Background information: During the Summer of 2014, two secondary school students from Co. Kerry, Ireland, discovered the lack of awareness in the world about Personality Disorders (PDs). Sinead O'Sullivan and Aoibhin O'Neill both had a love and interest in psychology, and after a study into PDs, realised the importance and need for more public knowledge and awareness on them. This lack of information and awareness among the public about PDs is unhelpful to prevention and intervention, and so Sinead and Aoibhin became eager to change it. They later conducted a survey in their school, questioning young people’s knowledge and perception of PDs. The results were revealing, with only 5% of the sample having heard of three of the ten PDs, and in addition to that, they knew very little about those three. Given this they decided to enter a project titled "Personality Disorders: Improving Awareness among Young People" into the 2015 BT Young Scientist and Technology Exhibition. Their aim was to increase public knowledge and awareness of PDs with the creation of a guidebook, while sharing their work on social media pages such as their own PDs awareness Facebook page, and also on PDAN Facebook page, which has an audience of over 170,000! In addition, they later became editors for the PDANteen Facebook page. In October 2014, they found out that their project qualified to be exhibited at the 2015 BT Young Scientist. This is the guidebook they created as part of their project.

Introduction: The word ‘personality’ refers to the pattern of thoughts, feelings and behaviour

that makes each of us the individuals that we are. Our personality develops as we

go through different experiences in life, and as our circumstances change. We

are usually flexible enough to learn from past experiences and to change our

behaviour to cope with life more effectively. Many aspects of our personality

remains stable overtime termed traits, changes can occur over the lifespan and

following traumatic events.

However, people with a personality disorder are likely to find it more difficult to

modify their behavior. Their patterns of thinking, feeling and behaving are more

difficult to change and they will have a more limited range of emotions, attitudes

and behaviours with which to cope with everyday life. They don't seem to be able

to learn from the experience as well.

Personality disorders usually become noticeable in adolescence or early

adulthood, but sometimes start in childhood. There are a number of

disorders apparent in childhood which present a risks of developing a PD,

conduct disorder and oppositional defiant disorder for example.

A person can’t be diagnosed with a personality disorder before the age of

18.

Life is more difficult for those who have a personality disorder. They are

more likely to have other mental health problems such as depression

(comorbidity), relationship problems and be out of work.

In some people who experience personality disorder there can be problems

with addiction, crime and self – harm, which in turn are more difficult to

treat in this population.

Personality disorders can cause problems with relationships, place people at of risk impulsive behaviors including suicide and bring about anxiety, paranoia and depression but can be managed. By making the first step and sharing your feelings with a doctor you have the best chance of successful treatment and management of any problem. The risks from treatment and of embarrassment are considerably less than the health and social problems associated with non­treatment / support.

What can cause a personality disorder?

Upbringing

emotional/physical or sexual abuse in childhood

domestic violence in the family

adverse family circumstances like addiction among parents

low education level and socio economic status

Trauma

being involved in major incidents or accidents

sudden bereavement life events

Genetics and inheritance

Some elements of our personality are inherited and indeed there is

evidence of a genetic link in some personality disorders. For example,

people whose parents experience schizophrenia are more likely to develop

Schizotypal personality disorder. In general, family history of personality

disorders or other mental illness places a person at risk.

Research suggests that personality disorders tend to fall into three groups,

according to their emotional 'flavour':

Cluster A: 'Odd or Eccentric

Cluster B: 'Dramatic, Emotional, or Erratic'

Cluster C: 'Anxious and Fearful'

Remember!:

As you read through the descriptions of each type, you may recognize some aspects of your own personality. This doesn't necessarily mean that you have a personality disorder. It’s only when these traits are spoiling your own life and often the lives of those around you, that a personality disorder diagnosis is possible.

A PD diagnosis only applies if you have personality difficulties which affect

all aspects of your life, and make life difficult for you and for those around

you. The diagnosis does not include personality changes caused by a life

event such as a sudden traumatic incident, or physical injury. In other

words, there must be nothing else which can account for the problems you

are experiencing.

A person can have the characteristics of more than one personality

disorder termed co morbidity.

For each disorder there are a minimum number of symptoms that a person

must experience. An individual does not have to experience all symptoms

for example not all people who experience Borderline personality disorder

self­harm.

Cluster A: ‘Odd and Eccentric’ Paranoid Personality Disorder: In order for a person to be diagnosed with paranoid personality disorder, they must meet four or more of the following symptoms:

Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

Reads hidden demeaning or threatening meanings into benign remarks or events

Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)

Perceives attacks on his or her character or reputation that are not apparent to others, and is quick to react angrily or to counterattack

Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Schizoid Personality Disorder: In order for a person to be diagnosed with schizoid personality disorder, they must meet four or more of the following symptoms:

Emotional coldness, detachment or reduced effect. Limited capacity to express either positive or negative emotions towards

others. Consistent preference for solitary activities. Very few, if any, close friends or relationships, and a lack of desire for

such. Indifference to either praise or criticism. Little interest in having sexual experiences with another person (taking into

account age). Taking pleasure in few, if any, activities. Indifference to social norms and

conventions. Preoccupation with fantasy and introspection.

