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Personality disorders

Explains personality disorders, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

Your stories

Katie's experience of inpatient care

Katie talks about borderline personality disorder and about her experience of inpatient care in her blog post.

Katie Evans
Posted on 04/12/2013

"What are you like when you're well?"

Louise talks about how her response when she was asked this question.

Posted on 27/04/2015

What are the different types of personality disorder?

Personality disorder can show itself in different ways. Psychiatrists in the UK tend to use an American system of diagnosis which identifies 10 different types of personality disorder. These types can be grouped into three categories:

Suspicious  Emotional and  impulsive Anxious
paranoid   borderline  avoidant
schizoid   histrionic  dependent
schizotypal   narcissistic  obsessive  compulsive
antisocial    

One person may meet the criteria for several different types of personality disorder, while a wide range of people may fit the criteria for the same disorder, despite having very different personalities.

Paranoid personality disorder

You are likely to:
• find it very difficult to trust other people, believing they will use you, or take advantage of you
• find it hard to confide in people, even your friends
• watch others closely, looking for signs of betrayal or hostility
• suspect that your partner is being unfaithful, with no evidence
• read threats and danger – which others don’t see – into everyday situations.

Schizoid personality disorder

You are likely to:
• be uninterested in forming close relationships with other people including your family
• feel that relationships interfere with your freedom and tend to cause problems
• prefer to be alone with your own thoughts
• choose to live your life without interference from others
• get little pleasure from life
• have little interest in sex or intimacy
• be emotionally cold towards others.

Schizotypal personality disorder

You are likely to:
• find making close relationships extremely difficult
• think and express yourself in ways that others find ‘odd’, using unusual words or phrases
• behave in ways that others find eccentric
• believe that you can read minds or that you have special powers such as a ‘sixth sense’
• feel anxious and tense with others who do not share these beliefs
• feel very anxious and paranoid in social situations.

Antisocial personality disorder (ASPD)

You are likely to:
• act impulsively and recklessly, often without considering the consequences for yourself or for other people
• behave dangerously and sometimes illegally
• behave in ways that are unpleasant for others
• do things – even though they may hurt people – to get what you want, putting your needs above theirs
• feel no sense of guilt if you have mistreated others
• be irritable and aggressive and get into fights easily
• be very easily bored and you may find it difficult to hold down a job for long
• believe that only the strongest survive and that you must do whatever it takes to lead a successful life, because if you don’t grab opportunities, others will
• have a criminal record
• have had a diagnosis of conduct disorder before the age of 15.

You will be at least 18 years old.

This diagnosis includes ‘psychopathy’. This term is no longer used in the Mental Health Act, but a ‘psychopathy checklist’ questionnaire may be used in your assessment.

Borderline personality disorder (BPD)

You are likely to:
• feel that you don’t have a strong sense of who you really are, and others may describe you as very changeable
• suffer from mood swings, switching from one intense emotion to another very quickly, often with angry outbursts
• have brief psychotic episodes, hearing voices or seeing things that others don’t
• do things on impulse, which you later regret
• have episodes of harming yourself, and think about taking your own life
• have a history of stormy or broken relationships
• have a tendency to cling on to very damaging relationships, because you are terrified of being alone.

The term ‘borderline’ is difficult to make sense of, and some people prefer the term ‘emotionally unstable personality disorder’ or ‘emotional instability disorder’, which is sometimes used in place of ‘borderline personality disorder’. (Also see our information about borderline personality disorder.)

Histrionic personality disorder

You are likely to:
• feel very uncomfortable if you are not the centre of attention
• feel much more at ease as the ‘life and soul of the party’
• feel that you have to entertain people
• flirt or behave provocatively to ensure that you remain the centre of attention
• get a reputation for being dramatic and overemotional
• feel dependent on the approval of others
• be easily influenced by others.

