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

Camlet three refrubishment inside shots 056 300x199 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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  • allasse

    So there are eleven personality disorders – what is the benchmark of “normal” personality?  Some folk are selfish, some are kind, some are shy, some are nippy, some are downright dangerous, some are meticulous etc etc.  Who are those perfect humans we are supposed to compare with, and who are these doctors to make the comparison?  This is like eugenics of the personality.  Those that don’t fit certain criteria (Consumer-Robot-Wage-Slave) are passing down their foibles onto their children and must be weeded out?  Take their children off them?  Fill them with lucrative drugs?  Psychiatry is 18th century codswallop that hasn’t matured and shows no compassion.  Are shrinks then “Narcissistic Labellers and Societal Control Freaks”?

  • Blaggerr2011

    “There’s a lot of knowledge out there that is not publicized, but should be”

    Interesting! Need to know how you arrive at that?

    However, in the meantime the fact is there isn’t. Understanding of mental health is where understanding of physical medicine was 100-150 years ago. Lets not forget penicillin (first antibiotic) was only discovered about 80 years ago! Before that a simple injury could kill you!!!

    Public attitude to mental health needs to change from the Victorian fiction of Jekyll and Hyde view as had to happen with physical medicine. That is 200-300 years ago whence if people had a fever or fits etc they were perceived to be possessed by the devil/evil spirits. Indeed, when people sneezed they thought that was the devil/evil spirits being ejected from the body/soul and hence the “Bless you.”

    Look at the attitude to gay people. Some people simply cannot accept that they are biologically and/or psychologically predisposed and it is not about sexual preference/fetish.

  • Neil

    The never-ending promotion of an authoritarian psychiatric agenda just goes on, and too often unchallenged. We are human beings with different strengths and weaknesses. By diagnosing an ever wider section of the population with new-fangled labels, we evade the real social and environmental causes of so much distress. One need only have minor bodily imperfections to feel totally alienated in our image-obsessed society. Worse we seem fixated with superficial smarm skills. While a very tiny fraction of the population may have some form of brain abnormality affecting behaviour, the weight of hard scientific evidence is against genetic causes for conditions such as OCD, Bipolar, Aspergers etc… These labels are all in the eye of the beholder and  are applied to a very disparate range of behavioural traits.
    May I suggest anyone who believes mental (ill-)health labels help read “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America” by Robert Whitaker. Sure, some people seem totally destitute, but that doesn’t mean the answer lies in labelling and medicalisation.

  • Lord Egbut Nobacon

    It seems that almost everyone I meet in the profession these days goes on about personality disorder. Psychiatry doesn’t have a great track record though with labelling and accurate diagnosis. Before I worked as a psychiatric nurse I did some voluntary work in an old institution. I met people there who had been locked up for years due to ‘moral wrongdoing’, this tended to mean becoming pregnant out of wedlock, or in one case telling people that her father had tried to have sex with her.
    Schizophrenia also had no clear diagnostic criteria. People with Epilepsy resided for years in abuse regimes. Remember too that Psychiatry routinely practiced lobotomies, resulting in a generation of conservatives.
    These days it seems that personality disorder labelling is the latest ‘thing’. It seems an utter waste of time to me, as labelling a thing doesn’t make the chance of a ‘cure’ any more likely.
    Also I would caution that practioners ought to be more reflective on their own odd behaviour!

  • Blaggerr2011

    As I noted below understanding of the brain and hence the diagnosis is about 150-200 years behind physical medicine. Just watch the film Beautiful Mind starring Russel Crow or read the Wikipedia entry for the unfortunate Ms Rosemary Kennedy.

    Indeed the understanding of the brain was hampered by the lack of means to study the live brain. After all Einstein’s and others brains have been hacked, sliced and diced without any idea how to produce more such geniuses. However, the invention of the brain scanner and subsequent advances in its capabilities has led to excellent progress. Additionally, with advances in computer modeling and other such research tools becoming available has speeded up progress. All none too soon given that people are living longer and hence one needs to be able to arrest the decline of the mental capacity for the obvious reasons.

    One also needs people to have an enlightened attitude to mental health and its sufferers.

  • Nigel

    I am surprised by Anthony Bateman’s success rate although I notice that his talking treatment can take “up to two years”. Are these  NHS  patients or are his clients the comfortably off  who can afford two years therapy? I suspect the latter.
     It is a suspicion that is reinforced by his failure to mention one of the primary characteristics present in the majority of PD diagnoses – that the symptoms are masked and complicated by sustance abuse.
     This is a desperately difficult illness to treat with a very low success rate as is echoed in
    medical literature.
     I beieive this article to be misleading and that Bateman is, in fact, treating the well heeled “worried well”.

  • Mrs Lionel Messi

    I quite liked this article and the comments. I personally see little difference between talking about personality disorders and astrology signs-same difference.

  • Mrs Lionel Messi

    I like this article and the comments. I personally don’t see much difference between talking about personality disorders and peoples astrology signs. Same difference.
    Can we please get rid of the Borderline Personality one though.

  • SamiTimimi

    Personality disorders like all psychiatric diagnoses are essentially social constructs, i.e. they reflect the subjective assumptions of a group of generally White Western people given the authority (as doctors) to define what should and shouldn’t count as normal. As such these concepts are always connected the dominant beliefs needed to perpetuate the ’status quo’ such as a neo-liberal market based economic system. Thus, the political backdrop to people’s struggles and suffering (such as poverty, unemployment, violence et.) need to be relegated to background factors and instead we individualise the problems and give priority to examining the space in between their ears (although some need and benefit from this too). Once this is done diagnoses come to function like brand names that can be commodified and exploited in a variety of ways (such as for profit pharmaceuticals or therapies). I write this as a full time practicing psychiatrist who has come to realise that our diagnostic systems are ideological in nature, not scientific. I invite all those reading this to join in the ‘No More Psychiatric Labels’ campaign I have recently started in an attempt to get some pressure for change on the unscientific (like astrology as someone suggested but more harmful) and sometimes harmful practices that have become mainstream in psychiatry.
    you can see the full campaign article at: can support the campaign if you are interested at:

  • Mrs Lionel Messi

    I think, also, the best thing regarding an intelligent discussion about personality disorders, is that teenagers routinely use it to slag each other off. Well done them for undermining this ridiculous concept!

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