Personality disorders

This section tells you what personality disorders are, what the symptoms are, and how you can get treatment. You might find it useful if you have a personality disorder yourself, or if you care for someone who does.

Overview

  • A personality disorder can affect how you cope with life, manage relationships, how you behave, and how you feel.
  • There are different types of personality disorders.
  • There is no single cause of personality disorder. It is likely to be a combination of reasons, including genetic and environmental causes.
  • Talking therapies are recommended as treatment for personality disorders.
  • You can have a personality disorder alongside other mental health problems, such as anxiety and depression.

About

What are personality disorders?

Everyone has different ways of thinking, feeling, and behaving. It is these thoughts, feelings, and behaviours that make up our ‘personality’. These are often called our traits. They shape the way we view the world and the way we relate to others. By the time we are adults these will make us part of who we are.

You can think of your traits as sitting along a scale. For example, everyone may feel emotional, get jealous, or want to be liked at times. But it is when these traits start to cause problems that you may be diagnosed as having a personality disorder.

A personality disorder can affect how you cope with life, manage relationships, and feel emotionally. You may find that your beliefs and ways of dealing with day-to-day life are different from others. You can find it difficult to change them.

You may find your emotions confusing, tiring, and hard to control. This can be distressing for you and others. Because it is distressing, you may find that you develop other mental health problems like depression or anxiety.

You may also do other things such as drink heavily, use drugs, or self harm to cope.

Research shows that personality disorders are fairly common. Around one in 20 people live with some form of personality disorder.

You can find more information about:

Anxiety disorders by clicking here.
Depression by clicking here.

Types & Causes

What are the different types of personality disorder and how are they diagnosed?

Doctors use guidelines for diagnosing mental health problems. The main guidelines used are the:

  • International Classification of Diseases (ICD-10) produced by the World Health Organisation (WHO), and
  • Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association.

When making a diagnosis your doctor will:

  • think about your symptoms, and
  • compare them to the guidelines.

A doctor will ask you questions about your life and what feelings, emotions, and behaviours you have. This is called an ‘assessment’. The doctor should be a psychiatrist.

You shouldn’t feel that it’s your fault, or that you’re to blame if you’ve been diagnosed with a personality disorder. Problems with diagnosis are explored in more detail in further down on this page.

Personality disorders diagnoses are grouped into three ‘clusters’, A, B, and C.

Cluster A personality disorders

People with cluster A personality disorders can find it hard to relate to other people. Their behaviour might seem odd or eccentric to other people.

Paranoid personality disorder
If you have been diagnosed with this, you may feel very suspicious of others without good reason. This can make you feel that other people are being nasty to you. Even though this isn’t true . You might feel easily rejected or hold grudges.

Schizoid personality disorder
With schizoid personality disorder, you may have few social relationships and will prefer to be alone. You may not enjoy or want to be part of a close relationship. This may include being part of a family. You might appear cold and removed from situations.

Schizotypal personality disorder
Schizotypal personality disorder is where you have problems with relationships with other people. You may have strange thoughts, feel paranoid and have odd behaviour or appearance. You might have an inappropriate display of feelings.

Cluster B personality disorders

People with cluster B personality disorders can find it hard to control their emotions. Other people might see them as unpredictable.

Antisocial personality disorder (ASPD)
Being diagnosed with antisocial personality disorder (ASPD) may mean you are impulsive and reckless. It might mean you don’t think about how your actions affect other people.

You may get easily frustrated, aggressive and be prone to violence. You may lie to get what you want. Others may see this as acting selfishly and without guilt. You may blame others for problems you are having in your life.

Borderline personality disorder (BPD)
You may have strong emotions, mood swings, and feelings you can’t cope with if you have borderline personality disorder (BPD). You may feel anxious and distressed a lot of the time.

You may have problems with how you see yourself and your identity. You may self-harm or use drugs and alcohol to cope with these feelings. This can affect the relationships you have with other people.

BPD is also known as ‘emotionally unstable personality disorder’.

You can find out more about ‘Borderline personality disorder’ by clicking here.

Histrionic personality disorder
If you are diagnosed with histrionic personality disorder, you may like being the centre of attention. You may feel anxious about being ignored. This can cause you to be lively and over-dramatic.

