Personality disorders and how we can help

What are personality disorders?

Our personality is the characteristic set of thoughts, feelings and behaviours that make us who we are. It guides us to make the decisions that we make and impacts all interactions that we have with others. Personality disorders describe conditions where the aforementioned elements of our personality cause us persistent difficulties in our lives. They represent significant deviations from the way in which a typical individual thinks/feels/behaves in certain situations - particularly in relation to others.

We all have aspects of our personality that can prevent us from, at times, being the people we want to be. Those with personality disorders are not fundamentally different to anyone else, but can sometimes need additional help.

Symptoms

There are many different classifications of personality disorder and the symptoms will vary depending on the specific disorder. Detailed information on symptoms can be found on pages 7 - 13 of this guide put together by Mind.

Borderline Personality Disorder (BPD), also known as Emotionally Unstable Personality Disorder (EUPD), is the most common presentation of a personality disorder and can be characterised by the following symptoms:

Fear of abandonment:Severe fears of abandonment or being left alone. A loved one going away for the weekend or coming home late can cause high levels of anxiety and one may take steps to stop them from leaving as much as possible.

Self-destructive behaviour and self-harm:BPD is characterised by an increase in risk-taking behaviour. This can include engaging in dangerous situations, particularly when upset, such as reckless driving, binge eating, excessive consumption of alcohol and/or drugs and unsafe sex. Self-harm behaviours or suicidal ideation are also not uncommon.

Extreme mood swings:Rapid cycling between emotional states is common, often due to reasons that others find perplexing. These mood swings are intense but are usually short, passing after hours or even minutes.

Unstable relationships:Relationships with others can be intense or short-lived and can be difficult to maintain - they can seem either perfect or terrible and nowhere in between.

Lack of identity:For individuals diagnosed with BPD, it can be difficult to identify a strong sense of self at times. It is not uncommon to switch jobs, friendship groups, values or even religion and sexual identity.

Paranoia and suspicion:Feeling on edge and suspicious about the motives of others. When stressed this can also lead to feeling disconnected from yourself and the world around you, known as disassociation.

Treatment

Treatment for personality disorders usually involves some form of talking therapy. Given the variations in personality disorder, there is no one set model that is applied, it is down to the individual and therapist. Generally speaking, talking therapy can help improve our understanding of our own thoughts, feelings and behaviour.

Depending on the severity of the condition, talking therapy may be recommended for a substantial amount of time, perhaps even indefinitely. Therapeutic communities, a type of intensive group therapy where a person’s condition is discussed in depth, have also proved to be effective for mild to moderate personality disorders.

DBT

Dialectical behavioural therapy (DBT) is a common therapeutic treatment for personality disorders. DBT is based on the assumption that two main factors have contributed to a person’s personality disorder:

1. You are emotionally vulnerable, that is to say you have strong emotional reactions to low levels of stress, for example.
2. You were raised in an environment where your emotions were dismissed or discouraged, perhaps being regularly told to ‘stop being silly’ when getting upset about something.

These factors create a vicious cycle in which you feel bad, wrong or weak for experiencing upsetting emotions. DBT aims to break that cycle by focussing on two concepts:

1. Validation: Accepting that your emotions are valid, real and acceptable.
2. Dialectics: Things in life are rarely black and white and it’s good to be open to ideas that challenge your own.

DBT essentially attempts to open you up to a new way of seeing the world which can mean you don’t feel the need to resort to destructive behaviour. DBT usually involves regular group and individual sessions.

MBT

Mentalisation-based therapy (MBT) is another therapeutic option for the treatment of personality disorders. Mentalisation, put most simply, can be described as ‘thinking about thinking’. Sessions help you think about what is going on in your mind, and in the minds of others, particularly in situations that can evoke problematic behaviour.

Working on understanding your own thoughts and feelings, as well as those of others, can help you control certain impulses, emotions and behaviours.

Medication

Medication may be prescribed to treat some of the associated problems of personality disorders such as anxiety, depression or psychosis, however medication alone is not recommended as a treatment of a personality disorder.

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