A personality disorder is, arguably, a rather unfortunate term to describe chronically disturbed ways of thinking and behaving. The most common type is Borderline Personality Disorder which can also be described as Emotional Intensity Disorder. It is characterised by difficulties controlling emotions, intense emotional changes, impulsive behaviour and intense unstable relationships. There is often a fear of abandonment and sufferers may self-harm or make suicidal threats when particularly distressed.
The causes are not fully understood but is probably a mix of genetic vulnerability and environmental factors during childhood. Some personality issues will be a result of experiencing either parental neglect or physical, emotional or sexual abuse.
By definition these emotional and behavioural difficulties need to be longstanding and not an acute presentation which might be better explained as an episode of depression, anxiety or stress.
Regarding treatment, the general approach needs to be consistent, non-judgmental and non-reactive. Patients with personality disorders can sometimes appear demanding and difficult and they can unconsciously project powerful emotions on those that are trying to treat them. This is known as transference and it is important for professionals to be aware of this and not react in an emotional way.
Dialectical behaviour therapy (DBT) is a talking therapy that has specifically been developed for treating patients with Borderline Personality Disorder. It is based on the assumption that the sufferer is emotionally vulnerable and subject to particularly intense and upsetting emotions but they grew up in an environment where these emotions were dismissed. This sets up a negative cycle when the sufferer feels guilty and worthless expressing any emotions and this can lead to maladaptive coping strategies such as self-harming behaviour.
DBT involves validating these emotions and accepting that they are valid, real and acceptable. Dialectics is a philosophical term meaning that most things are not black and white and hence it is important to remain open to other opinions. Regarding self-harming behaviour, the therapist would validate the intense emotions but challenge the assumption that self-harm is the only way to cope. DBT ideally involves weekly group and individual sessions and is recommended by NICE, particularly for females with self-harming and suicidal behaviour.
Not everyone is able to engage with DBT and in these circumstances Art Therapy can be a useful way of allowing people to articulate their feelings and emotions.
No specific medications are indicated for Borderline Personality Disorder but coexisting depression, anxiety or Bipolar Disorder should be treated. There is some evidence that mood stabilisers and anti-psychotics can have a general calming effect but their use is off licence.
Dr Tim Rank MRCPsych, Consultant Psychiatrist
At Brighton & Hove Clinic we understand that accessing help for mental health problems can be challenging so our team of experts are here to support patients through their journey. We offer psychiatric services, outpatient therapies and day care programmes for adults and young people who are experiencing difficulties with their life circumstances.
If you would like to know more about the treatments that we offer or you would like to book a consultation, please email the clinic.