Personality Disorders

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Author: Canadian Mental Health Association, BC Division

 

Each of us has a unique personality that that is reflective of both our genetic make-up and our life experiences. Our personality develops over the years, and is a vital part of what makes us who we are and how we interact with others.

Personality disorders involve patterns of behaviour, mood, social interaction, and impulsiveness that cause distress to one experiencing them, as well as to other people in their lives.

Many of these behaviours may cause severe disturbance in the individual’s personal and work life. In general, individuals with personality disorders have difficulty with close, intimate or attachment relationships. They experience chronic interpersonal problems, have difficulties in establishing a coherent sense of self or identity, and may be seen to be impulsive, irritable, fearful, demanding, hostile, manipulative, even violent.

Problem alcohol or drug use, mood disorders, certain anxiety or eating disorders, suicidal thoughts or attempts, and sexual problems often accompany personality disorders.

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Symptoms

The symptoms of personality disorders are varied and depend on the type of disorder the individual is experiencing. Since many of the symptoms are common across various personality disorders, an individual may exhibit signs of more than one personality disorder.

There are three personality disorders that describe people with social avoidance or low sociability issues. These are:

  • Paranoid Personality Disorder, which is a tendency to mistrust others and to suspect that their motives are hurtful

  • Schizoid Personality Disorder, which a tendency to not be able to relate to other people and to have a restricted range of emotional expression

  • Schizotypal Personality Disorder, which is a tendency to feel very uncomfortable in close relationships, and to have odd or distorted thoughts or perceptions

There are another four types of personality disordersat that describe those who appear to be highly emotional and dramatic in social situations, and react to feelings with impulsive or spur-of-the-moment behaviour. These include:

  • Antisocial Personality Disorder, which is seen when one persistently ignores and violates the rights of others

  • Borderline Personality Disorder, which is a tendency to have unstable relationships, intense mood changes, rapidly shifting self-image, high levels of anxiety, including chronic worrying and intense panic, and noticeably impulsive behaviour

  • Histrionic Personality Disorder, which is a tendency to be highly emotional in social situations

  • Narcissistic Personality Disorder, with its pattern of feeling overly important, needing admiration from others and having a lack of empathy

Additionally, there are three other personality disorders that describe people who seem very cautious and fearful:

  • Avoidant Personality Disorder, which includes extreme shyness, feeling inadequate or ‘not good enough', and being very sensitive to criticism

  • Dependent Personality Disorder, which involves a tendency of needing to be led in making decisions, clinging to others and having an extreme need to be taken care of

  • Obsessive-Compulsive Personality Disorder, which is a pattern of constantly needing things to be orderly and of wanting to be in control

It is important to remember that all of us may experience some of the characteristics of personality disorders from time to time in our lives in varying degrees. But an actual personality disorder is defined by the extremes of several traits and by the rather inflexible way these traits are expressed, as well as their influence on our activities and relationships of day-to-day life.

Symptoms of personality disorders are usually first displayed in childhood or adolescence and usually go on for a long time. However, this depends to some extent, on the type of personality disorder and the situation or events surrounding the individual. Borderline personality disorder, for example, usually peaks in adolescence and early adulthood, and may become less prominent by mid-adulthood in some individuals, or not. On the other hand, narcissistic personality disorder may not be identified until middle age.

Personality disorders also have a major effect on the people who are close to the individual experiencing them. The individual’s fixed ideas and patterns of behaviour make it difficult for them to adjust to various situations. As a result, other people adjust to them. This creates a major strain on all relationships among family and close friends, and in the workplace. At the same time, when other people do not adjust, the individual with the personality disorder can become angry, frustrated, depressed or withdrawn. This establishes a vicious cycle of interaction, causing the individuals to persist with their stressful behaviour until their needs are met.

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Causes

The symptoms of personality disorders are usually caused by a variety of factors, including early life experience and learned behaviours, social environment, biological make up and genetics. Individuals with personality disorders may have impaired regulation of the brain circuits that control emotion. This biological finding, when combined with psychological and social factors such as abuse, neglect or separation, may put a person at a higher risk of developing a personality disorder.

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Treatments

Although personality disorders are difficult to treat, there is evidence to suggest that a number of treatments are helpful in reducing distress and symptoms, and improving quality of life.

Intensive individual or group psychotherapy, combined with antidepressants, can be quite effective for some people. Difficulties may arise, however, from the persistence of symptoms and the negative impact of these symptoms on the therapeutic relationship. For example, those with the disorder, by definition, will have problems relating to others whether they will admit this or not, and these others include professionals treating them. As a result of their symptoms, such a person may be seen to be a difficult patient.

Additionally, treatment can be time-consuming, involving a real investment of time for both, the patient and the professional. Sometimes this is seen to be very unrewarding and can lead to termination of the treatment. Finally, there are very few public funded services for personality disorders and not many experts specializing in their treatment in British Columbia.

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Resources

You can contact your local mental health centre, an employee assistance counsellor if one is available through your workplace, a family physician who may refer you to a psychiatrist, or a registered psychologist or clinical counsellor. For further information on registered mental health professionals, you can contact:

 

Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.

 

 
About the author

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The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

 
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