About this
leaflet
This leaflet is for anyone who has been given
a diagnosis of personality disorder - and also for their family and
friends.
Introduction
It's not easy to pin down exactly what we mean by the word
‘personality’. It seems obvious, but it is hard to put into
words. Part of the reason is that many of the words we use to
describe people have wide meanings – and these meanings often
overlap.
These words can cover more than one area of
experience. ‘Anxiety’ describes the feeling of worrying,
‘nervousness’ describes the behaviour that others might notice if
you feel like this. ‘Shyness’ describes the feeling of awkwardness
with other people, but also the behaviour of being rather quiet in
company.
It is also difficult because the way we appear
to other people can be very different in different
situations. If you only know someone from work, you may see
quite a different side to them if you meet socially.
However, in mental health, the word
‘personality’ refers to the collection of characteristics or traits
that makes each of us an individual. These include the ways that
we:
By our late teens, or early 20s, most of us
have developed our own personality with our own distinctive ways of
thinking, feeling and behaving. It remains pretty much the same for
the rest of our life. Usually, our personality allows us to get on
reasonably well, if not perfectly, with other people.
Personality disorder
However, for some of us, this doesn't happen.
For whatever reason, parts of our personality develop in a way that
makes it difficult for us to live with ourselves and/or other
people. It can be difficult to learn from experience and to change
those traits - the unhelpful ways of thinking, feeling and behaving
- that cause the problems. Unlike the changes in personality that
can be caused by traumatic events, or an injury to the brain, these
traits will usually have been noticeable from childhood or early
teens.
You may find it difficult to:
- make or keep relationships
- get on with people at work
- get on with friends and family
- keep out of trouble
- control your feelings or behaviour
If, as a result, you:
- are unhappy or distressed
and/or
- find that you often upset or harm other
people
then you may have a personality disorder (see
below for descriptions of the different types). Having a
personality disorder makes life difficult, so other mental health
problems (such as depression, or drug and alcohol problems) are
also common.
Talking about personality disorder
There are different ways to describe mental
disorders, and to put them into categories. The difficulty in
describing any personality clearly, makes this more controversial
with personality problems than with mental illnesses, such as
depression or schizophrenia. Indeed, many people feel that it is
unhelpful to 'label' personality difficulties in this way. However,
although we are all individuals, certain patterns of personality
problems do seem to be shared by fairly large numbers of people. By
identifying these patterns, we can then develop ways of helping,
and treatments that can be of use to many people, not just an
individual.
Personality disorder – a suitable case for treatment?
There is good evidence that people with the
diagnosis of personality disorder have not received the attention
they should have from mental health services. These services have
focused mainly on mental illnesses, such as schizophrenia, bipolar
disorder and depression. There has been some uncertainty about
whether they have anything useful to offer people with personality
disorders. Research has made it clear that mental health services
can, and should, help people with personality disorders.
Different kinds of personality disorders
Research has shown that personality disorders
tend to fall into three groups, according to their emotional
'flavour':
Cluster A: 'Suspicious'
Cluster B: 'Emotional and impulsive'
Cluster C: 'Anxious'
As you read through the descriptions of
each type, you may well recognise some aspects of your own
personality. This doesn't necessarily mean that you have a
personality disorder. Some of these characteristics may even be
helpful in some areas of your life. However, if you do have
a personality disorder, these aspects of your personality will be
quite extreme. They may spoil your life, and often the lives of
those around you.
People may display the signs of more than one
personality disorder.
