Personality Disorders

It’s not easy to pin down exactly what we mean by the word ‘personality’. It seems obvious, but it can be hard to put into words. This can be because the words we use to describe people tend to have wide meanings – and these meanings often overlap. These words can also cover more than one kind of experience. For example, ‘shyness’ describes the feeling of awkwardness with other people, but also how we behave by being rather quiet in company.

It is also difficult because the way we behave – and appear to other people – can be very different in different situations. You can know a person well at work, but find that they behave quite differently in their private life.

In mental health, the word ‘personality’ refers to the collection of characteristics or traits that we have developed as we have grown up and which make 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. We have our own ways of thinking, feeling and behaving. These stay pretty much the same for the rest of our life. Usually, our personality allows us to get on reasonably well with other people.

For some of us, this doesn’t happen. For whatever reason, parts of your personality can develop in ways that make it difficult for you to live with yourself and/or with other people. You don’t seem to be able to learn from the things that happen to you. You find that you can’t change the bits of your personality (traits) that cause the problems. These traits, although they are part of who you are, just go on making life difficult for you – and often for other people as well.

Other people will often have noticed these traits from your childhood and early teens. For example, you may find it difficult to:

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

If this makes you

  • unhappy or distressed

and/or

  • often upset or harm other people

then you may have a personality disorder (see below for descriptions of the different types).

Life is more difficult if you have a personality disorder, so you are more likely to have other mental health problems such as depression or drug and alcohol problems.

 

How common are personality disorders?

There have been difficulties in clearly defining personality disorders. Previous research studies have suggested that up to 1 in 5 people might have a personality disorder. However, a larger and more rigorous UK study in 2006 suggested that, at any given time, about 1 in 20 people will have a personality disorder.

 

Personality disorder – treatable or untreatable?

People with a diagnosis of personality disorder have not, in the past, had enough help from mental health services. These services have been more focussed on mental illnesses like schizophrenia, bipolar disorder and depression. There have been arguments about whether mental health services can offer anything useful to people with personality disorders. Recent research makes it clear that mental health services can, and should help people with personality disorders.

 

Do personality disorders change with time?

Yes. There is evidence that they tend to improve slowly with age. Antisocial behaviour and impulsiveness, in particular, seem to reduce in your 30s and 40s.

It can, however, sometimes work in the opposite direction. For example, schizotypal personality disorder can develop into the mental illness ‘schizophrenia’.

Different kinds of personality disorders

There are different ways to describe mental disorders, and to put them into categories. The first step is to see if there are patterns, or collections of personality traits that are shared by a number of people. Once these patterns have been identified, we can start to find effective ways of helping.

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

 

Cluster A: ‘Odd or Eccentric

Cluster B: ‘Dramatic, Emotional, or Erratic’

Cluster C: ‘Anxious and Fearful’

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. If you do have a personality disorder, some of these traits will be spoiling your life – and often the lives of those around you.

A person can have the characteristics of more than one personality disorder.

 

Cluster A: ‘Odd and Eccentric’

Paranoid

  • suspicious
  • feel that other people are being nasty to you (even when evidence shows this isn’t true)
  • feel easily rejected
  • 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
  • see or hear strange things
  • sometimes related to schizophrenia, the mental illness

 

Cluster B: ‘Dramatic, Emotional and Erratic’

Antisocial, or Dissocial

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

 

Borderline, or Emotionally Unstable

  • impulsive – do things on the spur of the moment
  • find it hard to control your 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
  • have strong emotions 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
  • take advantage of other people
  • ask for favours that you do not then return

 

Cluster C: ‘Anxious and Fearful’ 

Obsessive-Compulsive (aka Anankastic)

  • worry and doubt a lot
  • perfectionist – always check things
  • rigid in what you do, stick to routines
  • 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 decisions for you
  • 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