You may become bored with normal routines, worry a lot about your appearance and want to be noticed. You might be easily influenced by others.

Narcissistic personality disorder
Narcissistic personality disorder can mean you have a high sense of self importance. You may fantasise about unlimited success and want attention and admiration.

You may feel you are more entitled to things than other people are. You might act selfishly to gain success. You may be unwilling or unable to acknowledge the feelings or needs of others.

Cluster C personality disorders

People with cluster C personality disorders have strong feelings of fear or anxiety.

Dependent personality disorder
If you have dependent personality disorder, you may allow other people to take responsibility for parts of your life. You may not have much self confidence or be unable to do things alone. You may find that you put your own needs after the needs of others. You may feel hopeless or fear being alone or abandoned.

Avoidant personality disorder
If you have avoidant personality disorder, you may have a fear of being judged negatively. This can cause you to feel uncomfortable in social situations. You might not like criticism, worry a lot and have low self esteem. You may want affection but worry that you will be rejected.

Obsessive-compulsive personality disorder
This is also known as anankastic personality disorder.

If you have this condition, you may feel anxious about things that seem unorganised or ‘messy’. Everything you do must be just right, and nothing can be left to chance. You may be very cautious about things and think a lot about small details. You may have problems completing tasks due to your own high standards. Others may see you as being controlling.

Obsessive-compulsive personality disorder is different to obsessive compulsive disorder (OCD). If you have obsessive-compulsive personality disorder, you may believe your actions are justified. People with OCD tend to realise that their behaviour isn’t rational.

You can find out more about ‘Obsessive compulsive disorder (OCD)’ by clicking here.

What causes personality disorders?

It isn’t clear what causes personality disorders. It seems that a mix of factors can mean some people develop personality disorders.

These can include:

  • biological factors, when it is passed on through your genes, and
  • the environment around you when you were growing up.

Many people diagnosed with personality disorders have experience of trauma. These might include difficulties growing up, including childhood neglect or physical, emotional or sexual abuse.

When you are growing up, you learn to cope with emotional changes and make relationships with other people. Children who are abused or neglected often don’t learn these things. So, they may find it more difficult to manage how they feel when they are adults.

This doesn’t mean that all people who experience trauma will develop personality disorders. But they may be more likely to.

Treatment

How are personality disorders treated?

Personality disorders are usually treated with group psychological treatments or talking therapies. Below we explain more about the different types of therapies.

The options for treating personality disorders are continuously developing.

You and your doctor or healthcare team should agree on a treatment plan that works best for you.

If your GP feels you have a complex personality disorder, they may refer you to a:

  • community mental health team, or
  • specialist personality disorder service or unit, if there is one locally.

These services are made up of professionals such as psychologists, psychiatrists and therapists. They will have experience in helping people with personality disorders. Sometimes you can contact these services yourself to get help.

It’s always worth asking why a certain treatment is being offered. And if there are other things that could help you to get better.

When thinking about what treatment to offer you professionals should consult guidelines NICE guidelines, if relevant. NICE stands for The National Institute for Health and Care Excellence. The NICE guidelines recommend treatment for conditions.

For personality disorders NICE only have guidelines for:

  • Borderline personality disorder (BPD), and
  • Anti-social personality disorder.

You can find these online, find link below:
www.nice.org.uk/guidance

Therapy for personality disorders is usually long term. You might have to complete the therapy to get the full benefit of it, to aid your recovery. If you are struggling with your therapy for any reason, you can tell your therapist this.

In some areas, services use pre-therapy preparation to help people understand the link between emotions and decisions. The aim is to help you recognise your emotions before starting therapy, and hopefully finish your sessions.

The following treatments can help if you have a personality disorder:

Cognitive behavioural therapy (CBT)

CBT can help you to change how you think and what you do. These are both linked to how you feel.

CBT looks at problems and difficulties in the ‘here and now’ more than your past or childhood.

CBT can help you understand how you think about yourself, the world and other people. And how that affects how you deal with things in your life.

Dialectical behaviour therapy (DBT)

DBT can help you learn to spot and control your emotions and behaviour.

