Posted by: carolg1849 | February 25, 2009

Royal college of Psychiatrists – leaflet

 

Personality Disorders

 

About this leaflet

This leaflet is for anyone who has been given a diagnosis of personality disorder – and also for their family and friends.

Introduction

It’s not easy to pin down exactly what we mean by the word ‘personality’.  It seems obvious, but it is hard to put into words.  Part of the reason is that many of the words we use to describe people have wide meanings – and these meanings often overlap.

These words can cover more than one area of experience. ‘Anxiety’ describes the feeling of worrying, ‘nervousness’ describes the behaviour that others might notice if you feel like this. ‘Shyness’ describes the feeling of awkwardness with other people, but also the behaviour of being rather quiet in company.

It is also difficult because the way we appear to other people can be very different in different situations.  If you only know someone from work, you may see quite a different side to them if you meet socially.

However, in mental health, the word ‘personality’ refers to the collection of characteristics or traits that makes each of us an individual. These include the ways that we:

  • think
  • feel
  • behave

By our late teens, or early 20s, most of us have developed our own personality with our own distinctive ways of thinking, feeling and behaving. It remains pretty much the same for the rest of our life. Usually, our personality allows us to get on reasonably well, if not perfectly, with other people.

Personality disorder

However, for some of us, this doesn’t happen. For whatever reason, parts of our personality develop in a way that makes it difficult for us to live with ourselves and/or other people. It can be difficult to learn from experience and to change those traits – the unhelpful ways of thinking, feeling and behaving – that cause the problems. Unlike the changes in personality that can be caused by traumatic events, or an injury to the brain, these traits will usually have been noticeable from childhood or early teens.

You may find it difficult to:

  • make or keep relationships
  • get on with people at work
  • get on with friends and family
  • keep out of trouble
  • control your feelings or behaviour

If, as a result, you:

  • are unhappy or distressed

and/or

  • find that you often upset or harm other people

then you may have a personality disorder (see below for descriptions of the different types). Having a personality disorder makes life difficult, so other mental health problems (such as depression, or drug and alcohol problems) are also common.

Talking about personality disorder

There are different ways to describe mental disorders, and to put them into categories. The difficulty in describing any personality clearly, makes this more controversial with personality problems than with mental illnesses, such as depression or schizophrenia. Indeed, many people feel that it is unhelpful to ‘label’ personality difficulties in this way. However, although we are all individuals, certain patterns of personality problems do seem to be shared by fairly large numbers of people. By identifying these patterns, we can then develop ways of helping, and treatments that can be of use to many people, not just an individual. 

Personality disorder – a suitable case for treatment?

There is good evidence that people with the diagnosis of personality disorder have not received the attention they should have from mental health services. These services have focused mainly on mental illnesses, such as schizophrenia, bipolar disorder and depression. There has been some uncertainty about whether they have anything useful to offer people with personality disorders. Research has made it clear that mental health services can, and should, help people with personality disorders.

Different kinds of personality disorders

Research has shown that personality disorders tend to fall into three groups, according to their emotional ‘flavour’:

 Cluster A:  ‘Suspicious’

Cluster B:  ‘Emotional and impulsive’

Cluster C:  ‘Anxious’

As you read through the descriptions of each type, you may well recognise some aspects of your own personality. This doesn’t necessarily mean that you have a personality disorder. Some of these characteristics may even be helpful in some areas of your life. However, if you do have a personality disorder, these aspects of your personality will be quite extreme. They may spoil your life, and often the lives of those around you. 

People may display the signs of more than one personality disorder. 

Cluster A: ‘Suspicious’

Paranoid

  • suspicious
  • feel that other people are being nasty to you (even when evidence shows this isn’t true) 
  • sensitive to rejection
  • tend to hold grudges

Schizoid

  • emotionally ‘cold’
  • don’t like contact with other people, prefer your own company
  • have a rich fantasy world

Schizotypal

  • eccentric behaviour
  • odd ideas
  • difficulties with thinking
  • lack of emotion, or inappropriate emotional reactions
  • can see or hear strange things
  • related to schizophrenia, the mental illness

Cluster B:  ‘Emotional and impulsive’

Antisocial, or Dissocial

  • don’t care about the feelings of others
  • are easily frustrated
  • tend to be aggressive
  • commit crimes
  • find it difficult to make intimate relationships
  • impulsive – do things on the spur of the moment without thinking about them
  • don’t feel guilty
  • don’t learn from unpleasant experiences

Borderline, or Emotionally Unstable

  • impulsive
  • find it hard to control emotions
  • feel bad about yourself
  • often self-harm, e.g. cutting yourself or making suicide attempts
  • feel ’empty’
  • make relationships quickly, but easily lose them
  • can feel paranoid or depressed
  • when stressed, may hear noises or voices

Histrionic

  • over-dramatise events
  • self-centered
  • show strong emotions, but which change quickly and don’t last long
  • can be suggestible
  • worry a lot about your appearance
  • crave new things and excitement
  • can be seductive

Narcissistic

  • have a strong sense of your own self-importance
  • dream of unlimited success, power and intellectual brilliance
  • crave attention from other people, but show few warm feelings in return
  • exploit others
  • ask for favours that you do not then return

Cluster C:  ‘Anxious’

Obsessive-Compulsive (aka Anankastic)

  • worry and doubt a lot
  • perfectionist – always check things
  • rigid in what you do
  • cautious, preoccupied with detail
  • worry about doing the wrong thing
  • find it hard to adapt to new situations
  • often have high moral standards
  • judgemental
  • sensitive to criticism 
  • can have obsessional thoughts and images (although these are not as bad as those in obsessive-compulsive disorder)

Avoidant (aka Anxious/Avoidant)

  • very anxious and tense
  • worry a lot
  • feel insecure and inferior
  • have to be liked and accepted
  • extremely sensitive to criticism

Dependent

  • passive
  • rely on others to make their own decisions
  • do what other people want you to do
  • find it hard to cope with daily chores
  • feel hopeless and incompetent
  • easily feel abandoned by others

What causes personality disorder?

The answer is not clear, but it seems that like other mental disorders, genes, brain problems and upbringing can play a part. There is evidence for the importance of:

Upbringing

  • physical or sexual abuse in childhood
  • violence in the family
  • parents who drink too much

If children are taken out of this sort of difficult environment, they are less likely to develop a personality disorder.

Early problems

Behaviour problems in childhood, such as severe aggression, disobedience, and repeated temper tantrums. 

Brain problems

Some people with antisocial personality disorder have very slight differences in the structure of their brains, and in the way some chemicals work in their brains. However, there is no brain scan or blood test for a personality disorder.

Things that make it worse

  • using a lot of drugs or alcohol

  • problems getting on with your family or partner

  • money problems

  • anxiety, depression or other mental health problems

    to read the entire leaflet click here

 

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