Unravelling the Intricacies of Personality Disorders: A Guide for the Non-professional Audience

Understanding personality disorders, their symptoms, implications, and the various approaches to managing them can often feel like navigating a labyrinth. This article aims to provide an in-depth view of personality disorders, answering several pertinent questions that may arise when dealing with this often misunderstood facet of mental health.

 

Personality Disorders in DSM-5: Prevalence and Types

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are ten specific personality disorders grouped into three clusters based on similarity of symptoms. These include:

Cluster A (odd, eccentric): Paranoid, schizoid, and schizotypal personality disorders.

Cluster B (dramatic, emotional, or erratic): Antisocial, borderline, histrionic, and narcissistic personality disorders.

Cluster C (anxious or fearful): Avoidant, dependent, and obsessive-compulsive personality disorders (American Psychiatric Association, 2013; Bender, Morey and Skodol, 2011).

The prevalence of personality disorders in the general population varies. However, data suggest that about 9.1% of adults in the US have at least one personality disorder (Lenzenweger, 2008). British estimates are comparable (Coid et al., 2006).

Development of personality Disorders

Personality disorders develop from an interplay of genetic, environmental, and social factors. Research suggests that inherited genetic traits contribute significantly to personality disorders, particularly through temperamental characteristics (Cohen, 2008). These traits, along with environmental influences such as early life experiences and parenting, may lead to the development of dysfunctional personality traits and subsequently, personality disorders (Johnson et al., 2006). Negative childhood experiences like abuse or neglect are often prevalent in the histories of those with personality disorders (McLean and Gallop, 2014), indicating a strong influence of these factors.

Additionally, some theorists argue that the interaction between an individual's temperament and their interpersonal environment, particularly during developmental stages, can have a substantial impact on the formation of personality disorders (Nigg and Silk, 2005). Personality disorders can often be observed to be patterns of behavior that were initially survival responses to difficult environments but became maladaptive over time.

Lastly, psychological factors can play a role in the development of personality disorders. According to cognitive theories, for instance, distorted thinking and dysfunctional beliefs can contribute to the development and persistence of personality disorders (Beck et al., 2004). Overall, the development of personality disorders is complex and likely to result from a combination of various factors.

Characteristic Symptoms and Warning Signs

Signs and symptoms of personality disorders vary widely depending on the specific disorder, but there are common indicators, including rigid and unhealthy patterns of thinking, functioning, and behaving, persistent difficulties with self and interpersonal functioning, and pathological personality traits (Beck, Freeman and Davis, 2004). Sudden changes in mood, difficulty in managing emotions, impulsivity, and problems with relationships are common features. These disorders often co-occur with other mental health disorders, such as depression, anxiety, or substance use disorders (Newton-Howes, Tyrer and Johnson, 2006).

Episodes of mania, hypomania, psychosis, and delusions can occur in certain personality disorders, particularly those in Cluster A and B, often triggered by stressors or significant life changes (Paris, 2004; Gunderson, 2011). However, it's important to remember that not all personality disorders feature these episodes, and their presence should always be evaluated by a mental health professional.

 

Early Signs, Ages of Onset, and Parental Guidance

Personality disorders typically begin in adolescence or early adulthood, but some signs might be visible during childhood (Cohen, 2008). Parents should look out for persistent patterns of behaviour that differ from societal expectations and cause significant distress or impairment. Early intervention is key to effective management (Johnson et al., 2006).

It can be challenging to differentiate between personality disorders and someone's natural personality. The distinction lies in the degree of distress or dysfunction that these traits cause and their persistence over time. A key identifier is that people with personality disorders often have a rigid pattern of behaviour that deviates from cultural expectations and is inflexible across a range of personal and social situations (Paris, 2015).

 

Management and Treatment of Personality Disorders

Treatment typically involves a combination of psychotherapy (individual, group, or family therapy), medications, and lifestyle changes (Soeteman, Verheul and Busschbach, 2008). Cognitive-behavioral therapy (CBT) is commonly used, focusing on changing thought patterns that lead to harmful behaviors (Beck, Freeman and Davis, 2004). Some cases might benefit from dialectical behavior therapy (DBT), schema-focused therapy, or mentalization-based therapy (Young, Klosko and Weishaar, 2003). Medications aren't specifically designed for personality disorders but can help manage co-occurring conditions or specific symptoms (Lieb et al., 2010).

