Академический Документы
Профессиональный Документы
Культура Документы
Personality disorder
w
Personality disorder is one of the most controversial psychiatric diagnoses. It covers
widely different kinds of behaviour. This booklet gives a brief description of the
various disorders, discusses the possible causes and looks at what sort of help is
available and where to find it.
Personality disorders disrupt people's lives (and those of others they come in contact
with) to different degrees. They also vary in their treatability. Often, someone
diagnosed with a disorder of this kind has an emotional problem such as depression
or phobia too. For example, someone suffering from a social phobia or agoraphobia
may also be diagnosed as having an avoidant personality disorder. Even if many of
the problems associated with the phobia have been resolved, stressful events may
trigger an underlying pattern of avoidance and dependency. (See Mind’s booklets,
Understanding Depression and Understanding Phobias, details on p. 10).
There are ten personality disorders according to the DSMIV – The American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. (The
terminology used and the characteristics described in this booklet follow DSM1V and
2
The Oxford Textbook of Psychiatry. There are slight differences between this
system and other classifications systems). Information about multiple personality
disorder is not included here since it is classified as a dissociative disorder, not a
personality disorder. The characteristics of the various personality disorders are
as follows:
3
rights. They may appear to be superficially charming, but are callous and self-serving
and lacking in empathy. They are often incapable of consistent employment and
maintaining a long-term relationship. People with APD behave impulsively without
considering the consequences. Impulsive behaviour is often linked with criminal
offences, particularly violent offences. Studies indicate a higher rate of alcoholism
and substance abuse among people with APD than the rest of the population.
Behaviour is made more extreme by the effects of alcohol or drugs. A central feature
of this disorder is complete lack of guilt about criminal or exploitative behaviour.
w
people may be diagnosed with both. The day-to-day functioning of people with
obsessive-compulsive disorder is likely to be much more impaired. People with OCPD
may also suffer from depression or social phobia. (See Mind’s booklet Understanding
Obessessive Compulsive Disorder, p. 10).
4
automatically means that more is known about the person. Mind also recognises
that many of these terms have been used in a stigmatizing, derogatory way.
Eccentric or 'abnormal'?
Personality disorders can be seen as extreme examples of tendencies which are
observable in everyone. Negative personality traits and extremes of behaviour tend
to be regarded as excusable and unremarkable in the socially dominant or creatively
gifted. Some people may have one or two particularly offensive traits such as being
smug or long-winded or perpetually irritable, which cause them to experience more
rejection and distress than someone suffering from a personality disorder whose
overall personality is more pleasant.
Misdiagnosis
Labels such as 'masochistic', 'dependent', 'inadequate' may be used in an insulting,
punitive and pointless way and applied to people who are perceived as being in some
way 'difficult'. Victims of domestic violence or child abuse may be more likely to be
diagnosed as suffering from a personality disorder. Because post-traumatic symptoms
w
are so persistent and wide-ranging, they may be mistaken for enduring characteristics
of the victim's personality. Many survivors may be misdiagnosed as having a
dependent or avoidant personality disorder. (See Understanding Post-traumatic Stress
Disorder, on p.11).
Psychological causes have been suggested for most personality disorders. Most
psychological explanations speculate that people with personality disorders have
experienced poor parenting, rejection, lack of love or abuse when young. Negative
childhood experiences seem to be particularly important in borderline personality
disorder. Many people with this diagnosis report having been neglected, or
physically or sexually abused as children.
5
w hat are the causes of
antisocial personality disorder?
Antisocial behaviour in childhood seems to be linked with antisocial behaviour in
adults. Research has established that high levels of stress and family problems are
important causes of behaviour problems in childhood. The significant factors in
developing behaviour problems or delinquency seem to be:
Genetic causes
Studies of identical twins and the adopted children of antisocial parents have
attempted to show that there is a genetic factor in the development of this disorder.
