a therapist with those skills is available.

Finally, you might choose not to have psychological therapy, or you might do it and not find it helpful. If this happens, you might still want to explore alternative approaches or forms of therapy. If one approach doesn’t work for you, this doesn’t mean another won’t.

Which therapy works best?

Unfortunately, there is not enough detailed, high-quality research into therapies for people with a personality disorder diagnosis. The people treating you should think about what you might need at any given time. They should try to adapt your treatment to your needs as your circumstances, experiences and challenges change.

A research study of a number of different clinical trials has shown that:

• DBT is the most researched therapy, followed by MBT
• DBT is more effective at reducing self-harm and making it easier for someone to function socially and psychologically
• MBT is more effective at reducing suicidal feelings and depression
• Research did not show if one treatment was more likely to remain effective for longer than the other after a person has completed treatment.

Spending time in hospital or residential care

In some cases, you might need to spend time in hospital or a residential setting. For example, if you have harmed yourself or are a risk to yourself or someone else.

However, removing people with a personality disorder diagnosis from their support networks can have a negative effect on their wellbeing. Spending time in environments that don’t allow someone to use their usual coping strategies can also mean that these coping strategies escalate and become more dangerous. Because of this, healthcare teams will want to help you to:

• remain in your community wherever possible
• stay in hospital for as short a time as possible
• be involved in decision making about your care
• avoid wherever possible detention under the mental health act.

Medication

There is no medication that has been shown by research to treat personality disorder. However, if someone with a personality disorder diagnosis is also experiencing mental health problems like depression or anxiety, they might be prescribed medication to help with this. Some people find medication helpful, while other people don’t.

Guidance from the National Institute for Health and Care Excellence (NICE) says that antipsychotic medications can be used in people with a personality disorder diagnosis in a crisis in the short term.

Making decisions about medication

If you have a personality disorder diagnosis, you should be able to talk with your doctor about whether the medication they suggest is right for you. They should answer any questions or concerns you might have. All medications come with side-effects, which should be made clear to you before you start taking them.

If you want to stop taking any medication, it is important to speak to the people treating you first. Stopping medication suddenly can be dangerous. Your clinical team can help you to stop or change your medication safely, and in a way that reduces any potential risks.

Consistent care

Experiencing consistent relationships with the people caring for you has been shown to have a positive effect on people with a personality disorder diagnosis. This does not mean that the relationships are easy. In therapy you might have to explore the difficult thoughts and feelings that led to you seeking help.

Sometimes people describe therapy not as a ‘safe space’, but as a ‘brave space’.

Services will often try to create consistency by:

• holding appointments in the same place
• communicating clearly to you about when your appointments will be
• making sure you know how to contact the person leading your care between appointments.

Developing strong relationships with the people who are providing your care can feel challenging. It’s understandable that it might take you a while to get to know and trust the people who are treating you. If you are having difficulties, staff will want to hear about these. Try to explore them with your clinician.

Occupational therapy

People with a personality disorder diagnosis can benefit from the support of occupational therapists.

An occupational therapist can help you if you have been discharged from:

• hospital
• a drug or alcohol rehabilitation placement
• prison.

They can help you to:

• develop a routine
• take part in social and occupational activities
• get back to work or help you to find ways to manage better at work
• manage your home environment.

Peer support

Peer support is where someone with a personality disorder diagnosis offers support to someone else with that diagnosis. Peer support has been shown to help people feel connected, validated and hopeful.

Peer support can be done informally, or as part of the service you are in. It is done individually or in a group. Groups work better if they have someone acting as a ‘facilitator’ to oversee and support helpful conversations.

Support from friends and family

Many people who have a personality disorder diagnosis can lead full lives with the support of their family and friends. This support can be:

• emotional - for example, having someone to talk to or confide in
• practical - for example, help with sorting bills or applying for jobs.

It can be helpful for someone with a personality disorder diagnosis to share their feelings with people who are important to them and whom they trust. Friends and family can support someone better if they know:

• which things that person finds challenging
• the kind of environments that can make them feel worse.

There is a misconception that people who have a diagnosis of personality disorder don’t get better. In fact, some studies have shown that between 50-70% of people with a BPD diagnosis improve in the long term. Other studies have shown that people can get better as they get older.

What happens if someone doesn’t get help?

It is extremely important that people with a personality disorder diagnosis are treated with support and understanding. For people who don’t get help, daily life can remain challenging. They can struggle to have fulfilling, supportive relationships.

People with a diagnosis of personality disorder are at an increased risk of dying by suicide. Many people who are admitted to A&E because of self-harm have a personality disorder diagnosis.

People who are pregnant and have a personality disorder diagnosis are also at a higher risk of postnatal depression and postnatal anxiety.

People diagnosed with BPD or antisocial personality disorder who are in prisons or secure hospitals are more likely to harm others.

However, with the right support and treatment, people who have a personality disorder diagnosis can:

• have rich social lives
• have careers and hobbies
• feel happy and content in themselves.

Some people will get better over time without treatment. Fulfilling, meaningful activities can lead to people getting better over time or as they get older. However, it’s still important to get help if you are struggling.

There are lots of things you can do to support yourself to stay as well as possible. The NHS suggests five steps that evidence has shown can improve mental health and wellbeing.