 

Personality Disorders and Relationships

People with personality disorders can find romantic relationships challenging, often struggling with fear of abandonment, impulsivity, mood swings, or difficulty trusting others (Bouchard and Sabourin, 2009). Their perception of relationships can be coloured by their personality disorder. Friendships can be similarly impacted. However, understanding, patience, and appropriate boundaries can go a long way in building and maintaining relationships with those affected (Nigg and Silk, 2005).

 

Conduct Disorder, Antisocial Personality Disorder, and Risks

Conduct disorder is a childhood disorder characterised by aggressive, destructive, deceitful behaviour, often seen as a precursor to antisocial personality disorder (Burke, Waldman and Lahey, 2010). Antisocial personality disorder involves a long-term pattern of manipulating, exploiting, or violating the rights of others, without remorse (American Psychiatric Association, 2013).

People with personality disorders are at increased risk of self-harm, suicide, and substance abuse. They're also more likely to experience social and occupational difficulties, legal problems, and incarceration (Goodman et al., 2012).

 

Understanding and Reducing Stigma

Persons with personality disorders are often stigmatised as 'toxic' or labelled as 'depressed'. Reducing this stigma requires education, empathy, and understanding. It's crucial to remember that they are not their disorder — they're individuals dealing with a challenging mental health condition (Aviram, Brodsky and Stanley, 2006).

 

Parenting Teenagers with Personality Disorders

Parents of teenagers with personality disorders should seek professional help, establish a structured, predictable environment, and learn effective communication strategies. It's also crucial to take care of their own mental health (Gunderson, Berkowitz and Ruiz-Sancho, 1997).

 

Recovery from Personality Disorders

While personality disorders are enduring, recovery is possible. It's a long-term process and usually involves learning healthier coping mechanisms, improving relationships, and managing symptoms (Livesley, 2005). The process can be challenging, but with appropriate treatment and support, individuals can lead fulfilling, productive lives (Koons et al., 2001).

 

Communicating with Teenagers with Personality Disorders: Effective Strategies for Parents

Understanding how to communicate with teenagers diagnosed with personality disorders can be challenging for parents. Here, we provide a detailed guide of effective strategies that can help facilitate positive communication, based on insights from various psychological and educational studies.

Firstly, it is critical to establish an open line of communication, whereby your teenager feels comfortable to express their feelings and concerns without fear of judgement or reproach (McLean et al., 2014). Creating a safe space involves active listening and acknowledging their feelings. This doesn't mean you have to agree with everything they say, but it's crucial to validate their experiences, providing empathy and understanding (Lavender, 2018).

Secondly, clear, consistent and calm communication is essential (Kreger and Mason, 2013). Setting clear boundaries is key to preventing miscommunication and misunderstandings. Parents should also ensure their expectations are realistic and adapted to the teen's capacities and needs (Schuppert et al., 2019).

The usage of "I" statements instead of "you" statements can help in expressing concerns without making the teenager feel attacked. For instance, say "I feel worried when you come home late" instead of "You are always coming home late." This focuses on your feelings and reactions, reducing the likelihood of defensive responses (Potter-Efron, 2015).

Moreover, problem-solving communication strategies can be beneficial. Encouraging your teen to think about solutions for problems rather than dwelling on the issues themselves can foster a sense of responsibility and resilience (Carr, 2016). This also helps them feel empowered, as they contribute to finding solutions for their challenges.

Finally, remember that patience and persistence are key in dealing with personality disorders. Progress may be slow, and there may be setbacks. It’s essential to stay patient, stay the course, and celebrate every small achievement (Kernberg et al., 2017). Moreover, don't hesitate to seek professional help, both for your teen and for yourself. Mental health professionals can provide the necessary support and teach effective strategies to manage the challenges that come with personality disorders.

 

Dr Robert Becker, FCMA, Neuropsychologist, Psychotherapist, Psychiatric Assessor

 

References:

 

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