Narcissistic personality disorder

You are likely to:
• believe that there are special reasons that make you different, better or more deserving than others
• have fragile self-esteem, so that you rely on others to recognise your worth and your needs
• feel upset if others ignore you and don’t give you what you feel you deserve
• resent other people’s successes
• put your own needs above other people’s, and demand they do too
• be seen as selfish and ‘above yourself’
• take advantage of other people.

Avoidant (or anxious) personality disorder

You are likely to:
• avoid work or social activities that mean you must be with others
• expect disapproval and criticism and be very sensitive to it
• worry constantly about being ‘found out’ and rejected
• worry about being ridiculed or shamed by others
• avoid relationships, friendships and intimacy because you fear rejection
• feel lonely and isolated, and inferior to others
• be reluctant to try new activities in case you embarrass yourself.

Dependent personality disorder

You are likely to:
• feel needy, weak and unable to make decisions or function properly without help or support
• allow others to assume responsibility for many areas of your life
• agree to things you feel are wrong or you dislike to avoid being alone or losing someone's support
• be afraid of being left to fend for yourself
• have low self-confidence
• see other people as being much more capable than you are
• be seen by others as much too submissive and passive.

Obsessive-compulsive personality disorder (OCPD)

You are likely to:
• need to keep everything in order and under control
• set unrealistically high standards for yourself and others
• think yours is the best way of making things happen
• worry when you or others might make mistakes
• expect catastrophes if things aren’t perfect
• be reluctant to spend money on yourself or others
• have a tendency to hang on to items with no obvious value.

OCPD is separate from obsessive compulsive disorder (OCD), which describes a form of behaviour rather than a type of personality. (See our information about obsessive-compulsive disorder.)

Why is the diagnosis controversial?

Although the system of diagnosis in this booklet is the one generally used in this country, some psychiatrists disagree with its use, and many people who are given the diagnosis find it stigmatising and unhelpful.

The classification is not accepted by some specialists

Some psychiatrists believe that the standard categories are unhelpful, because:
• there is no scientific evidence for them
• most people who are diagnosed with a personality disorder do not fit any one category
• the categories are based on how people behave when they are in hospital, not in the community – where most people live
• they do not help with deciding what treatment is appropriate for someone
• the focus should be on what each individual needs in order to deal with their problems and live in society more successfully, not what category they are in.

I'm keen on the alternative approach, currently being advocated by the British Psychological Society, that it is more appropriate and useful to ask 'What has happened to you?' rather than 'What symptoms do you have?'

You can feel labelled and insulted

Diagnoses of mental health problems feel personal in a way that physical health problems don’t. And no diagnosis feels more personal than that of a personality disorder. 

Clare Allan, The Guardian

 

The term ‘personality disorder’ can sound very judgemental. Your personality is the core of your self, and to be told it is ‘disordered’ can be very upsetting and undermining. Many of the diagnostic labels used, e.g. ‘dependent’ and ‘inadequate’, can stigmatise, insult and hurt people.

I hate the term 'personality disorder'. It assumes that the very core of who you is disordered because it doesn't fit into what someone else has decided is the norm… Almost anyone can fit the criteria for each personality disorder, but that doesn't mean they are ill.

It can be mistakenly diagnosed

Survivors of domestic violence or child abuse have sometimes been mistakenly diagnosed with a personality disorder. This is because they have developed persistent and wide-ranging post-traumatic symptoms, which have been misread as part of their basic personality. If you feel that your diagnosis is incorrect, you can ask to be referred for a second opinion.

It is sometimes associated with crime

At least half of criminals have a diagnosis of personality disorder, with a high proportion of those having antisocial personality disorder (ASPD). This is explained by the fact that criminal behaviour is one of the criteria for the diagnosis of ASPD.   People who have a diagnosis of a personality disorder and are also considered to pose a serious risk of harm to others, or have committed a violent crime, may be described as having ‘dangerous and severe personality disorder’. This is not a clinical diagnosis, but a term introduced by a government consultation paper in 1999. It usually applies to people diagnosed with ASPD who are considered to pose a risk to others. Such people were identified as needing to be detained for treatment under the Mental Health Act 1983 (as amended in 2007).


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