It is adapted from CBT. It helps you recognise then change unhelpful behaviour by learning new skills. Unhelpful behaviour might include thinking about suicide, self harming, drinking alcohol or using drugs to cope with your emotions.

The National Institute for Health and Care Excellence (NICE) says DBT can be helpful if you have borderline personality disorder.

A course of DBT usually takes place over 18 months.

Cognitive analytical therapy (CAT)

CAT helps you recognise relationship patterns that can cause you problems and are difficult to change. You may have learnt these patterns while growing up to cope with difficult emotions.

You and the therapist will work together to recognise these patterns and then to try and change them. This therapy is based on the individual’s needs. And takes into account their current situation and the problems they are having.

This type of therapy can usually last between 4 – 24 weeks. But on average lasts 16 weeks.

You and your therapist will agree the end goal at the start of the therapy.

Mentalisation based therapy (MBT)

Mentalising is about making sense of what other people think, need, or want. It is about being aware of what’s going on in your own mind and in the minds of others. Mentalising refers to the fact that sometimes when you feel distressed, it can be harder to ‘mentalise.’

You would attend group and one-to-one therapy. This may help you better understand yourself and others and learn how to mentalise. Treatment programmes can last for 12 to 18 months.

Psychodynamic or psychoanalytic therapy

This type of long-term therapy is a therapeutic process which helps patients understand and resolve their problems. It does this by increasing awareness of their inner world and its influence over relationships both past and present.

It differs from most other therapies in aiming for deep seated change in personality and emotional development.

It helps people to understand and change complex, deep-seated emotional and relationship problems.

Therapeutic communities

A therapeutic community is a place you would get long-term group therapy.

You would visit, or sometimes stay, for a number of weeks or months. Sometimes you may visit for just a few days a week.

You learn from spending time with other people in the treatment group. It offers a safe place if there are any disagreements or upsets. People in a therapeutic community often have a lot of say over how the community runs.

There are only a few therapeutic communities in the UK. You could check with your local Patient Advice Liaison Service (PALS) if your NHS trust has one. You can search for your PALS office here:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363

Medication

There is no recommended medication for the treatment of personality disorders.

But your doctor may give you medication to help with symptoms such as anxiety, anger, or low mood. These might include antidepressants, mood stabilisers, or antipsychotics.

You can find out more about:

  • Antidepressants by clicking here.
  • Mood stabilisers by clicking here.
  • Antipsychotics by clicking here.

If you are given any medication, your doctor should tell you how it should help. And about any side effects that you might get.

Care Programme Approach

Having a personality disorder may put you at risk, mean you have a lot of needs, and need a high level of care. You can be supported through the Care Program Approach (CPA).

The CPA is used to plan and outline the support you need to manage complex needs and your mental health.

If you are on the CPA you will have a care coordinator. They will work with you to write a care plan. This will set out how the NHS will support you.

You can find more information about the ‘Care Programme Approach’ by clicking here.

What if I’m not happy with my treatment?

Patient Advice and Liaison Service (PALS)

You could call the Patient Advice and Liaison Service (PALS) at your NHS trust if you:

  • feel unhappy with how your treatment or care is being handled,
  • You are struggling to get the right treatment, or
  • feel that the relationship between you and a professional is not working well.

They can try to sort out any problems or questions you have. You can find your local PALS’ details at www.nhs.uk/Service-Search/Patient-adviceand-liaison-services-(PALS)/LocationSearch/363.

Complaining

You can also complain if you aren’t happy. You can find out more about ‘Complaints’ by clicking here.

Advocacy

You might find an advocate helpful if you are unhappy with your treatment. You can get help from an NHS Complaints advocate.

An advocate is independent from mental health services. They can help to make your voice heard when you are trying to sort out problems. They might help you write letters or support you in appointments and meetings.

You can search online for a NHS Complaints advocate or the Rethink Mental Illness Advice Service could search for you.

You can find out more information about ‘Advocacy’ by clicking here.

Linked Problems

What problems can be linked to personality disorders?

Diagnosis

Doctors sometimes find it difficult to diagnose personality disorders. This can be because of the following.