In pairs of identical twins in which one of the pair had committed a criminal offence
it was more likely that the co-twin had also offended. Research suggests that
antisocial behaviour is higher in adopted children of antisocial biological parents.
6
Brain damage/abnormalities in brain function
Tests have demonstrated brain damage and abnormalities in brain function in
habitually aggressive men convicted of violent offences. Such abnormalities would
make it more difficult for people to reflect, to judge the consequences of their
actions, to learn from experience and to feel fear or remorse. Studies have found
that people with antisocial personality disorder respond less to expectations of
a
stress. Because of this relative lack of anxiety, people may not learn to avoid
threatening situations and, instead, may actively seek out danger in order to feel
stimulated and alive.
Some practical changes may be brought about quite quickly through therapy, but
for many people progress is likely to be slow and difficult.
Talking treatments
Group therapy can be particularly beneficial for some people. For people who avoid
social situations or tend to become excessively dependent on one person, a group
provides a useful practice ground. People diagnosed with borderline personality
disorder tend to form intense 'special' relationships, so again a group gives them the
chance of forming a range of attachments to people.
7
Cognitive therapy can analyse a person's characteristic pattern of thoughts and
attitudes. It attempts to challenge and change misperceptions. With a client who is
very dependent, for instance, therapy might focus on challenging the idea that they
are helpless and incompetent. With someone who has a diagnosis of obsessive-
compulsive personality disorder, therapy might attempt to change the belief that
mistakes must be avoided and challenge their concentration on duties and work.
Individual therapy is not universally beneficial for people with personality disorders.
An intense one-to-one relationship may increase an already-too-great dependency
or encourage manipulative, exploitative behaviour in people who are antisocial or
narcissistic. However, it can be helpful if people are well-motivated and can be
honest with themselves and come to trust another person. (For information on
various talking treatments see Further Reading p. 10).
Therapeutic communities
Research shows that some people with more severe personality disorders may
be helped by the experience of living for a number of months in a therapeutic
community. The NHS runs in-patient therapeutic communities which specialise in
treating clients with personality disorders (see Useful Organisations p.10).
There is no individual therapy and drugs are not used. Therapy takes place
w
informally through the day-to-day process of community living and through group
psychotherapy, community meetings and other types of group activities. There are
similar therapeutic communities within the prison system (see Further Reading and
Useful Organisations).
There is little point in telling someone that they are narcissistic or dependent unless
this is accompanied by an explanation of what these terms mean, what treatment
8
approaches might be helpful and how people can best help themselves. People
should be encouraged to avoid adding to their problems by abusing alcohol or drugs
or entering into abusive relationships. Blanket judgemental terms such as 'immature'
or 'inadequate' should never be used. We may all display immature or inadequate
responses in particular situations.
u
It is important to identify situations which bring out the best or worst in people. For
example, someone who is fearful of intimacy and ill at ease with people may lose
their inhibitions when discussing a subject which really interests them, so joining a
relevant society or club or further education class may be a way of learning to enjoy
the company of others.
seful organisations
Association of Therapeutic Communities
Pine Street Day Centre, 13-15 Pine Street, London EC1R 0JH, tel. 020 8950 9557
e-mail: therap.comm@btinternet.com, website: www.pettarchiv.org.uk/atc.htm
Produces a directory of therapeutic communities which includes some for those
diagnosed with personality disorders.
Alcoholics Anonymous
PO Box 1, Stonebow House, Stonebow, York YO1 7NJ, tel. 01904 644026,
helpline (London): 020 7833 0022, website: www.alcoholics-anonymous.org.uk
Everyman Project
40 Stockwell Road, Stockwell, London SW9 9ES, helpline: 0207 737 6747
Counselling for men who want to stop their violent or abusive behaviour.
Families Anonymous
tel. 020 7498 4680
Self-help groups in the UK for families and friends of those with a drug problem.
