Personality disorders( updated Oct 2006)


Personality disorders are pervasive mental disorders often seen emerging in ones late teens. They affect ones ability to have healthy relationships with others and ones self. People with these disorders have behaviours that make it hard for them to function in society. Affected people usually do not learn from mistakes and do not adapt well to changes in their lives. The origins of these conditions can usually be identified to childhood experiences and subsequent maladaption. In many cases the severity of the maladaptive pattern of behaviour lessens with maturity. Most people can live fairly normal lives with mild disorders. But when stress increases, symptoms often increase and begin to interfere with the person's ability to function. Personality disorders are characterised into different subgroups, which have different symptoms. Below are a list of the commonly described conditions and some of their key features;

Cluster A

  • paranoid -- affected people think others are out to get them
  • schizoid -- affected people are "loners" and prefer to be alone
  • schizotypal -- affected people have very strange thoughts and beliefs

Cluster B

  • histrionic -- affected people are very emotional and dramatic
  • narcissistic -- affected people are very self-centered and think they are better than others
  • antisocial -- affected people lack a conscience, take advantage of others, and refuse to obey the laws of society
  • borderline -- affected people have unstable relationships and a poor self-image

Cluster C

  • avoidant -- affected people feel inferior to others and fear rejection
  • dependent -- affected people rely too much on others, often staying in abusive relationships because they fear being alone
  • obsessive-compulsive -- affected people are more concerned with the rules than the goal of an activity
  • passive-aggressive -- affected people are aggressive in a passive way, such as being late on purpose

Some theories as to why a person may develop a personality disorder include:

  • biological causes, such as genetic defects, or head injury
  • social causes, or learned responses
  • psychological causes, such as poor parent-child relationships

The diagnosis is made by observing a person's symptoms and behaviours over an extended period of time. It is not recommended that a diagnosis of a personality disorder is made without knowing the patient and their history very well.
 
Many people with severe personality disorders cause considerable dislocation to the lives of other people with whom they are in close contact. This is particularly applicable to the family environment. Of particular concern is often their capacity to look after children in a safe manner.

Personality disorders are hard to treat. Treatments that focus on increasing social and coping skills tend to be helpful. Medications may be used to reduce anxiety and depression. Family and group psychotherapy may also be helpful. Treatment is usually long and required a strong commitment from both patient and therapist. Often the pattern seen is that these patients repeatedly drop out of therapy. Some personality disorders, in particular anti-social personality disorders are believed by many to be untreatable. Unfortunately many people with anti-social and borderline personality disorders end up in jail as a result of their behaviours.  

The most commonly observed personality disorder amongst mental health workers is Borderline Personality disorder. Below is further information about this condition.

Borderline personality disorder

Borderline personality disorder is a serious psychiatric condition. People with a borderline personality have an unstable self-image, erratic moods, impulsive behaviour, and chaotic relationships. This pattern makes interacting with other people and society difficult for the affected person. A borderline personality is one of the most difficult and unstable to deal with. The exact reason why people develop this condition is unknown. Childhood traumas are commonly seen amongst sufferers of this condition. People with this disorder:

  • are often impulsive. This can get affected people into trouble. For example, they may spend money they don't have, have sex with strangers, gamble, abuse drugs, or steal things.
  • have intense and unstable relationships. Affected people may manipulate others. They may also shift back and forth from loving to hating someone, or make and break friendships often.
  • may have intense anger and inability to control it.
  • have a poor and shifting sense of who they are. For example, a person may shift their goals or values constantly. Affected people may switch from being attracted to women to being attracted to men, or back again.
  • may have rapid and intense mood swings. For example, an affected person may change from total happiness to depression and thoughts of suicide. This can even occur a number of times in a single day.
  • do not like being alone. People with this disorder are often unhappy when they are alone. They may even fake an illness to prevent someone from leaving.
  • often harm themselves. This may include suicide attempts, intentional self-harm, or frequently starting fights.
  • may have chronic feelings of emptiness and boredom.


Inherited factors and the environment a person is raised in are thought to contribute. People with borderline personality disorder often have not had proper care during childhood, but it is important to remember that this is not always the case. These people feel empty and angry, and seem to long to be nurtured. The main risks of this disorder are related to social and legal problems. Affected people often have few or no lasting friends, and may get into trouble with the law. They may commit suicide or die from the risks they take.

This condition is diagnosed when a person shows the symptoms and signs. There is no one test that can make the diagnosis. In some cases, a written survey of symptoms or a psychological test may be used to help make the diagnosis. Long-term effects are mostly related to the person's behaviour. This may include financial, legal, and social problems.

Many people with this condition respond to either specific cognitive behavioural therapy or to modified psychodynamic psychotherapy which addresses the patient's deficient sense of self. Medication may be useful in reducing the extremes of mood and associated chaotic behaviour. In some cases, therapy may bring out anger and impulsive behaviour. Treatment does not "cure" this disorder. Most affected people have lifelong problems. As people get older, they often become a little more stable. Most people with this disorder need help and therapy for life, if they are willing to accept it.