Personality Disorders

Personality disorders include a cluster of personality traits that significantly and negatively impact on a person’s functioning and wellbeing. These personality traits tend to be long standing and associated with unhelpful responses to life’s challenges and can cause the person a lot of distress. While personality disorders can be difficult to diagnose, approximately 6% of the adult population will meet the
criteria for a personality disorder over their lifetime.

A person with a personality disorder has longstanding and persistent difficulties resulting from the way they feel about and view themselves, others and the world in general. They often experience themselves as unworthy or different, experience others as uncaring or even hostile and may view the world as a dangerous place devoid of any real meaning or sense of purpose.

As a result of these ways of viewing themselves and the world, relationships - whether intimate or in the work setting - are often fraught with difficulty. These difficulties are often so great that education, work and day-to-day living are disrupted to the point that significant social disadvantage may occur.

• People with personality disorders experience an inner fragility and lack the resilience to cope with many of life's difficulties. Not only can stressful or adverse life events have a devastating impact on their well-being, but so too can the responses of others towards them.
• Responses or actions of others which seem to confirm their sense of unworthiness or their expectation that others will treat them badly, for example, may lead to emotional responses of depression, anxiety, or even rage. These painful emotional experiences frequently lead to self-harm or suicide attempts.
• Individuals usually develop characteristic strategies to protect themselves from such painful experiences. These might include, on the one hand, either an intense need for relatedness, acknowledgement and support, or, on the other hand, avoidance of contact with others at all costs.
• Substance abuse, compulsive behaviour or idiosyncratic preoccupations are other ways that people with personality disorders attempt to deal with their internal distress.

Personality disorders have been divided into three main groups:

• odd or eccentric behaviour (eg paranoid personality disorder);
• highly emotional, dramatic and erratic behaviour with particularly intense and problematic relationships (eg borderline personality disorder); and
• predominant anxiety, avoidance of social situations and a need for considerable support (eg dependent personality disorder).

Many individuals with personality disorders display features of more than one of these groups. Personality disorders may range from mild to severe.

The person's behaviour or the disruption caused to others around the person may make it obvious that a problem exists. On the other hand, a person with a personality disorder may keep their distress well-disguised and hidden.

There is a significant association between personality disorders and dysfunctional or abusive childhood experiences. As with other types of mental illness, it is likely that a number of other factors may also contribute to these disorders, including genetic inheritance and physical damage (eg to parts of the brain that influence personality).

• Treatment of personality disorders has generally been viewed as more difficult compared to other disorders, however, there is now strong evidence for the benefit of certain types of therapies.
• These are generally long-term and involve the development of a relationship with a therapist in which difficulties and their origins can be explored and understood, or in which new strategies, coping skills and alternative behaviours can be learnt.

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