A few weeks ago, I wrote a blog post (linked here) about my experience of being put on mood stabilisers after a decade of trying antidepressants that weren’t helpful. After I wrote and published it, I had therapy and discussed it again with my psychologist.
I vented my frustrations about having to wait so long to try something new and also my sadness at how different things might have been had I tried mood stabilisers earlier. And she said something that I have been thinking about since: “I think once a clinician decides you have BPD, they lose curiosity.”
Of course, I know there is stigma around all mental health conditions and also I know some conditions have more stigma attached than others. Some conditions have a huge prevalence of stigma in the mental health community, even and especially from practitioners.
I have experienced this, as someone diagnosed with a personality disorder, and know quite a bit about it but articulating it always helps me process it on a deep level.
I’m going to do a series of posts on unravelling this in my head. About personality disorders, BPD, stigma and, of course, my own experiences.
Here we go…
what is a personality and how can it be disordered?
Prior to diagnosis, which made me think critically about the definition of the word “personality”, I thought of personality as the ineffable, intangible things that make up who a person is. The words you used to describe someone – funny, generous, empathetic, reserved, bubbly – was their personality. That’s not wrong, but it’s also not completely right.
Technically, your personality is your specific way of thinking, feeling and behaving. It’s influenced partly by biology and what you inherit from your parents and by the environment you exist in and the experiences you have. Your personality is fairly consistent over time.
Although everyone’s personality is different, there are ways of thinking, feeling and behaving that are expected and typical and there are ways that aren’t. If someone’s personality deviates significantly from what we would expect and, in some cases, it causes them distress, it might be classed as a personality disorder.
I think personality disorders face such stigma because we don’t know enough about them. We hear the phrase “personality disorder” and think that their personality, who they are as a person, must be inherently bad or dangerous or crazy. It can feel like that when you are diagnosed with one too, as though you are fundamentally broken in a deep-seated way. That at your core, you are wrong.
That’s not the case. Really, they are just a group of symptoms that affect how a person thinks of themself and how they interact with others. We all experience the same “symptoms” at some point, but it exists on a spectrum. Most of the population will experience these traits to a lesser extent. People with personality disorders just experience these symptoms consistently and to a severe and debilitating degree.
Personality disorders are often present and noticeable from a young age, but it’s recommended to wait until adulthood to diagnose them as some people may experience adolescence, schooling and puberty as inherently distressing and triggering and their symptoms may improve with age.
🎶 let’s get clinical 🎶
The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists 10 specific personality disorders that fall into 3 clusters of similar/overarching characteristics.
In general, personality disorders have four defining features and one has to have enduring and severe difficulties in at least two of these four areas to “have” a personality disorder:
distorted thinking;
difficult emotional responses;
interpersonal challenges; and
poor or over-regulated impulse control.
The three clusters
Cluster A is characterised by paranoia, lack of connection with others, withdrawal and eccentric or “odd” thinking and includes Paranoid Personality Disorder, Schizoid Personality Disorder and Schizotypal Personality Disorders.
Cluster B is characterised by intense emotions, dramatic thinking and unpredictable behaviour and includes Borderline Personality Disorder, Narcissistic Personality Disorder, Anti-Social Personality Disorder and Histrionic Personality Disorder.
Cluster C is characterised by severe anxiety, fear and obsessive thinking and includes Avoidant Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder. (It’s important to note this is not the same as Obsessive Compulsive Disorder, which is an incredibly distressing and debilitating disorder that presents very differently from OCPD).
When we think of personality disorders in popular culture, I think we mostly think dramatic, difficult, attention seeking, manipulative, dangerous, crazy, just to name a few. This mostly fits with the Cluster B disorders. Most people have heard of Anti-Social, Narcissistic and Borderline Personality Disorders, but I don’t think many people in the general population could name the remaining seven listed in the DSM.
the prognosis
This is a bit tricky. There is a lot of information on the prognosis of BPD, but it’s harder to find information on the other personality disorders. Overall, personality disorders symptoms have shown to lessen with age in some people.
I imagine there could be quite a difference in prognosis depending on the specifics of each disorder and the severity of symptoms. The below quote highlights some the difficulties and intricacies of a few of the disorders.
Antisocial personality disorder prognosis, in particular, is poor, as people have low motivation for treatment and are often distrusting of help. However, aggressive and illegal behaviors tend to lessen with age.
Similarly, paranoid personality disorder treatment prognosis is also poor due to resistance to treatment. However, some people with this personality disorder are able to maintain stable relationships and jobs and function fairly well, while others are incapacitated by the disorder.
Borderline personality disorder long term prognosis shows that it can go into remission with proper treatment, but the condition is chronic and must be managed throughout the lifespan.
Narcissistic personality disorder treatment prognosis shows that individuals can make significant improvements in their relationships, achievements and coping mechanisms with appropriate forms of treatment.
As with all mental illnesses, early intervention and understanding treatment is key to helping people live the best life they can. Even the most severe disorders and symptoms can benefit in some degree from therapy. But obviously any treatment is dependent on the correct disorder being diagnosed and treated by someone with thorough knowledge of the disorder and personality disorders in general. That is not always easy to come by. More on that next week, where I will dive into BPD specifically.