What are personality disorders?

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It’s mental health awareness week, so I’ve decided to do a blog post to make you aware of one of the most misnamed and misinterpreted mental health problems – personality disorders.
What do you think when I say “personality disorder”? Some of you will think of multiple personalities, some will think of split personalities. Well unfortunately, you’ll all be wrong. Individuals who have a personality disorder only have one personality, as do all of us. Each of our personalities is unique and it makes up what makes us think, feel and act the way that we do.  So how can someone have a disordered personality? Well, they don’t, not really. Read on and let me explain.

What is personality?

“Personality” is a pattern of behaviour and thinking, and is consistent across time and situations, but is different for each person (Martin et al., 2010). Psychologists who study personality traits (trait theorists) describe personality as ‘a set of personal characteristics that determines the different ways we act and react in a variety of situations’ (Martin et al., 2010)

There are several theories of what makes up our personality. Two of the biggest theories are the Five factor Model (McCrae & Coasta, 1985) and Eysenk’s (1985) Three Factors. Eysenk identified three important and bipolar (they have opposites) factors – extraversion, neuroticism and psychotics. He believed that an individuals temperament are determined by these three dimensions. McCrae and Costa believed that personality is composed of five factors; neuroticism, extraversion, openness, agreeableness and conscientiousness.

You know yourself, that your personality is different from your boyfriends, girlfriends, parents, friends, etc. You all differ on how open you are, how neurotic you may be, or how extraverted you come across as. There is a misunderstanding that those with personality disorders (PD) have multiple versions of who they are, and that you can’t identify who the real “them” is, because of their differing personalities. This, however, isn’t true.

Just as it is with those without personality disorders, individuals who suffer with PD still have only one personality. This is very important to remember throughout this blog post, and if it’s the only thing that you take away from reading this then that is fine. “Personality disorder” is a very misleading label to give someone, and those who contribute to the DSM (the diagnostic statistical manual that lists every psychological disorder and is used by clinicians to diagnose individuals) have been trying to come up with a different name for those with “personality disorder” but have so far failed. Emotional instability was one option for the DSM 5 (the most recent edition of the DSM), but it didn’t get through to the final publication, so for now we are left with “personality disorder”. So whilst we are left with a misleading label, only education on the subject can overcome ignorance, which is why I’m doing this blog post.

So what are personality disorders?

Personality disorders are psychological disorders which create disruptive and enduring behaviour patterns. The individual may have impaired social and cognitive functioning, and not recognise emotions or find them difficult to cope with in a healthy way. In a lot of cases the disorder is what’s called “Ego-syntonic” which means the person experiencing the PD does not necessarily think that they have a problem, which makes the PD difficult to manage and treat by professionals let alone by the sufferer.

There are several common features which the NHS list on their website that are associated with PD:

  • Being overwhelmed by negative feelings
  • Avoiding others and feeling disconnected
  • Difficulty managing feelings without self harming.
  • Odd behaviour
  • Difficulty maintaining stable and close relationships
  • Periods of losing contact with reality

These are common, but also vague. There are several different types of personality disorder, and the DSM organises these into clusters:

Cluster A:
There are three types of personality disorder within cluster A of the DSM. Paranoid personality disorder sufferers are suspicious and extreme mistrust of others. They have a perception of being under attack by others. They are easily insulted, have a tendency to to bear grudges and interprets others actions as hostile. Schizoid personality disorder sufferers have difficulty in social functioning. These individuals have poor ability, but also little desire, to become attached to others. They lack in their close relationships, and have very few of them. They live very sheltered lives, are apathetic, and are emotionally cold. Though it is not the same as schizophrenia, or the same as schizotypal personality disorder, it is thought of as a “schizophrenia spectrum disorder“. Finally, Schizotypal personality disorder sufferers have unusual thought patters and perceptions. Paranormal and superstitious beliefs are common, and sufferers usually interpret situations as being strange or having an unusual meaning for them. Schizotypal disorders make up about 3% of the general population and sufferers are more commonly male than female.

Cluster A disorders are similar to that of schizophrenia, however suffers appear to have a greater grip on reality than those with schizophrenic disorders. Cluster A PD perceptions may be unusual, but they are not hallucinations or delusions such as with schizophrenia. Cluster A, for these reasons, are described as the ‘odd’ or ‘eccentric’ personality disorders.