9
First Steps to Freedom
7 Avon Court, School Lane, Kenilworth, Warwickshire CV8 2GX,
helpline: 01926 851608 , fax: 01926 864473, e-mail: info@firststeps.demon.co.uk,
website: www.firststeps.demon.co.uk
Supports friends and relatives of those with borderline personality disorder.
f
YoungMinds
102-108 Clerkenwell Road, London EC1M 5SA, tel. 020 7336 8445,
fax: 020 7336 8446, parents information service: 0800 018 2138
e-mail: enquiries@youngminds.org.uk, website: www.youngminds.org.uk
Information for anyone concerned about the mental health of a child or adolescent.
urther reading
oo
Qty
A-Z of Your Rights under the NHS and Community Care Legislation (Mind 1993) £3
Cognitive Analytic Therapy and Borderline Personality Disorder A. Ryle et al.
oo
(John Wiley 1997) £17.99
Factsheet: Cognitive Behaviour Therapy (Mind 1999) 35p
o
Factsheet: Counselling (Mind 1999) 35p
Factsheet: Psychosis (Mind 1998) 50p
10
oo Getting the Best from your Counsellor or Psychotherapist (Mind 1995) £1
Hostage of the Mind – Living with obsessive-compulsive disorder from the
oo
point of view of a sufferer A. Lowe (A. Lowe 1998) £11.99
How to Help Someone who is Suicidal (Mind 2000) £1
o
How to Look After Yourself (Mind 1999) £1
Making us Crazy – DSM: The psychiatric bible and the creation of mental
oo
disorders H. Kitchings and S. Kirk (Constable 1999) £14.99
Managing Anger G. Lindenfield (Thorsons 1993) £6.99
oo
Obsessive-compulsive Disorder: The facts (Oxford University Press 1998) £9.99
Overcoming Social Anxiety and Shyness G. Butler (Robinson 1999) £7.99
o
Stop Walking on Eggshells P. T. Mason, R. Kreiger (New Harbinger 1998) £11.99
Risks and Rights – Mentally disturbed offenders and public protection (NACRO
oo
1998) £10
Understanding Obsessive-compulsive Disorder (Mind 2000) £1
oo
Understanding Paranoia (Mind 1999) £1
Understanding Post-traumatic Stress Disorder (Mind 2000) £1
oo
Understanding the Psychological Effects of Street Drugs (Mind 1998) £1
Understanding Schizophrenia (Mind 2000) £1
o
Understanding Self-harm (Mind 2000) £1
Understanding Talking Treatments (Mind 2000) £1
If you would like to order any of the titles listed here, please photocopy or tear out
these pages, and indicate in the appropriate boxes the number of each title you
require. Please add 10% for postage and packing, and enclose a cheque for the
whole amount, payable to Mind.
Return your completed order form together with your cheque to:
Mind Mail Order, 15-19 Broadway, London E15 4BQ
tel. 020 8221 9666, fax: 020 8534 6399,
e-mail: publications@mind.org.uk (Allow 28 days for delivery).
Name
Address
Postcode
Tel.
11
Mind works for a better life for everyone
with experience of mental distress
For details of your nearest Mind association and details of local services contact
Mind’s helpline, MindinfoLine, 020 8522 1728 from within London or 0845 7660163
outside London. Mon-Fri 9.15 am - 4.45 pm.
Mind also has six regional offices and a national office in Wales:
Mind Cymru Third Floor, Quebec House, Castlebridge,
Cowbridge Road East, Cardiff CF11 9AB
Northern Mind Pinetree Centre, Durham Road, Birtley,
Chester-le-Street, County Durham DH3 2TD
North West Mind 21 Ribblesdale Place, Preston PR1 3NA
South East Mind First Floor, Kemp House, 152-160 City Road,
London EC1V 2NP
South & West Mind Pembroke House, 7 Brunswick Square,
Bristol BS2 8PE
Trent & Yorkshire Mind 44 Howard Street, Sheffield S1 2LX
West Midlands Mind 20/21 Cleveland Street, Wolverhampton WV1 3HT