  • An overlap with other mental health problems can make it difficult to pinpoint or ‘narrow down’ symptoms.
  • Personality disorders are complex. The symptoms may not easily fit into any one of the clusters.
  • If you use drugs or drink alcohol a lot, it can make it more difficult for health professionals to reach a correct diagnosis.
  • Some doctors are reluctant to give this diagnosis. They might feel that it may be ‘problematic’ or make it harder for you to get help.

You may feel you have been given a diagnosis of personality disorder because a professional is unsure of your diagnosis.

You may find it an unhelpful label or that it is stigmatising. But some people find that a diagnosis can help them to understand certain things they do and help with finding the right treatment and support.

Jenny's Story

I didn’t understand why I had been given the diagnosis of personality disorder. At first, it was insulting. It felt like I was being told my personality was wrong or that I was somehow ‘flawed’. Everyone has faults and traits and everyone does things wrong. However, after some encouragement from my partner, I started the therapy that was offered. Over time, I began to learn techniques and methods that slowly helped with how I was feeling.

Jenny

Services and recovery

The Department of Health says that people with personality disorders should be able to get the right care and services.

Some people aren’t always able to get the right treatment. This is because there aren’t specialist personality disorder units in every area.

If this is the case for you:

  • You should still be offered treatment for your personality disorder by mental health services, and
  • You can try to apply to get treated by a personality disorder service in another area. You can ask your GP about this.

You can find out more about ‘NHS treatment – your rights’ by clicking here.

Self-harm

Self-harm is common if you have borderline personality disorder (BPD).

People might self-harm to help manage feelings that are triggered by specific events or strong emotions. It can also act as a way of coping with distressing events and communicating the stress that they feel.

You can find out about ‘Self-harm’, by clicking here.

Use of alcohol and drugs

People with personality disorders can find that they use drugs or drink alcohol to cope with difficult emotions and feelings. This is sometimes known as dual diagnosis.

Drinking alcohol or using drugs can lead to:

  • doing things that you might not do normally,
  • behaving impulsively – this means acting on the spur of the moment, and
  • poor physical health.

Antisocial personality disorder and borderline personality disorder have the strongest links with alcohol and drugs.

Some specialist personality disorder services may have some conditions if you use drugs or drink alcohol. They may say you need to cut down or stop before you can use the service.

More Information

Information for carers, friends, and relatives

As a carer, friend, or family member of someone living with a personality disorder, you might find that you also need support. Caring for someone with a personality disorder can be challenging.

It is important to get emotional support for yourself if you are finding it hard to cope. You can contact one of the organisations in the ‘useful contacts’ section below.

You can also check whether there are any local support groups for carers, friends and relatives in your area. New education and support programmes for families are being set up in some parts of the country.

You can ask for a carer’s assessment if you feel you need more support to care for your loved one.

You should be involved with decisions about care planning. If your loved one is supported by a mental health team and you are their carer.

There are rules regarding confidentiality and carers. Unless the person you care for agrees, confidential information about them can’t be passed on to you. Professionals should ask their permission and ask what they are happy for others to know. This would also include any care plans they have.

You can find out more about:

  • Supporting someone with a mental illness by clicking here.
  • Carers’ assessments by clicking here.
  • Confidentiality – for carers, friends and relatives by clicking here.

Useful Contacts

BPD World
An organisation committed to raising awareness and reducing the stigma of mental health with a focus on borderline personality disorder (BPD). It provides online information, advice and support and has an online forum.

Website: www.bpdworld.org

Time to Change
Time to change offers a space for people to tell their own story. You can submit your own.

Website: www.time-to-change.org.uk/category/blog/borderlinepersonality-disorder

Tara (Treatment and Research Advancements) for BPD
An American education-based and support community for carers and families of people living with BPD.

Website: www.tara4bpd.org

Out of the Fog
They offer information on personality disorders and an online support forum.

Website: www.outofthefog.net/index.html

Carers4PD
It is a voluntary service dedicated to providing information, support and advocacy for carers of people diagnosed with a personality disorder.

Website: www.carers4pd.co.uk/default.html;
Yahoo chat group: www.uk.groups.yahoo.com/neo/groups/carers4pd/info
Email: info@carers4pd.co.uk

Personality Disorders UK
Information and news on personality disorders

Website: www.personalitydisorder.org.uk/

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