Cluster B
There are four types of personality disorder that fall into Cluster B. Histrionic personality disorder is characterised by a pattern of ‘attention-seeking’ emotions. I find it difficult to use the word ‘attention-seeking’ when it comes to mental health, but the behaviours of those with HPD are attention seeking in the way that the sufferers are literally looking for some sort of attention. It can involve inappropriately seductive behaviour, or a need for approval . They are dramatic, pre-occupied with their own personal attractiveness, and they are prone to anger outbursts when attempts at attracting their attention fail. Narcissistic personality disorder sufferers tend to exaggerate their feelings of self-importance, they lack the understanding for other peoples feelings and have an extreme need for admiration. They are self-promoting, take advantage of other people and, like with HPD, they are attention seeking.  Anti-social personality disorder is sometimes referred to as sociopathy. Some believe it can also be called psychopathy, but psychopathy is slightly different. Anti-social personality disorder sufferers fail to conform to standards of decency, they have a lack of morals, and can be known to cause distress in society. They fail to sustain loving, long-lasting relationships, and can have a history of criminal and impulsive or aggressive behaviour. Finally in this cluster, borderline personality disorder is characterised by a lack of impulsive control. Sufferers have drastic mood swings, can be inappropriately angry and become bored easily. They have unstable emotions and an unstable sense of self. They also have a high rate of suicidal behaviours and self-harm – 10% of people affected die by suicide.

Cluster B disorders are overall characterised as dramatic, emotional or impulsive personality characteristics. Individuals in this cluster tend to find it difficult to relate to others.

Cluster C
Cluster C contains three different types of personality disorder. Avoidant personality disorder sufferers are oversensitive to rejection with little confidence in themselves initiating and maintaining social relationships. Despite this, they have a strong desire to be close to others. APD is usually noted to have developed in childhood with either childhood emotional neglect (from parents), or peer group neglect, or both. Dependent personality disorder is quite the opposite. Sufferers have a pervasive psychological dependence on other people. They rely on others to meet their physical and mental needs and have little dependence for themselves. Obsessive-compulsive disorder sufferers are total perfectionists, pay excessive attention to details, and have a mentality to control their environment and what’s going on within in. They are reluctant to spend money, even on necessities, and are generally workaholics.

Cluster C personality disorders are characterised as anxious, fearful or avoidant. People with these disorders tend to appear frightened, nervous and are co-morbid with anxiety disorders.

Some of the personality disorders can overlap, and they may be hard to tell apart. Symptoms of each type of disorder can be similar, and it may be almost impossible to identify the type of personality disorder in an individual who doesn’t believe they are suffering from a personality disorder. Professionals diagnose this as personality disorder not otherwise specified (PDNOS).

I know that all of that seemed like a total overload of information, but I just wanted to show you that personality disorders are not what they seem. They are clustered by personality traits, but the traits are usually exaggerated and they effect how the individuals manage their emotional, social and cognitive functioning. Symptoms of personality disorders typically emerge in childhood and adolescence and continue into adulthood. They may be associated with genetic and family factors, but experiences of distress or fear during childhood (neglect or abuse) are common in adults with PD.

Can personality disorders be treated?

There are forms of treatment for individuals with personality disorders. Another part of being labelled with a “personality disorder” is that because it is assumed to be wholly involved with your personality, it seems unchangeable. This is not true. Your personality is yours, and yours to keep, but when it comes to having a personality disorder the symptoms and the coping strategies of the disorder can be treated.

Dialectical Behavioural Therapy (DBT) is an extremely successful form of therapy when it comes to many mental health illnesses, but it was originally developed from CBT for personality disorders, specifically borderline personality disorders. It involves teaching the individuals skills to help them cope with their symptoms in a healthy way. Skills taught involves emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness. Individuals, through having a strong relationship with their DBT therapist, can learn how to understand and analyse their own and others emotions, understand how to recognise what is going on in their own head, how to balance and cope with their own distress in a healthy manner, and how to improve relationships with others.

Other forms of therapy include psychodynamic psychotherapy which explores distortions in thoughts and beliefs with the understanding that they arose in childhood. Interpersonal therapy is also used to deal with negative issues associated with relationships and looks at how these issues can be resolved.

I hope this gives you a brief overview into the complexities of what “Personality Disorder” means, and how there are different types of the disorder, and how none of these types mean that someone has multiple personalities!


Further reading:

Martin, G. (2010). Psychology. 4th ed. Massachusettes: Pearson Education UK.

mind.org.uk

http://www.nhs.uk/pages/home.aspx

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