What are Personality Disorders?
Personality disorders are a class of mental health conditions characterised by enduring maladaptive patterns of behaviour, cognition, and inner experience that deviate significantly from cultural norms. These patterns develop early, are inflexible, and are associated with significant distress or disability.
Causes of Personality Disorders
There is no single definitive cause of personality disorders. Instead, they are thought to result from a complex interaction of multiple factors:
Genetics
- There appears to be a genetic component, as personality disorders can run in families.
- Researchers have identified some possible genetic factors, like malfunctioning genes linked to traits such as aggression, anxiety and fear.
Brain chemistry and development
- Problems with neurotransmitters in the brain, particularly serotonin, may play a role.
- Brain scans have shown differences in size or activity levels in certain brain regions (amygdala, hippocampus, orbitofrontal cortex) in people with personality disorders.
Childhood experiences
- Trauma, abuse (physical, sexual, verbal), neglect, or unstable/chaotic family environments in childhood are linked to higher rates of personality disorders.
- Even verbal abuse from parents has been associated with increased risk
Environmental factors
- Unstable or unsupportive early life experiences can negatively impact personality development.
- Lack of secure attachment to caregivers in infancy/childhood
Temperament
High reactivity or sensitivity as a child may increase the risk for specific personality disorders.
Other potential factors
- Exposure to fear/distress as a child
- Having a family member with serious mental illness or substance abuse issues
The current understanding is that personality disorders likely result from a combination of genetic predisposition and environmental influences, particularly negative experiences in childhood that affect brain and personality development. However, the exact causes are still not fully understood, and more research is needed.
Symptoms of Personality Disorders
The symptoms of personality disorders can vary depending on the specific type, but there are some common signs across different personality disorders. Here are the key symptoms:
General Symptoms
- Difficulty with interpersonal relationships
- Unstable or intense emotions
- Distorted perceptions of themselves and others
- Problems with impulse control
- Difficulty adapting to stress or change
Specific Symptoms by Cluster
Cluster A (Odd or Eccentric)
- Suspicion and distrust of others
- Social withdrawal and detachment
- Odd beliefs or magical thinking
- Eccentric behaviour or appearance
- Difficulty reading social cues
Cluster B (Dramatic, Emotional, or Erratic)
- Intense fear of abandonment
- Unstable and intense relationships
- Impulsive and risky behaviors
- Rapid mood swings
- Inappropriate anger or aggression
- Chronic feelings of emptiness
- Inflated sense of self-importance
Cluster C (Anxious or Fearful)
- Extreme sensitivity to criticism
- Avoidance of social situations
- Feelings of inadequacy
- Need for excessive reassurance
- Perfectionism and preoccupation with details
- Difficulty making decisions without advice
Additional Common Symptoms
- Strange or unpredictable behaviour
- Problems at work or school
- Difficulty maintaining stable relationships
- Emotional instability
- Distorted self-image
- Lack of empathy
- Substance abuse problems
It’s important to note that individuals with personality disorders may not recognise that their behaviour is problematic. The patterns of thought and behaviour are typically long-standing and begin by late adolescence or early adulthood. A mental health professional should be consulted for proper diagnosis and treatment, as many of these symptoms can also be associated with other mental health conditions.
How are Personality Disorders Treated?
Personality disorders are primarily treated through psychotherapy, with medications sometimes used as a supplemental treatment. Here are the key points about Psychotherapy as the primary treatment approach:
Different types of psychotherapy are used, including:
- Cognitive behavioural therapy (CBT)
- Dialectical behaviour therapy (DBT)
- Psychodynamic psychotherapy
- Schema-focused therapy
- Mentalisation-based therapy (MBT)
- Systems Training for Emotional Predictability and Problem-Solving (STEPPS)
Goals of Psychotherapy
- Helping patients understand their thoughts, motivations, and feelings.
- Teaching skills to manage emotions and improve relationships
- Reducing impulsive behaviours.
- Changing dysfunctional beliefs and thought patterns.
Medications
- There are no FDA-approved medications specifically for treating personality disorders.
- Medications may be used to treat specific symptoms or co-occurring conditions like depression, anxiety, or mood instability.
- Common medications include antidepressants, anti-anxiety medications, mood stabilisers, and, in some cases, antipsychotics.
Treatment approach
- It often involves a combination of individual therapy, group therapy, and family education.
- It may require a team approach involving various healthcare professionals.
- Long-term treatment is typically necessary, as personality disorders are enduring patterns of behaviour.
Additional strategies
- Self-care and coping techniques (e.g., journaling, relaxation techniques)
- Support groups
- Psychoeducation for patients and family members
Hospitalisation may be necessary in severe cases or during crises, especially if there’s a risk of self-harm or suicide.
It’s important to note that treatment can be challenging and takes time, but many people see significant improvement with appropriate care. The specific treatment approach may vary depending on the type of personality disorder and individual circumstances.
Dr Clem Bonney & Personality Disorders
Personality disorders can be complex problems that require engagement with both the worker and the employer. Dr Clem Bonney can assist with this engagement, identifying processes to assist the worker to remains engaged.
