What are they?
Personality disorders are a class of mental conditions where an individual’s personality severely differs from others in society. Individuals with a personality disorder may perceive, think, feel and relate differently from the average person. This can have a huge impact on them and can make socialising and spending time with others incredibly difficult.
Personality disorders may start in childhood but become more noticeable in adolescence and adulthood. Relationships and friendships may be difficult to maintain and living with a personality disorder may become very isolating and lonely. However, help is available to teach individuals coping strategies to help integrate them into social settings as well as to help them understand people promoting better relationships.
What causes them?
There is no clear cause of personality disorders but it has been suggested that there may be a combination of factors such as childhood trauma, other mental disorders, differing brain structures and in how the chemicals in the brain work, upbringing, genetics, and family circumstances.
Signs and symptoms (how to spot it / what does it feel like)
Research suggests that there are 3 main groups which personality disorders fall into:
A) Odd or Eccentric
B) Dramatic, Emotional, or Erratic
C) Anxious and Fearful
There are several types of personality disorder which would be diagnosed by a psychiatrist.
Group A personality disorders (Odd and Eccentric) include:
Paranoid personality disorder – A person with paranoid personality disorder has tendencies to be suspicious, paranoid and feel easily rejected. Individuals with this type of personality disorder can find it hard to trust others, as they believe they are being manipulated or lied to. They look into what others say trying to find hidden messages and meaning. They do not trust that their partners are faithful even when there is no evidence to suggest otherwise. They worry that if they share confidential information that it will be used against them.
Schizoid personality disorder – A person with schizoid personality disorder avoids close social contact and appears detached and cold. They have little desire to form any relationships with people and prefer not to take part in any activities which require social interaction. They have little interest in sex and prefer to be alone.
Schizotypal personality disorder – A person with schizotypal personality disorder may be perceived as odd or eccentric. They are likely to have delusion thoughts and feel anxious when others do not share their beliefs. They tend to feel incredibly paranoid and anxious in social settings and find it hard to make close relationships. They may display poor social skills and seem unusual in the way they communicate, often being vague or rambling.
Group B personality disorders (Emotional and Erratic) include:
Antisocial personality disorder (ASPD) – A person with antisocial personality disorder lacks consideration for others and does not consider the consequences of their actions. They may behave aggressively, recklessly, dangerously and sometimes illegally. They put their needs first and believe the strongest survive. They have no sense of guilt, show no remorse or regret about how their behaviour impacts on others. They can be perceived as intimidating bullies and display anger quickly. They blame others for their issues and do not learn from bad experiences.
Borderline personality disorder (BPD) – A person with borderline personality disorder is very impulsive and does not have a strong sense of who they are. People with BPD can have short periods of psychosis where they may hallucinate and hear voices. They often self-harm or make suicide attempts and report feeling “empty”. They can be described as emotionally unstable and whilst they may form relationships easily they find it difficult to sustain them. People with BPD do not like to be alone and tend to stay in unhealthy relationships.
Histrionic personality disorder – A person with histrionic personality disorder likes to be the centre of attention and gets anxious if ignored. They may appear insincere in their display of excessive emotion. They may flirt inappropriately and display sexual behaviour and dress provocatively. They seek constant approval from others and are self-centred. Their emotional state can change very quickly and despite seeking reassurance they care very little for others. A person with histrionic personality disorder may also display signs and symptoms of narcissistic and borderline personality disorders.
Narcissistic personality disorder – A person with a narcissistic personality disorder has a need for others to look up to them and has an inflated sense of self-importance. They tend to take and not give, taking advantage of others. They lack empathy and feel they deserve to be treated better than other people. They long for success and envy anyone who they feel are “above” them. They look down on anyone who they feel are “beneath” them.
Group C personality disorders (Anxious and Fearful) include:
Avoidant personality disorder – A person with avoidant personality disorder is withdrawn, painfully shy, fears rejection, feels they are inferior to others, are extremely sensitive, worry constantly, feel isolated and alone, tries to avoid any situation they may feel embarrassed by, are socially inhibited, expect criticism and avoid friendships and relationships.
Dependent personality disorder – A person with a dependent personality disorder is incredibly passive, has low self-confidence and relies heavily on others to support them. They allow others to make decisions for them and are seen as submissive. They do not take responsibility for themselves and are guided by others even when they don’t agree. They do not like to be alone and fear having to fend for themselves. They have an intense need to be looked after and cling to others. They try to avoid any gaps in relationships. If one relationship ends they are desperate to find another. They feel that other people are more capable than them and feel unable to function properly without help.
Obsessive-compulsive personality disorder (OCPD) – A person with OCPD likes to control their environment. They like order and become anxious when things are “messy” or if they lack control. They like lists, rules, structure, routines, have rigid views, hoard invaluable objects, are reluctant to spend money, are workaholics, judgemental, worry a lot, have obsessive thoughts and get upset when things aren’t perfect. They have perfectionist tendencies and have exceptionally high standards which may not be realistic. They find it hard to adapt to new situations. This condition differs from obsessive-compulsive disorder (OCD) as people with OCPD are unable to recognise that they behaviour is odd and they don’t want to change.
Long-term psychological therapy is required in the treatment of personality disorders. An integrative approach is often adopted in the treatment of personality disorders and structured care. A range of therapies may be used to help individuals regulate their thoughts and emotions. Group therapy is used so individuals can develop a better understanding of social relationships. Dialectical behavioural therapy (DBT) can teach individual’s ways of helping them change unhelpful ways of thinking. Strategies can be taught to help individuals adjust their behaviour and attitudes helping them to resolve problems. Psychodynamic psychotherapy may be used to look at an individual’s early childhood experiences which influence thoughts, beliefs and behaviours. This is used particularly with borderline personality disorder (BPD). It is important that consistency and reliability are maintained with the therapist during treatment.
Medication may be prescribed by your GP for other mental health issues such as depression and anxiety but no specific medication is prescribed for personality disorders.
Talk to a doctor online or BACP registered therapist face-to-face on your smartphone or computer with Babylon Health.
By Helen Rutherford