Personality disorders are a group of disorders where a person’s ways of thinking, behaving and feeling interpersonally is rigid, inflexible and unhealthy. The person has difficulty in accurately perceiving other people and relating to them effectively as well as managing their thoughts, feelings and behavior. Personality disorders are chronic conditions and show up early in a person’s life, usually adolescence. The pattern of inflexible and rigid behaviours needs to be observed for long periods across time and situations, therefore personality disorders are not diagnosed in childhood. Personality disorders are hard to treat and require longer term psychotherapy.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizes personality disorders into 3 clusters based on some similarities, however there are a lot of important differences between each. These include:
Cluster A: paranoid, schizoid and schizotypal personality disorders. The common features of these disorder is feelings of paranoia and mistrust; odd eccentric ways of thinking and feeling; social awkwardness and social withdrawal.
Cluster B: borderline, narcissistic, histrionic and antisocial personality disorders. These are characterized by dramatic, overly emotional or unpredictable thinking or behavior interpersonally.
Cluster C: obsessive-compulsive, dependent and avoidant personality disorder. These are characterized by experiencing compulsions and anxiety.
The current system continues to have controversy and often clinicians, like those in our clinic, see personality disorders as dimensional as opposed to categorical. This means that people can demonstrate traits or characteristics of one or more of personality disorders that causes them problems in their life and can lead to anxiety and depression.
Borderline Personality Disorder
The most common and perhaps most discussed and studied is Borderline Personality Disorder (BPD). In fact, this personality disorder has quite diverse presentations and can look very different in different people. Borderline Personality Disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image and emotions, as well as impulsivity.
The following symptoms can be a sign of BPD although usually someone shows some not all of these:
- Frantic efforts to avoid real or imagined abandonment
- Suicidal threats or behavior and self-harm such as cutting, hitting oneself, burning oneself, often triggered by interpersonal situations such as someone leaving
- Difficulty with emotion regulation and sensitivity to many situations
- Chronic feelings of emptiness
- Unstable and intense relationships such as idealizing someone one moment and suddenly perceiving the person as cruel and uncaring
- Rapid changes in self-identity and self-image such has shifting goals and values, or seeing yourself as bad or non-existent
- Impulsivity and risky behaviours such has gambling, unsafe sex, spending sprees, binge eating or drug abuse
- Intense and inappropriate levels of anger that lead to conflict
- Mood swings that last from a few hours to days and include intense feelings of happiness in one moment and anger or irritability in another
Often a person with borderline personality disorder will engage in problematic behaviours such has excessively calling someone they think is going to leave them or anger that goes out of control and then later feel shame about these behaviours. Even though part of them knows this is not productive, they cannot help it in the moment and the shame grows.
Like most personality disorders, borderline personality disorder is hard to treat and requires a longer commitment from a client to psychotherapy. One very effective approach in the treatment of BPD is Dialectical Behaviour Therapy.