Personality Disorders

Your personality is determined by the way you act, think, and feel. Everyone has different sides to their personalities and the way we act with a work colleague will differ from with a loved one, for example. Consistent patterns of being and relating are generally cemented by the time an individual reaches their 20s. However, we can all behave out of character when experiencing challenging or traumatic events.

A counsellor or psychotherapist can help you to discuss and understand your behaviour thoughts and feelings. If your personality disorder is connected to conduct disorder, anxiety, or obsessive-compulsive disorder, they will also work with you on these issues.

Personality disorders are simply the description given to groups of people with similar symptoms that place them outside the current ‘norms’ of behaviour.

Individuals with a personality disorder will experience behaviours, thoughts, and feelings that often make their life difficult. They may find that they can’t seem to change this no matter how hard they try, which may make life challenging and make it difficult to maintain relationships.

Research has previously suggested that 20% of people have a personality disorder, but more recent studies have lowered this to 5%.

The controversy surrounding personality disorders is substantial.

Many mental health professionals believe the label of a personality disorder can be unhelpful to their clients, or that personalities themselves are too individual or unique to the personal life experience of the individual concerned to be broken down to fit the diagnosis criteria of a ‘disorder.’

The word ‘disorder’ can be limiting as it mainly focuses on what is wrong with someone; often overlooking their resilience and individual strengths. It also raises a question – what is ‘ordered’? The definition of ‘ordered’ can change according to different cultures and present societal norms.

Labels can be useful for some. It can be a good shorthand term for doctors and healthcare professionals to work with. Some individuals with symptoms of a personality disorder also find that receiving a diagnosis offers a great relief if they have long suffered with patterns of behaviours that can be difficult to control or understand.

It is important to remember a diagnosis does not define you. Personality disorders are not illnesses that can be seen as similar across all sufferers, and are more terms that describe a group of people with similar patterns of behaviours. Mental health diagnoses are not an exact science, and they cannot describe your individual experiences or predict the strengths you may develop in the future.

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All personality disorders share the main symptom of a marked way of behaving and thinking that does not match the norms of your culture. These differences can cause individuals constant difficulties when attempting to relate to others and fit in with society, meaning they often upset other people despite themselves.

It is important to not self diagnose or jump to conclusions as most people will recognise themselves in some way when they research the symptoms of personality disorders. For those with a personality disorder these behaviours do not occur occasionally when they feel upset; develop as a new behaviour in response to a challenging circumstance; or behaviours they exhibit because they are a teenager who is still discovering more about themselves.

Individuals with a personality disorder will experience the behaviours listed below on a consistent and long-term basis. These behaviours will become clear by early adulthood. These behaviours either cannot be changed no matter how hard the individual may try or are so ingrained in the individual that they struggle to understand why others have a problem with their behaviour.

There are currently ten diagnosable personality disorders; schizoid, paranoid, schizotypal, borderline, antisocial, histrionic, narcissistic, dependent, avoidant and anarkistic. Each personality disorder is organised into one of three groups called ‘clusters', which act as an umbrella term for several disorders that share symptoms or traits.

The summaries below give a brief description of what it can be like to have a certain personality disorder. It is possible to have symptoms of more than one.

Cluster A personality disorders and their symptoms:

Schizoid personality disorder: Symptoms include preferring to be alone rather than in the company of others. You find it difficult to understand emotions and you do not feel them often. People may call you cold, and you may not understand why you would care what others think of you. You may not enjoy sex and or go along with social conventions. You may prefer to engage with your rich internal world of thoughts and imaginative streams than engage with others.

Paranoid personality disorder: You may feel that you cannot trust others because everyone wants to exploit and deceive you. You are sure that people, especially sexual partners, are not to be trusted. You believe conspiracy theories are true, fight for your rights, and hold grudges rather than practice forgiveness. When others show friendliness, you may believe they are secretly belittling you.

Schizotypal personality disorder: Relationships make you anxious and uncomfortable. You find it difficult to understand others and when you try to communicate with them, you may be told that your ideas and behaviours are odd or that you are wrong. You may dress in unusual styles. Your emotions are never what others expect and you find it hard to understand them. You may sometimes worry that people are out to get you. You may be superstitious or believe in the paranormal, believing that you can see messages just for you in the things around you.

Cluster B personality disorders and their symptoms:

Borderline personality disorder: You may seem like a very sensitive person who experiences emotions and impulses more strongly than others. You can make friends or romantic connections easily, but you may seem to lack the emotional boundaries that others have. You can be prone to outbursts, which can lead to difficulties sustaining relationships and others often being upset with you. When things get too much, you may self-harm or threaten suicide. You may feel like you do not know the real you and feel empty. Abandonment may be your biggest fear.

Antisocial personality disorder: You get easily frustrated and angry with other people and their opinions. You may not like to stick to the rules and others may describe you as impulsive. You may see others as very emotional and uptight. You find it difficult to hold down a job or be in a relationship. You may have committed crimes or are known to be aggressive. You may believe that should be able to do what you want, with no reason for guilt.

Histrionic personality disorder: Life needs to be exciting no matter what. Everyone must like you and you put a lot of effort into your appearance. You may dress seductively, even when it is inappropriate to do so. You may have been told that you are too dramatic, emotional, selfish, or out of touch with reality. If you like someone, you may follow their suggestions without real rationality.

