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The Royal College of Psychiatrists Improving the lives of people with mental illness

Personality Disorder: key facts

 

How does it feel to have this disorder?

  • Personality DisorderOur 'personality' is the collection of ways that we think, feel and behave that makes us all individuals.
  • 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 often feel unhappy or distressed and/or find that you upset or harm other people.
  • You may 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

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

Paranoid

  • 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

Schizoid

  • You don't have strong emotions, don't like contact with other people and prefer your own company.
  • You have a rich fantasy world.

Schizotypal

  • You have odd ideas and difficulties with thinking. Other people may see you as eccentric.
  • You may see or hear strange things.

Cluster B: 'Emotional and Impulsive' - includes

Antisocial

  • 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.

Histrionic

  • 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.

Narcissistic

  • You feel very important and dream of success, 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 perfectionist, 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 obsessional 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.

Dependent

  • You rely on others to make decisions for you and do what others want you to do.
  • You find it hard to cope with daily tasks, feel hopeless and incompetent, and easily feel abandoned by others.

Treatments that can help

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 main treatments for Personality Disorder are based on talking therapies, behavioural therapies and regular contact with support services. For most people treatment is most effective a community setting. Drug treatments can also help in a small number of people.

Medications

It has been difficult to study the benefits of medications in Personality Disorder, which means evidence for their effects is limited. Medication may be used to manage distressing and severe symptoms in some people, usually in the short-term. They are also used to treat other mental disorders, such as depression which people with Personality Disorders may also suffer with at times. Most drug trials are based on Borderline Personality Disorder.

Antipsychotic drugs can help if people feel paranoid, or are hearing noises and voices.

Antidepressants can help treat depressive and anxiety disorders in people with Personality Disorders. There is some evidence to suggest they may also help with reducing aggressive, impulsive and self-harming behaviours.

Mood stabilisers such as lithium, carbamazepine and sodium valproate may also reduce impulsiveness and aggression in some people.

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 and encouraging evidence to show that symptoms of Borderline Personality Disorder can improve and even resolve over time.

Which approach is best for me?

This depends on what approach and setting you prefer, as well as the type of problem that you have. However, a lot depends on what is available in your area. The choice of treatment should be discussed with your psychiatrist or care co-ordinator.

How to help yourself

There are lots of things you can do to help you manage and reduce your difficulties. Some of these things may sound obvious, but they can make a big difference. For example:

  • Develop a hobby or interest. This can help you deal with stress. Any activity or interest can help, from knitting to reading to watching football, so long it is something you enjoy doing. 
  • Regular exercise. Although this can be difficult to do in stressful times, it can be a very good stress-reliever. Any sort of exercise can help, such as a brisk walk for 30 minutes a day - whatever you feel most comfortable with.

  • Reduce alcohol use. When we’re feeling low or stressed, alcohol can provide some temporary relief. However, more often it makes us feel even more stressed and angry. Avoid alcohol in stressful times and this can greatly reduce the chance of you coming to any harm (from other people and from yourself).

  • Avoid any illicit drugs. Like with alcohol, drugs can seem like they help relieve stress, but in reality they make situations much more difficult to deal with, and make people much more vulnerable to developing even more negative feelings.
  • Regulate your sleep. Irregular or lack of sleep can leave us feeling tired which makes most people vulnerable to becoming more irritable and stressed. Regular sleep can make us better prepared to face challenges which life can throw at us.

  • Engage with your mental health team. Sticking with your treatment plan can, over time, provide a helpful routine and allow you develop better ways of coping. Seeking help from your team at times of crisis can also help you avoid coming to harm in difficult times.

How other people can help?

Some people think it can be helpful to let those around you know about you mental health problems, whether they are family, friends or colleagues at work. This may help people know what things can help you, especially during times of crisis.

 

It is not easy to be open with people about these issues. It may help to discuss this with your doctors or mental health team to decide if this is the right approach for you.

 

Helping someone else

It can be difficult to understand why someone might be behaving in a certain way. Their behaviour may be difficult and even dangerous. It is important to try to understand things from their perspective, however difficult that may be at times. If you are concerned about someone with a Personality Disorder, it may be useful to encourage them to adopt some of the simple, ‘healthy-living’ measures outlined above. You may also find it helpful to get advice from your local doctor.

 

For more in-depth information see our main leaflet: Personality Disorders

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Michael Yousif

© February 2014. Due for review: February 2016. Royal College of Psychiatrists. You can link to, download, print, photocopy and distribute this leaflet free of charge. But you must not change it or repost it on a website.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 7235 2351 x 2552.

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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