We appreciate that some of these things can feel very difficult to do. Having a trusted friend, family member or professional to support you can make it easier to engage in these helpful steps.

1. Connecting with other people
If you are struggling to connect with others, you could try joining groups or classes local to you that are linked to things you are interested in. This can help you to meet like-minded people.

2. Being physically active
Find a form of physical exercise that you enjoy and try to do it regularly. You should try to get at least an hour of moderate exercise a day, such as going for a walk, and one hour of vigorous exercise three times a week, such as running or swimming.

3. Learning new skills
This should be something that you enjoy or are interested in. Some examples include cooking a new meal, learning to knit or crochet, painting a picture or writing a short story. You could also join a club or class in your local area.

4. Doing things for others
Research shows that doing things for others can help you to feel positively about yourself and to connect with others. You could do something as simple as telling a friend something that you like about them. Or you could volunteer in your local community.

5. Mindfulness
These are free, simple exercises you can do to connect to the world around you. One example is walking around outside and looking for and counting everything you see of a certain colour. You can find out more about mindfulness on the NHS website.

Finally, if you are struggling with your housing or finances, take a look at our resource on benefits, financial support and debt advice. This resource explains what kinds of benefits you might be entitled to and how to get them. If you have an occupational therapist in your mental health team, they might be able to help you with this.

Supporting someone who has a personality disorder diagnosis can be challenging. It can be hard not to take the way they act personally and feel as though they are ‘taking things out on you’.

Many people who have a personality disorder diagnosis also have other mental or physical health conditions. These can come with their own additional challenges and care needs. However, there are things you can do to support yourself and the person you know:

• Shared decision making – If you are involved in someone’s care it can be hard to know how much you should encourage them to be in charge of their care, and how much you should do yourself. Try to work together to decide what works best for both of you. Empower the person to be involved in their care in ways that are beneficial for both of you.
• Seeing the whole person – It can be difficult to find the balance between knowing that someone’s mental illness is an important part of them, and remembering that someone is more than their mental illness. It is okay to be frustrated or to find things about someone you love challenging or upsetting. Find someone you can be totally honest with and talk to them about your feelings.
• Understanding personality disorder – Personality disorder is a complicated diagnosis. There is a lot of misunderstanding and stigma around it. Try to find out more about it from reliable sources, and from other people with experience of personality disorder. This can help you to understand the person you know more.
• Recovery Colleges – These are based at NHS trusts across the UK. They provide a learning environment to people who have an interest in, or personal challenges with mental health. Courses focus on success, strategy and skill building, rather than highlighting problems or failures. There are courses open to carers, and courses are co-produced with patients and carers.
• Family therapy – Families, in whatever form they take, are often an important part of people’s lives. Family therapy can help by looking at the relationships in your family and supporting you all to develop coping strategies.
• Knowledge and Understanding Framework (KUF) training – This training is created and delivered by professionals and people with a personality disorder diagnosis. It teaches understanding, awareness and ways of communicating well. Speak to the healthcare team about whether KUF training is available where you live.

“It’s not your job as a carer to ‘fix’ someone or make their life totally safe. It’s more about walking alongside and being there for someone. I think that’s a trap I see a lot of carers fall into.” Hameed

If you are a carer, there are some additional things that might be helpful:

• Carer’s assessment – If you are a carer for someone with a personality disorder diagnosis, you are entitled to a free carer’s assessment. This will help to work out what might make your life easier. You can find out more about how to get one on the NHS website.
• Support groups – Join a local carers’ support group where you can meet and speak to people with similar experiences to you.
• Taking breaks – If you are a full or part-time carer for someone with a personality disorder diagnosis, it is important to take time for yourself if you can. That could mean asking a friend or family member to step in or using a professional service. The Carers Trust has useful information on getting a break if you are a carer.

Find out more about being a carer and the support you might be entitled to in our carers resource.

Information on personality disorder

• Personality disorders, NHS – Information from the NHS on personality disorder.
• Personality disorder, Mind – Information from the mental health charity Mind on personality disorder.
• Personality disorders, Rethink Mental Illness – Information from the charity Rethink Mental Illness on personality disorder.

Treatment guidance

These two pieces of NICE guidance for the public explain the treatment people with a diagnosis of BPD or antisocial personality disorder should receive. They also include useful information, such as questions you can ask your healthcare team when you are diagnosed, and questions that carers can ask health services.

• Antisocial personality disorder (PDF)
• Borderline personality disorder (PDF)

Personality disorder organisations

• Emergence - Emergence is a service user-led organization. It supports all people affected by personality disorder including service users, carers, family and friends and professionals.

Information for carers

• Helping someone diagnosed with personality disorder, Mind – Information for friends and family who want to support someone with a diagnosis of personality disorder.
• Caring for someone with a mental health problem, Mind – Information for people who care for someone with a mental health problem.
• Families and Carers Training and Support Programme (FACTS), Anna Freud – Information on a carer-led training programme for friends and family of people with a diagnosis of BPD by the Anna Freud National Centre for Children and Families.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Oliver Dale and Dr Pamela Peters

Experts by experience: Ellie Wildbore, Hameed Khan, Marsha McAdam