Narcissistic personality disorder: You desire power and crave success. It is all that matters to you and you will do whatever it takes to earn it, no matter who or what stands in your way. You usually do not feel bad about taking advantage of others to achieve your goals. You may enjoy taking attention from others and getting others to do what you want.

Cluster C personality disorders and their symptoms:

Dependent personality disorder: You believe that you cannot cope with looking after yourself or being by yourself. Your life may be ruled by your need for others and deep desire to hold onto other people. You may feel passive and hopeless, and do whatever others tell you to do. You may be scared that everyone wants to abandon you.

Avoidant personality disorder: You worry a lot, particularly about relationships. You find relationships and interacting with others difficult as they often hurt you or make you feel bad. You want nothing more than to be liked and accepted and thus often wonder why others are horrible to you. You believe that fault lies with you, and you may avoid intimacy, as you believe it is too difficult.

Anankastic personality disorder: Everything must be just right or it is very upsetting. You constantly worry over doing the wrong thing. You are obsessed with details and routines, often checking things to make sure they are right. New situations can be very challenging. You may hate when others criticise you and/or you may be told that you are too critical of others.

The exact causes of personality disorders remain unclear. A combination of genetics, brain abnormalities, childhood experiences and social disadvantages that have affected development are generally associated with the development of personality disorders.

All personalities are varied and complex and a personality disorder must only be diagnosed through accurate information and careful approach. The diagnosis of a personality disorder can seriously affect an individual’s sense of self, so it is important not to self-diagnose or diagnose others even if you or they fit the symptoms. We all act out of character or experience bad moods on occasion and this does not mean that we have a personality disorder.

It is important to seek advice from a mental health professional if you believe you or a loved one might have a personality disorder. In the UK, only psychiatrists can diagnose personality disorders. It can be helpful to meet with a qualified psychotherapists or psychologist who has experience working with personality disorders. You are entitled to a second opinion if you feel you have been given an incorrect diagnosis.

Personality disorders cannot be diagnosed using an exact science. Diagnosis often depends on the expertise and discretion of mental health professionals who specialise in personality disorders. Once they have asked questions about your life, behaviour and relationships, they can compare this information to criteria taken from the appropriate diagnostic manual for your country. The World Health Organisation (WHO) guide to Mental and Behavioural Disorders (ICD-10) is used in the UK, alongside guidance from the National Institute for Health and Care Excellence (NICE).

Treatment usually involves talking therapy. Therapy does not provide a long-term solution and involves weekly sessions over the course of months or years. It can, however, help you to understand yourself, your thoughts and how you are feeling better, and identify new strategies to resolve problems.

Medication is sometimes prescribed to help with symptoms. For example, antidepressants may be prescribed for the symptoms of depression and anxiety. Antipsychotics may also help with symptoms of Cluster A personality disorders.

Talking therapies for personality disorders can include:

Cognitive behavioural therapy: a form of talking therapy that allows individuals to recognise the link between their thoughts, emotions, and behaviours and develop new ways of thinking.

Interpersonal therapy: directly focuses on your relationships with others, which is often a central issue for those with personality disorders.

Dialectical behavioural therapy: created specifically to deal with borderline personality disorder, this involves examining the connection between your thoughts and actions as well as learning techniques sourced from ancient Eastern philosophy.

Psychodynamic therapy: examines the way your childhood experiences may have contributed to distorted thinking in your adult life and created unhelpful patterns of behaviour that are no longer working.

Many people with personality disorders do not seek help, but it is important to seek treatment if you believe you show symptoms, as it can make life more manageable.

It can feel overwhelming if someone you are close to suffers from a personality disorder. You may feel like they are may not be able to behave in ways you understand or may even feel threatened by their choices.

It is important to remain compassionate for what they are experiencing and curious about what life can be like with the viewpoint and personality they have.

While it is important to educate yourself about their condition to understand them better, do not use the information you gather against your loved one or argue that that they must fit what you have read. Each individual has unique life experiences.

You may not always agree with the way the individual with a personality disorder thinks or feels. It can be helpful to validate their thoughts or feelings than simply dismissing them. Choose to say “I appreciate that you feel that way” instead of phrases like “feeling that way makes no sense.”

Be realistic about your expectations, as life can be hard on a person with a challenging personality. Focus on what progress they are making, rather than waiting for them to change. If they believe that you see them as a letdown, untreatable, or incapable of change, then this may leave them feeling defeated or inhuman. However, this will depend on the disorder your loved one has been diagnosed with.

It is important to look after yourself and remove yourself from the situation if things become dangerous. You may also benefit from support from a counsellor, psychotherapist, or support group if your loved one’s behaviour is negatively affecting you emotionally. This can help you understand what you are dealing with and set boundaries.

A qualified, professional therapist will work with you to examine your thoughts and behaviours and improve how you feel. You will build a relationship based on trust, giving you the confidence to share your feelings and emotions with them. Your counsellor will listen to all that you have to share with empathy and openness.

An experienced therapist or counsellor like those listed on the Harley Therapy platform can help you to manage your symptoms and find your own way forward.

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