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;
* 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
* 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
* 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
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 individual. People with Borderline Personality Disorder:
Are often impulsive. This means that often BPD individuals might spend money they don’t have, have sex with strangers, gamble, abuse drugs, or steal things.
Have intense and unstable relationships. They may also shift back and forth from loving to hating someone, or make and break friendships often.
May have intense anger and an 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.
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.
Often harm themselves. This may include suicide attempts and intentional self-harm.
May have chronic feelings of emptiness and boredom.
Borderline individuals are understood to have been born with an emotionally sensitive temperament, leaving them vulnerable to a constant rollercoaster of intense emotions.
Often people in their environment don’t understand what it is like to live with intense emotions, they tend to doubt the individual’s experience and often without meaning to, the environment invalidates the Borderline individual. So the interaction between their biology (sensitive temperament) and their environment (often invalidating, abusive or neglectful) lead an individual to develop the problems listed above. Because they have such difficulty managing their emotions they tend to turn to self harming behaviours and thoughts and attempts at suicide. In fact the suicide rate for Borderline individuals is from 8-10%.
This condition is diagnosed when a person shows the symptoms and signs. There is no one test that can make the diagnosis. The main treatment for people living with BPD is Dialectical Behaviour Therapy, which basically teaches the individual skills to manage their sensitive temperament and improve relationships in their lives. DBT skills training and long-term psychotherapy are the preferred treatment for these individuals. Medication may be useful in reducing the extremes of mood and associated chaotic behaviour. Although treatment does not “cure” this disorder, it helps significantly in teaching these individuals necessary skills to cope with everyday life and offers a validating environment for them to work through problems and difficulties in their lives.