Schizotypal Personality Disorder: In order for a person to be diagnosed with

schizotypal personality disorder, they must meet five or more of the following

symptoms:

Ideas of reference (excluding delusions of reference) Odd beliefs or magical thinking that influences behavior and is

inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)

Unusual perceptual experiences, including bodily illusions Odd thinking and speech (e.g., vague, circumstantial, metaphorical,

overelaborate, or stereotyped)

Suspiciousness or paranoid ideation Inappropriate or constricted affect Behavior or appearance that is odd, eccentric, or peculiar Lack of close friends or confidants other than first­degree relatives Excessive social anxiety that does not diminish with familiarity and tends

to be associated with paranoid fears rather than negative judgments about self

Cluster B: ‘Dramatic, Emotional and Erratic’

Antisocial Personality Disorder: In order for a person to be diagnosed with antisocial personality disorder, they must meet three or more of the following symptoms:

Callous unconcern for the feelings of others.

Gross and persistent attitude of irresponsibility and disregard for social

norms, rules, and obligations.

Incapacity to maintain enduring relationships, though having no difficulty

to establish them.

Very low tolerance to frustration and a low threshold for discharge of

aggression, including violence.

Incapacity to experience guilt, or to profit from adverse experience,

particularly punishment.

Marked proneness to blame others, or to offer plausible rationalizations for

the behaviour bringing the subject into conflict with society.

(Persistent irritability and the presence of conduct disorder during childhood and

adolescence, complete the clinical picture but are not required for the diagnosis.)

Borderline Personality Disorder (sometimes referred to as emotionally unstable

personality disorder): In order for a person to be diagnosed with borderline

personality disorder, they must meet four or more of the following symptoms:

Extreme reactions—including panic, depression, rage, or frantic

actions—to abandonment, whether real or perceived

A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)

Distorted and unstable self­image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)

Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating

Recurring suicidal behaviors or threats or self­harming behavior, such as cutting

Intense and highly changeable moods, with each episode lasting from a few hours to a few days

Chronic feelings of emptiness and/or boredom Inappropriate, intense anger or problems controlling anger Having stress­related paranoid thoughts or severe dissociative symptoms,

such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Histrionic Personality Disorder: In order for a person to be diagnosed with histrionic personality disorder, they must meet five or more of the following symptoms:

Is uncomfortable in situations in which he or she is not the center of attention

Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

Displays rapidly shifting and shallow expression of emotions Consistently uses physical appearance to draw attention to them self Has a style of speech that is excessively impressionistic and lacking in

detail Shows self­dramatization, theatricality, and exaggerated expression of

emotion Is highly suggestible, i.e., easily influenced by others or circumstances Considers relationships to be more intimate than they actually are

Narcissistic Personality Disorder: In order for a person to be diagnosed with narcissistic personality disorder, they must meet five or more of the following symptoms:

Has a grandiose sense of self­importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high­status people (or institutions)

Requires excessive admiration Has a very strong sense of entitlement, e.g., unreasonable expectations of

especially favorable treatment or automatic compliance with his or her expectations

Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends

Lacks empathy, e.g., is unwilling to recognize or identify with the feelings and needs of others

Is often envious of others or believes that others are envious of him or her Regularly shows arrogant, haughty behaviors or attitudes

Cluster C: 'Anxious and Fearful'

Avoidant Personality Disorder: In order for a person to be diagnosed with avoidant personality disorder, they must meet four or more of the following symptoms:

Persistent and pervasive feelings of tension and apprehension.

Belief that oneself is socially inept, personally unappealing, or inferior to

others.

Excessive preoccupation about being criticized or rejected in social

situations.

Unwillingness to get involved with people unless certain of being liked.

Restrictions in lifestyle because of need of security.

Avoidance of social or occupational activities that involve significant

interpersonal contact, because of fear of criticism, disapproval or rejection.

Dependent Personality Disorder: In order for a person to be diagnosed with

dependent personality disorder, they must meet four or more of the following

symptoms:

Has difficulty making everyday decisions without an excessive amount of

advice and reassurance from others

Needs others to assume responsibility for most major areas of his or her life

Has difficulty expressing disagreement with others because of fear of loss of support or approval

Has difficulty initiating projects or doing things on his or her own (because of a lack of self­confidence in judgment or abilities rather than a lack of motivation or energy)

Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant

Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself

Urgently seeks another relationship as a source of care and support when a close relationship ends

Is unrealistically preoccupied with fears of being left to take care of himself or herself

Obsessive­Compulsive Personality Disorder: In order for a person to be diagnosed with obsessive­compulsive personality disorder, they must meet four or more of the following symptoms:

Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)

Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

Is unable to discard worn­out or worthless objects even when they have no sentimental value

Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

Shows significant rigidity and stubbornness

In Table 1 below are sex differences in the frequency of personality disorders.

