Personality Disorder

Personality Disorder: key facts

What is a personality disorder (PD)? 

• A “personality” is the collection of ways that we think, feel and behave  that makes each of us an individual.
• 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 don't learn from experience how to change the unhelpful parts of yourself

You may have a personality disorder if you find it difficult to:

• make or keep relationships
• get on with people at work or with friends and family
• keep out of trouble
• control your feelings or behaviour.

and

• you are unhappy or distressed and/or find that you upset or harm other people.

How common is PD

Probably about 1 in 10 people has a PD.

Personality disorders tend to fall into three groups:

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 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 can also 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 (aka Anxious/Avoidant)

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.

Professional help

This can include:

• Individual Therapy

Counselling and dynamic psychotherapy, cognitive therapy, cognitive analytical therapy and dialectical behaviour therapy.

• Treatment in a therapeutic community

A place where you can attend (or sometimes stay in) for several weeks or months. Most of the work is done in groups. You learn from being with other people in a unit. It differs from 'real life' in that any disagreements or upsets happen in a safe place. The staff and other patients help you to get through such problems and learn from them.

• Medication

Antipsychotic drugs can reduce the suspiciousness of cluster A personality disorders (paranoid, schizoid and schizotypal). They can also help with borderline personality disorder if people feel paranoid, or are hearing noises or voices. 

Antidepressants can help with the mood and emotional difficulties of people with cluster B personality disorders. Some selective serotonin reuptake inhibitor antidepressants can also reduce anxiety in cluster C personality disorders.

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

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.

Which approach is best for me?

This depends on what you prefer as well as the type of personality disorder that you have. However, a lot depends on what is available in your area.