Cluster A:
'Suspicious'
Paranoid
- suspicious
- feel that other people are being nasty to you
(even when evidence shows this isn’t true)
- sensitive to rejection
- tend to hold grudges
Schizoid
- emotionally 'cold'
- don't like contact with other people, prefer
your own company
- have a rich fantasy world
Schizotypal
- eccentric behaviour
- odd ideas
- difficulties with thinking
- lack of emotion, or inappropriate emotional
reactions
- can see or hear strange things
- related to schizophrenia, the mental
illness
Cluster B:
'Emotional and impulsive'
Antisocial, or Dissocial
- don't care about the feelings of others
- are easily frustrated
- tend to be aggressive
- commit crimes
- find it difficult to make intimate
relationships
- impulsive - do things on the spur of the
moment without thinking about them
- don’t feel guilty
- don’t learn from unpleasant experiences
Borderline, or Emotionally Unstable
- impulsive
- find it hard to control emotions
- feel bad about yourself
- often self-harm, e.g. cutting yourself or
making suicide attempts
- feel 'empty’
- make relationships quickly, but easily lose
them
- can feel paranoid or depressed
- when stressed, may hear noises or voices
Histrionic
- over-dramatise events
- self-centered
- show strong emotions, but which change
quickly and don't last long
- can be suggestible
- worry a lot about your appearance
- crave new things and excitement
- can be seductive
Narcissistic
- have a strong sense of your own
self-importance
- dream of unlimited success, power and
intellectual brilliance
- crave attention from other people, but show
few warm feelings in return
- exploit others
- ask for favours that you do not then
return
Cluster C:
'Anxious'
Obsessive-Compulsive (aka Anankastic)
- worry and doubt a lot
- perfectionist - always check things
- rigid in what you do
- cautious, preoccupied with detail
- worry about doing the wrong thing
- find it hard to adapt to new situations
- often have high moral standards
- judgemental
- sensitive to criticism
- can have obsessional thoughts and images
(although these are not as bad as those in obsessive-compulsive
disorder)
Avoidant (aka Anxious/Avoidant)
- very anxious and tense
- worry a lot
- feel insecure and inferior
- have to be liked and accepted
- extremely sensitive to criticism
Dependent
- passive
- rely on others to make their own
decisions
- do what other people want you to do
- find it hard to cope with daily chores
- feel hopeless and incompetent
- easily feel abandoned by others
What causes personality disorder?
The answer is not clear, but it seems that
like other mental disorders, genes, brain problems and upbringing
can play a part. There is evidence for the importance of:
Upbringing
- physical or sexual abuse in childhood
- violence in the family
- parents who drink too much
If children are taken out of this sort of
difficult environment, they are less likely to develop a
personality disorder.
Early problems
Behaviour problems in childhood, such as
severe aggression, disobedience, and repeated temper
tantrums.
Brain problems
Some people with antisocial personality
disorder have very slight differences in the structure of their
brains, and in the way some chemicals work in their brains.
However, there is no brain scan or blood test for a personality
disorder.
Things that make it worse
-
using a lot of drugs or alcohol
-
problems getting on with your family or
partner
-
money problems
-
anxiety, depression or other mental health
problems
Help
Treatment for people with personality
disorders can be psychological (talking therapies) and/or physical
(medication).
1. Psychological: talking treatments
or therapies
- Counselling – talking and listening.
This depends on a trusting relationship between the counsellor and
the person counselled.
- Dynamic psychotherapy – looks at how past
experiences affect present behaviour.
- Cognitive therapy – a way to change unhelpful
patterns of thinking.
- Cognitive analytical therapy – a way to
recognise and change unhelpful patterns in relationships and
behaviour.
- Dialectical behaviour therapy – this uses a
combination of cognitive and behavioural therapies, with some
techniques from Zen Buddhism. It involves individual therapy
and group therapy.
- Treatment in a therapeutic community – this
is a place where people with long-standing emotional problems can
go to (or sometimes stay) for several weeks or months. Most of the
work is done in groups. You learn from getting on – or not getting
on - with other residents. It differs from 'real life' in that any
disagreements or upsets happen in a safe place. The staff and other
residents help you to get through such problems and learn from
them. Users/residents often have a lot of say over how the place
runs, but have to be prepared to stay and work through difficult
periods.
2. Physical
Medication can help in some personality
disorders.
Antipsychotic drugs (usually at a low
dose)
- Can reduce the suspiciousness of the three
cluster A personality disorders (paranoid, schizoid and
schizotypal).
- Can help with borderline personality disorder
if people feel paranoid, or are hearing noises or
voices.