These differences could be due to a lack of diagnosis in one gender rather than

actual differences.

Table 1:

Sex differences in the frequency of personality

disorders:

Type of personality disorder Sex

Paranoid personality disorder: Male

Schizoid personality disorder: Male

Schizotypal personality disorder: Male

Antisocial personality disorder: Male

Borderline personality disorder: Fema

le

Histrionic personality disorder: Fema

le

Narcissistic personality disorder: Male

Avoidant personality disorder: Equal

Dependent personality disorder: Fema

le

Obsessive–compulsive personality disorder: Male

Treatment:

1. Psychological: talking treatments or therapies

A number of psychotherapies seem to work well, particularly for cluster B

personality disorders ('Dramatic, Emotional and Erratic').

Mentalisation­based therapy

Dialectical Behaviour Therapy

Cognitive Therapy

Schema Focused Therapy

Transference Focused Therapy

Dynamic Psychotherapy

Cognitive Analytical Therapy

Treatment in a therapeutic community 2. Physical: medication

Antipsychotic drugs (usually at a low dose)

Can reduce the suspiciousness of the three cluster A personality

disorders (paranoid, schizoid and schizotypal).

Can help with borderline personality disorder if people feel paranoid, or

are hearing noises or voices(Delusions).

Antidepressants

Can help with the mood and emotional difficulties that people with

cluster B personality disorders (antisocial or dissocial, borderline or

emotionally unstable, histrionic, and narcissistic) have.

Some of the selective serotonin reuptake inhibitor antidepressants

(SSRIs) can help people to be less impulsive and aggressive in

borderline and antisocial personality disorders and also can decrease

the anti social PD symptoms due to their low serotonin.

Can reduce anxiety in cluster C personality disorders

(obsessive­compulsive, avoidant and dependent).

Mood stabilisers

Medication such as lithium, carbamazepine, and sodium valproate can also

reduce impulsiveness and aggression.

These medications and treatments also help if someone with a personality disorder develops depression or schizophrenia. Self­help for those with a personality disorder:

Try to unwind when stressed ­ have a hot bath or go for a walk. You may

find yoga, massage or aromatherapy useful.

Make sure to get a good night’s sleep.

Look after your physical health and what you eat. You'll feel better on a

balanced diet going by the food pyramid.

Avoid drinking too much alcohol or using dangerous drugs.

Take some regular exercise. This doesn’t have to be extreme.

Give yourself a treat (not drugs or alcohol) when things are difficult or

you have coped at a stressful time.

Take up an interest or hobby. This is a good way to meet others and take

your mind off day­to­day stresses.

Talk to someone about how you are feeling. This could be a friend or

relative or, if preferred, a therapist or counsellor. If you don’t have

access to a counsellor or therapist, then try your GP.

The internet is a good resource of information.

If things get really tough, try phoning Samaritans. Family & friends: Day­to­day living with someone who has a personality disorder can be difficult ­ but it isn’t always difficult. The following can be useful:

give them their own space. listen to and acknowledge their concerns. involve others (friends, relatives and, at times, mental health

professionals – nurses, therapists or doctors). don’t forget to look after your own physical and mental health in any way

you can. Further Information:

Emergence: Supports all people affected by a diagnosis of personality

disorder, whether you are a service user, carer (which is a family member or

friend of a service user) or a professional in the field

http://www.emergenceplus.org.uk/

Samaritans: Available 24 hours a day to provide confidential emotional support

for people who are experiencing feelings of distress or despair, including those

which may lead to suicide.

Phone number: 116 123 (in ROI only)

The website has helpful information about stress and self­harm:

http://www.samaritans.org/

Email: jo@samaritans.org

Rethink Mental Illness: Works to help everyone affected by severe mental

illness recover a better quality of life. Has information on personality and

personality disorder.

http://www.rethink.org/

Aware: Assists and supports those suffering from depression (which can occur

in those diagnosed with a personality disorder) and their families in Ireland. A

helpline is available as well as support groups, lectures, and current research

on depression.

http://www.aware.ie/

What needs to be done?

Mental health services have been focused on mental illnesses such as bipolar disorder and depression, but not personality disorders. Recent research makes it clear that mental health services can, and should, help people with a personality disorder. With the right help, many can start to lead a normal and fulfilling life. Most can, at least, cope more effectively with their difficulties.

Personality disorders can be prevented in some cases if more information and awareness is spread about them in the world. ­ (people will be aware of the causes of them).

Personality disorder is a real problem, that demands real help. Let’s begin here.

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