Comorbidity
The notion that people have varied personalties is well accepted. It is commonplace to talk about someone being ‘obsessive’ or ‘neurotic’ or ‘outgoing’ or ‘antisocial’. Personality disorder, however, is a controversial subject. As with common mental health problems such as anxiety and depression, there is the idea of a normal range, in this case of personality traits, and extreme versions of these which are then called personality disorders.
over expressive personality and emotional regulation
What kinds of personality are there?
The International Classification of Diseases, ICD-11, categorises both the nature and the severity of traits, that are continuous with normal personality characteristics in individuals who do not have personality difficulties, as personality disorders. These are not diagnostic categories, but rather represent a set of dimensions that correspond to the underlying structure of personality…
Emotionally expressive :: frequent and intense negative emotions, negative attitudes, emotional lability and poor emotional control, low self-esteem and mistrustful.
Emotionally cold :: social detachment, avoidance of intimacy, few friendships, reserved and aloof, with limited emotional expression.
Narcissistic :: self-centredness, feeling of entitlement, temper tantrums, denigration of others, a lack of empathy, and an indifference to the consequences of any behaviours for other people.
Outgoing :: impulsive actions, pursuit of immediate gratification, easily distracted, lack of responsibility or sense of accountability, over-confident and reckless behaviour.
Obsessional :: rigid standard of perfection and of right and wrong, rigid control over emotional expression, stubbornness and inflexibility, risk-avoidance, and perseveration.
Are these useful categories?
Well, yes and no. On the one hand, each of these categories says a lot about what somebody is like, and how they are likely to behave. Most people will recognise these different sorts of individual, perhaps among family and friends. Also people who are distressed by their experience of living with their personality may want an understanding of what is happening to them, as might their family and friends. On the other hand, there can be a stigma attached to being labelled with a personality disorder, and the prognostic and treatment implications are modest. Current thinking leaves a couple of moot points:
① If, as ICD-11 suggests, personality disorder categories are not to be taken as diagnostic, then in what way do they differ from anxiety or depression where both normal and disorder states are accepted? Should previously diagnosed personality disorders be reconsidered and given a mental illness label?
② If a personality disorder label is stigmatising, does it follow that the concept be abandoned? Drug and alcohol labels are seen by some as stigmatising but does anybody want to abandon their existence? The behaviour of people falling into these groups can be challenging and they may be hard to engage, but doesn’t this call for better education of the public and specialist services committed to helping?
Personality problems find their roots in childhood and early development. Important early life factors include: trauma from emotional, physical or sexual abuse; exposure to long-term fear or distress, which could arise from mental health problems in the family; and neglect by parents. There are no specific medications for this kind of problem and any use of drugs for symptomatic relief will need caution given the risks of impulsive misuse.
What interventions are there?
The most effective intervention is called Dialectical Behavioural Therapy, or DBT. This is an intensive kind of therapy and requires specialist practitioners.
This is one person’s experience of DBT…
“DBT has changed my life in a way I didn’t believe was possible. I always thought that I had too many problems and no-one could understand how much I was struggling with my mental health. I’d tried so many other forms of therapy and healing, and nothing had worked. DBT provided me with the answers I’d been looking for, for so many years! It’s so simple and concise and makes it really easy to understand how you can take control of your emotions and create a better life for yourself. Plus, having constant support available from the DBT team was truly invaluable. It’s also amazing to meet so many people who are struggling with similar things, and to see them grow and get better as well.
I’ve definitely made life-long friends from my time in DBT and my life is better than it’s ever been. It’s a hard journey but if you trust the process and give it your all, it really does work!"
more about mental health…