Antidepressants
- Can help with the mood and emotional
difficulties that people with cluster B personality disorders
(antisocial or dissocial, borderline or emotionally unstable,
histrionic, and narcissistic) have.
- Some of the selective serotonin reuptake
inhibitor antidepressants (SSRIs) can help people to be less
impulsive and aggressive in borderline and antisocial personality
disorders.
- Can reduce anxiety in cluster C personality
disorders (obsessive-compulsive, avoidant and dependent).
Mood stabilisers
Medication such as lithium, carbamazepine, and
sodium valproate can also reduce impulsiveness and
aggression.
These medications and treatments also help if
someone with a personality disorder develops depression or
schizophrenia.
The type of therapy offered depends on:
- individual preference (of the patient/service
user);
- the type of personality disorder;
- the availability of the treatment in that
geographical area.
If you have a personality disorder, you may
not need treatment at all – but you might find medication or
talking treatments helpful, and sometimes both. Admission to
hospital usually happens only as a last resort (e.g. when a person
with borderline personality disorder is harming themselves badly)
and for a short time. A lot of the help that was once only offered
in hospital wards is now available in day centres or clinics.
How common are personality disorders?
- About 40-70% of people on a psychiatric ward
will have a personality disorder.
- 30-40% of psychiatric patients being treated
in the community by a psychiatric service will have a personality
disorder.
- Around 10-30% of patients who see their
general practitioner (GP) will have a personality disorder.
Do personality disorders change with time?
Yes. There is evidence that they tend to
improve slowly with age. Antisocial behaviour and impulsiveness, in
particular, seem to reduce in your 30s and 40s.
It can, however, sometimes work in the
opposite direction. For example, schizotypal personality disorder
can develop into the mental illness schizophrenia.
Do interventions/treatments work?
There is evidence for both psychotherapies and
medication, but it is weak because:
- the interventions are usually quite
complicated, so it is difficult to know what part (or parts) of the
intervention are actually having an effect;
- the number of participants is usually
small;
- the ways of measuring improvement are
poor;
- the studies into interventions and
treatments have mostly been quite short.
Living with personality disorder
People with a personality disorder, just like
anyone who has mental health difficulties, can be stigmatised
because of their diagnosis. They can attract fear, anger and
disapproval rather than compassion, support and understanding. This
is both unfair and unhelpful. Personality disorder is a real
problem that demands real help. We can all help by extending our
friendship, support and understanding, rather than our judgement
and discrimination, to people with a personality disorder.
Self-help
- Try to unwind when stressed - have a hot bath
or go for a walk. You may find yoga, massage or aromatherapy
useful.
- Make sure you get a good night’s sleep - but
don’t get too upset if you can’t sleep.
- Look after your physical health and what you
eat. You'll feel better on a balanced diet, with lots of
fruit and vegetables.
- Avoid drinking too much alcohol or using
street drugs.
- Take some regular exercise. This
doesn’t have to be extreme. Even getting off the bus one stop
early, and walking the rest of the way can make a difference.
- Give yourself a treat (although not drugs or
alcohol!) when things are difficult or you have coped at a
stressful time.
- Take up an interest or hobby. This is a good
way to meet others and take your mind off the day to day stresses
that we all face.
- Talk to someone about how you are feeling.
This could be a friend or relative or, if preferred, a therapist or
counsellor. If you don’t have access to a counsellor or
therapist, then try your general practitioner (GP).
- Looking for information on the internet is a
good resource (see further information).
- If things get really tough, try phoning the
Samaritans (see further information).
Living with someone who has a personality disorder
You may worry about the effects the
personality disorder is having on them, and maybe on your life too.
How would they react if you talked to them about it?
If they take your worries seriously, find out
some more information, perhaps from the sources at the end of this
leaflet. Even if they don’t see a problem at the present time, they
may do in the future.
Day to day living with someone who has a
personality disorder can be difficult - but it isn’t always
difficult. Giving people their own space, listening to and
acknowledging their concerns, and involving others (friends,
relatives and, at times, mental health professionals – nurses,
therapists or doctors) can all be useful. It is also important to
look after your own physical and mental health.
