Personality disorders: One of the most controversial & misunderstood areas of mental health

Ask the average person what they associate with personality disorders and you get a blank stare or description of a human chameleon capable of changing from normality to social menace in the blink of an eye.

In reality, the majority of people with a personality disorder are a greater danger to themselves than others, with high rates of self-harm and attempted suicide as a way of managing often turbulent emotions.

Most of us recognise our moods and feelings and manage them until they pass, while many people with personality disorders have a tendency to get stuck in these emotional states which increase in intensity, resulting in behaviour that many of us find unusual.

These limiting patterns of behaviour and response become engrained like a scratched record, producing great feelings of anxiety and frustration.

Sadly, public perception of the condition is largely media driven with a succession of sensationalist headlines, films and books. These inevitably focus on people with antisocial personality or psychopathic conditions which are among eleven recognised disorders.

There is no doubt that those with severe psychopathic traits are dangerous and prone to criminal activity. This is  through characteristics that include impulsive self centred behaviour that puts their own needs above others. However, they are in a minority and their impact on society is greatly exaggerated and dramatised in all but the most extreme cases.

It is somewhat ironic that that the media’s highly manipulative and attention grabbing behaviour itself shows the collective symptoms of a personality disorder. They involve showing signs of extreme behaviours that we all share, which is why we can recognise and identify many of the traits in ourselves – albeit at a less amplified level.

An interesting illustration of this was a study by psychotherapists in 2005 that matched the personalities of top British executives with psychiatric patients at Broadmoor Hospital. The results found the two groups had more in common than first expected. This included Histrionic Personality Disorder, whose characteristics include superficial charm and ego-centricity, Narcissistic Personality Disorder, which includes grandiosity and self focused lack of empathy, and Obsessive Compulsive Disorder, reflecting excessive devotion to work, dictatorial tendencies and perfectionism.

Of course, this should be taken with a pinch of salt. There are people who can function with personality disorders but they are rare, and the severity of their condition questionable.

In reality, diagnosed disorder types have difficulty forming or maintaining relationships, meaning many are isolated by unemployment and have associated conditions such as depression and anxiety.

So how common are personality disorders? A sensible bench mark is around 1% of the population, with some of these conditions being more common than others, such as Obsessive Compulsive Personality disorder. These individuals become fixated on orderliness, cleanliness and being in control, while those with borderline personality disorder have a poor self image and often experience feelings of emptiness, depression and paranoia. Although I’d be the first to admit that diagnosis isn’t straightforward as the disorders often share overlapping symptoms.

There has been much debate about the stigmatisation of labelling people with conditions, but I have found patients and families often find relief in finding something tangible to get to grips with.

Seeing more than 30 patients a week in one-to-one and group sessions, I primarily use one of several ‘talking therapies’ I co-developed called Mentalisation. This teaches patients to become more aware of their own thinking and learn to rationalise, manage and understand their mental states and emotions, as well as those of others. Therapy can take up to two years and the good news is that the majority of patients make a significant or full recovery through a combination of talking therapy treatments like ‘Mentalisation’ and ‘Improvement with Age’.

Two of the biggest challenges our profession currently face are:

Firstly, discovering an effective way of measuring the severity of personality disorders so we can plan the duration and intensity of treatment and its likely long-term impact on mental health services.

Secondly, we have to treat people with these disorders as a matter of course and that calls for greater education and awareness both in and outside the health service.

There are still incidences where an as yet undiagnosed patient may turn up at a GP surgery or reception areas of some NHS facility and be told to leave the premises because they are being difficult or aggressive. Staff probably don’t recognise the possibility of an underlying problem and that is something that needs to be more widely addressed so patients can be quickly and effectively signposted to the right service.

Greater public awareness and compassion are powerful tools that can be used to give both ourselves and those being treated a greater insight into personality disorders.

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