Pervasive, persistent and problematic
Support and Information on personality disorders, including possible causes and how you can access treatment and help.
Why am I as I am? To understand that of any person, his whole life, from birth must be reviewed. All of our experiences fuse into our personality. Everything that ever happened to us is an ingredient.Malcolm X
What is a Personality?
Before considering Personality Disorder, it is useful to think about what a personality is. There is no such thing as a ‘good’ personality, as all humans have both positive (adaptive) and negative (dysfunctional) parts to theirs. A personality is a combination of characteristics or qualities that form an individual’s distinctive character.
The Big Five
Psychological researchers often define personality in terms of five core traits, known as the ‘Big 5’. This model states that every human has elements of the five characteristics in this diagram, to a lesser or greater extent, and it is the mix of these that lead to our unique personalities.
Personality is the dynamic organisation within the individual of those psychophysical systems that determine his characteristics, behaviour and thought.Allport
What is a Personality Disorder?
Personality Disorder can be categorised by those that display characteristics which signify extreme differences for the average person in their given culture. This pattern needs to be seen in two or more of the following areas:
- cognition (thinking and views of the self, others or events)
- affect (the range intensity and appropriateness of emotional responses)
- interpersonal functioning (being able to develop mutual relationships)
- impulse control
Personality Disorders include a deeply ingrained and enduring behaviour pattern that lead to unhelpful reactions towards self and others. Usually you would be seen over a number of years, across different life situations (work, home, friendships).
Usually, someone with a Personality Disorder will either suffer from distress and social problems themselves or will cause these for others.
They are not directly resulting from disease or damage to the brain, or from another psychiatric disorder, these are called Organic Personality Disorder.
It’s not PD unless the symptoms are…
- Problematic – unusual and causing distress to self or others
- Persistent – starting in adolescence and continuing into adulthood
- Pervasive – affecting a number of different areas in the person’s life
We continue to shape our personality all our life. If we knew ourselves perfectly, we should die.Albert Camus
What are the different types of personality disorder?
The diagnostic criteria for Personality Disorder are set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in the US and in the International Statistical Classification of Diseases and Related Health Problems (ICD 10) in Europe.
There are some differences in name of diagnosis between these manuals – for example, Borderline Personality Disorder in the DSM V is the same as Emotionally Unstable Personality Disorder in the ICD 10. Also notable is that Narcissistic Personality Disorder only appears in the DSM V.
The three clusters of personality disorder include A: Odd and Eccentric, B: Dramatic and Erratic and C: Anxious and Fearful.
Click on the different types of personality disorder to learn more specific in-depth information on each of these.
Cluster A: Odd and Eccentric.
Paranoid Personality Disorder
Mistrust and suspicion of others
Schizoid Personality Disorder
Disinterest in social interactions and limited expression of emotions
Schizotypal Personality Disorder
Unusual beliefs and a pervasive feeling of being different
Cluster B: Dramatic and erratic.
Antisocial/ Dissocial Personality Disorder
Rule breaking, angry, contemptuous
Borderline/ Emotionally Unstable Personality Disorder
Emotional, impulsive, unstable relating patterns
Histrionic Personality Disorder
Excessive emotionality and attention-seeking
Narcissistic Personality Disorder
Grandiosity, lack of empathy and hypersensitivity to the evaluation of others.
Cluster C: Anxious and Fearful
Avoidant Personality Disorder
Social discomfort, fear of negative evaluation and shyness
Dependent Personality Disorder
Persistent dependant and submissive behaviour
Obsessive-Compulsive | Anankastic Personality Disorder
Indecisiveness, excessive caution, rigidity and a need to plan in immaculate detail
A useful way of considering the different Personality Disorders is using Aaron Beck’s cognitive behaviour model. This focuses on the core beliefs, view of self and others that may perpetuate personality problems:
The Chart below, taken from the Cognitive Behavioural Therapy to Personality Disorders, offers further insight into how the different Personality Disorders may manifest:
Why do people get Personality Disorder?
There are a number of different models that look at how Personality Disorder is formed. Most people identify that it is a mixture of both biological influences and early childhood social environment that can form a Personality Disorder.
Biological: This includes the natural temperament that we are born with (introvert/ extrovert; emotionally sensitive; impulsive) as well as other factors such as gender, physical health and IQ.
Psychological: A person’s attitudes, emotional coping style, expectations and beliefs about self/ others, coping skills, social skills. Likely to be heavily impacted by social environment and biology, however, once these have been developed these areas will lead to repeated unhelpful patterns of behaviour.
Social Environment: Early childhood experiences can shape attachment and coping mechanisms that are used throughout life. Abuse, neglect, invalidation and inconsistency in parenting may lead to dysfunctional management of emotions and behaviour.
Over the last few years, there has been debate as to whether the name Personality Disorder should be changed to a complex trauma reaction or complex PTSD.
This is because there is growing research that some Personality Disorders, in particular Borderline PD, have strong correlations with childhood abuse and trauma.
What therapies are available to treat Personality Disorder?
There are a number of therapies that have growing an evidence base in the treatment of Personality Disorder. These include:
Designed specifically for individuals with Emotionally Unstable PD, DBT has a focus on teaching skills to manage crisis behaviours, emotions and relationship dynamics.
Full DBT involves both individual and group sessions over approximately 18 months. It has a strong evidence base for effectiveness
Radically Open DBT
This is a fairly new therapy in the UK and looks to work with individuals who are over controlled – so it may help individuals who have Avoidant, Dependant and Obsessive-Compulsive personality traits. The skills in this therapy look at helping people to connect with their emotions and learn to express these more.
This focuses on understanding the dysfunctional patterns of thinking, feelings and behaviour that individuals have developed over their life (schemas). It focuses on both the here and now and making links to past childhood experiences. It can be used for individuals with any of the Personality Disorders above, although research has focused mainly on Emotionally Unstable, Dissocial and Narcissistic Personality Disorder.
Mentalisation Based Therapy
This therapy focuses on ‘thinking about thinking’. It helps individuals to understand their own and others mental states, and how these impacts on behaviour.
Often run in a group, treatment is recommended for 18 – 24 months. It has been found to be effective with Dissocial Personality types, as well as potentially helpful for other Personality Disorders as well.