Further Information
Mind
Mind is a leading mental health charity in
England and Wales and has extensive information on personality and
personality disorder.
National
Personality Disorder Website
This provides information, resources and
learning opportunities for those with a personality disorder and
their carers.
Borderline
UK
This is a national user-led network of people
within the United Kingdom who meet the criteria, or who have been
diagnosed with borderline personality disorder.
Scottish Personality
Disorder Network
Contains information about the network set up
by the Mental Health Divison, and provides information about the
services available for those with personality disorders in
Scotland.
The BBC’s Health Website
Contains articles on personality, personality
difficulties and personality disorder.
Samaritans
Helpline: 08457 90 90 90, R.O.I: 1850 60 90 90; email: jo@samaritans.org
Samaritans is available 24 hours a day to
provide confidential emotional support for people who are
experiencing feelings of distress or despair, including those which
may lead to suicide. The website has helpful information about
stress and self-harm.
Rethink
Rethink is a leading national mental
health membership charity and works to help everyone affected by
severe mental illness recover a better quality of life. Has
information on personality and personality disorder.
The ‘Mental Health
Shop’
This is an online resource for mental health
publications, leaflets, booklets, videos and DVDs. Has
information on personality and personality disorder.
Aware
Assists and supports those suffering from depression (which can
occur in those diagnosed with a personality disorder) and their
families in Ireland. A helpline is available as well as support
groups, lectures, and current research on depression.
“Personality disorder: No longer a
diagnosis of exclusion” (published by the National Institute
for Mental Health in England). Free to download at: www.personalitydisorder.org.uk/assets/Resources/56.pdf
This gives detailed information on
personality disorder, current available treatments and
services, and future plans. It also discusses the minority of
those with a personality disorder who have committed a crime, and
services available for them.
References
American Psychiatric Association (1994)
Diagnostic and Statistical Manual of Mental Disorders (4th edn.)
(DSM-IV). Washington, DC: APA.
Bateman, A. and Fonagy, P. (1999) The
effectiveness of partial hospitalisation in the treatment of
borderline personality disorder – a randomised controlled
trial. American Journal of Psychiatry, 156,
1563-1569.
Bateman, A. and Tyrer, P. (2004) Psychological
treatment for personality disorders. Advances in Psychiatric
Treatment, 10 (5), 378-388.
Bateman, A. and Tyrer, P. (2004) Services for
personality disorder: organisation for inclusion. Advances in
Psychiatric Treatment, 10 (6): 425-433.
Coid, J. (2003) Epidemiology, public health
and the problem of personality disorder. British Journal of
Psychiatry, 182 (suppl. 44) s3-s10.
Coid, J. et al. (2006) Prevalence and
correlates of personality disorder in Great Britain.
British Journal of Psychiatry, 188, 423-431.
Hill, J. (2003) Early identification of
individuals at risk for antisocial personality disorder.
British Journal of Psychiatry, 182 (suppl. 44)
s11-s14.
Kendell, R. (2002) The distinction between
personality disorder and mental illness. British Journal of
Psychiatry, 180, 110-115.
Tyrer, P. (ed.) (2002) Personality Disorders,
Psychiatry, Volume 1:1 March 2002, The Medicine Publishing Company
Ltd.
Tyrer, P. and Bateman, A. (2004) Drug
treatment for personality disorders. Advances in Psychiatric
Treatment, 10 (5): 389-398.
Tyrer, P. et al. (2007) Critical developments
in the assessment of personality disorder. British
Journal of Psychiatry, 190 (suppl. 49), s51-s59.
Produced by the Royal College
of Psychiatrists’ Public Education Editorial Board
Series Editor: Dr Phillip Timms
Original Author: Dr James Stoddart
Editorial Board: Dr Ros Ramsay, Dr Martin Briscoe, Deborah
User and Carer Input: Royal College of
Psychiatrists’ Committee of Patients and Carers
Illustration by Lo Cole/inkshed.co.uk
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available through the generosity of the Charitable Monies
Allocation Committee of the mental health charity St Andrew’s,
Northampton. (Registered charity number 1104951).
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