When I worked in the National Health Service in the UK as a highly specialised psychologist, part of my work was in a unit working with people with personality disorders. When I returned to Ireland, such specialised services either did not exist or were in their infancy, but that has changed in the intervening years, with more highly specialised training, such as Dialectical Behavioural Therapy, being employed. I wrote this article to give a broad overview of personality disorders and to outline what help is available. From my experience working as a psychologist with people with personality disorders, I strongly urge you to work with multidisciplinary teams (MDT) as opposed to seeking therapy from one individual. A MDT team will give you the support you need from properly qualified mental health professionals that are trained and have experience in treating personality disorders.
Understanding personality disorders is crucial, not just for those who may have one, but also for friends, family, and society as a whole. With the right support, people living with personality disorders can improve their lives and relationships. This guide will help you better understand personality disorders, how they are diagnosed, and the treatments available. It also offers practical advice for seeking help in Ireland and the UK.
What Are Personality Disorders?
Personality disorders are a group of mental health conditions that affect how you think, feel, and behave. If you have a personality disorder you will more than likely have;
- Difficulty relating to others
- Trouble managing emotions and behaviour; when I worked in personality disorders using dialectical behavioural therapy (DBT), the skills teaching part of the model was entitled managing your emotions, as they can be intense.
- Distorted thinking patterns
There are different types of personality disorders and I think it worth spending some time outlining them below, as most people tend to think of ‘borderline’ when there are many more types. They are grouped into three clusters as follows.
Cluster A: Odd or Eccentric Behaviour
- Paranoid Personality Disorder: Characterised by distrust and suspicion of others, even without evidence.
- Schizoid Personality Disorder: People with this disorder tend to avoid social activities and prefer to be alone.
- Schizotypal Personality Disorder: Involves eccentric behaviour and unusual thinking, often resembling mild schizophrenia.
Cluster B: Dramatic, Emotional, or Erratic Behaviour
- Borderline Personality Disorder (BPD): Intense emotions, fear of abandonment, and unstable relationships. People with BPD may experience rapid mood changes and impulsive behaviour.
- Narcissistic Personality Disorder: An inflated sense of self-importance and a deep need for admiration. Those with this disorder often lack empathy.
- Antisocial Personality Disorder: Disregard for others’ rights, often leading to criminal behaviour or manipulation.
- Histrionic Personality Disorder: Excessive emotionality and attention-seeking behaviour.
Cluster C: Anxious and Fearful Behaviour
- Avoidant Personality Disorder: Extreme shyness, feelings of inadequacy, and sensitivity to rejection.
- Dependent Personality Disorder: A need to be taken care of, leading to clingy or submissive behaviour.
- Obsessive-Compulsive Personality Disorder (OCPD): Preoccupation with orderliness, perfectionism, and control, often at the expense of flexibility and openness.
How Are Personality Disorders Diagnosed?
Getting a diagnosis involves a series of tests which simply means you will receive different tests to help the clinician come to the correct diagnosis. This is a highly specialised task to carry out these assessments which is why I recommended at the start of this article that you get referred into a MDT Team where there are people with the correct level of expertise to carry out these assessments. The level of expertise that you get from the HSE or NHS, not only helps you understand what has been happening to you, but is necessary to decide the best course of treatment.
Personality disorders are typically diagnosed using criteria outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-11 (International Classification of Diseases). The key element is that the patterns of behaviour are persistent, inflexible, and cause significant distress or problems in functioning.
A psychologist or psychiatrist will usually assess the individual through a series of interviews and standardised questionnaires. The process also includes taking a detailed history to rule out other potential causes, such as medical conditions or substance abuse.
Living with a Personality Disorder
Living with a personality disorder can feel overwhelming. People may find it difficult to trust others, manage emotions, or keep jobs due to their condition. For instance, someone with Narcissistic Personality Disorder might struggle with maintaining friendships because of their self-centred behaviour, while an individual with Avoidant Personality Disorder may feel so anxious in social situations that they avoid them altogether.
Case Example
Sarah, a young woman living in Belfast, has Avoidant Personality Disorder. She finds it nearly impossible to attend social events without fearing rejection. This fear keeps her isolated, which only worsens her self-esteem. Therapy has helped her understand the root of her fears and gradually rebuild her confidence.
Unfortunately, many people with personality disorders face stigma. Misunderstandings about these conditions can lead to isolation or even discrimination. It’s important for society to foster greater empathy and awareness to break down these barriers.
Treatment Options for Personality Disorders
Treatment can significantly improve the quality of life for people with personality disorders. The most common forms of treatment include psychotherapy and, in some cases, medication.
- Cognitive Behavioural Therapy (CBT): CBT helps individuals challenge and change unhelpful thought patterns and behaviours. It’s effective for many personality disorders, especially those in Cluster C, such as Avoidant Personality Disorder.
- Dialectical Behaviour Therapy (DBT): DBT is particularly helpful for Borderline Personality Disorder, focusing on managing emotions and building healthy relationships.
- Schema Therapy: Schema therapy explores deeply ingrained patterns that may stem from early life experiences. It’s often used for more complex cases, such as Narcissistic Personality Disorder.
- Mentalisation-Based Therapy (MBT): MBT helps individuals understand their own and others’ emotions, and is commonly used for people with Cluster B disorders, such as BPD.
Medications
In some cases, medications like antidepressants or mood stabilisers may be used to manage symptoms, particularly if the person is also dealing with anxiety or depression.
Seeking Help: How to Get Support for Personality Disorders
Who to Contact
If you or someone you know may have a personality disorder, it’s important to reach out to professionals who specialise in these conditions. In Ireland and the UK, psychologists, psychiatrists, and counsellors can provide support.
Choosing the Right Therapist
When selecting a therapist, look for someone experienced in treating personality disorders. Therapists trained in DBT, MBT, or schema therapy are often well-equipped to help. In Ireland, organisations like Psychological Society of Ireland (PSI) and Aware can help you find accredited professionals.
The Role of Support Networks
Family, friends, and support groups play a crucial role in the recovery process. Encouraging someone with a personality disorder to seek treatment and offering ongoing support can make a huge difference.
Resources and Further Reading
- Aware: Provides mental health support services across Ireland (aware.ie).
- Jigsaw: A mental health service for young people in Ireland (jigsaw.ie).
- Samaritans: A 24/7 helpline for those in distress, available across the UK and Ireland (samaritans.org).
Conclusion
Personality disorders can be challenging, both for those who have them and for those around them. However, with proper treatment and support, it’s possible to manage symptoms and live a fulfilling life. If you suspect you or a loved one may have a personality disorder, reaching out for professional help is the first step toward a better future.
Breaking the stigma surrounding personality disorders is essential to ensure that everyone feels empowered to seek help when they need it.