Personality disorders in adults

Diagnoses such as anxiety and depression manifest themselves by symptoms that you are not used to living with. This may, for example, be sadness or heart palpitations. In contrast to this, personality disorders manifest themselves in the form of certain character traits. If you have a personality disorder, you will therefore often experience your reactions as natural because they have been there for a long time.

One example could be a woman with a personality disorder who experiences that she is an unwanted person. She will act in a quiet and restrained manner and not show very much of herself in social contexts for fear of doing or saying something from which others will distance themselves.

She will not think that her experience is something that can be talked about and nuanced. Instead, she will see it as a truth. In her contact with other people, she will therefore think that she is wrong, embarrassing or unwanted.

For example, if she has experienced several times that others do not approach her and that they overlook her, she will see it as proof of her thoughts about herself. This experience will repeat itself in new situations in which she will be restrained and convinced that others think that she is wrong or embarrassing. She will pay close attention to signs that others are not addressing her or are talking across her as if she were someone with whom you do not want to have contact.

The experience of being overlooked and unwanted will typically make her sad and perhaps also angry, rather than trying to understand it as a pattern in her experiences.

A personality disorder often manifest itself at two extremes: introvert and extrovert.

At one extreme, the person will be introvert and humble in relation to others. It can be seen as an attempt to avoid anxiety and conflicts.

At the other extreme, the person will be extrovert and impulsive. It can be seen as an attempt to dominate the relationship with others.

A person with a personality disorder is most typically dominated by one extreme or the other. However, the extremes may alternate. In some situations, the person will thus appear inhibited, while, in other situations, he or she will be more dominant and explosive.

The two extremes may be expressed as follows:

• Either great dependence on boyfriend or girlfriend, family and friends or repeated conflicts with the same
• Either excessive self-control or lack of self-control
• Difficulty understanding and setting boundaries. A person with personality disorder will either accept that other people overstep his or her boundaries or overstep other people’s boundaries
• Persistent problems at a place of study or workplace. Some avoid relevant work assignments and are quiet and inconspicuous. Others are too controlling, unstable and desire-driven in their work performance.

Seen from the outside, the various types of personality disorders may look very different. But they have many common traits. Most people with personality disorder have:

• Very low self-esteem
• Difficulty adjusting their emotions and impulses. Some over-regulate their emotions and impulses and barely notice them. Others under-regulate their emotions and impulses and notice them way too much
• A tendency to perceive social situations from their own perspective, and difficulty considering other people’s perspectives.

We especially develop our personality during the first 2-3 years of our life. What the child learns during this period about how to handle adversity and deal with his or her own needs as well as those of others is of great importance to the relationship patterns that he or she establishes.

Although the first 2-3 years are of great importance, a person’s personality develops until the age of 10-12. The patterns founded in the early years can be reinforced. This happens if the child’s relationship with others continues along the same track. Conversely, the patterns can be adjusted if interactions with others change.

A fundamentally secure attachment can therefore become less secure. This may occur if there are sudden large changes in the child’s life. Likewise, an insecure attachment can become more secure if the child’s carers become more stable and present.

The overall criteria indicate whether you have a personality disorder. There are also criteria for specific types of personality disorders.

The essence of paranoid personality disorder is anxiety about humiliation and general insecurity about other people. It is often expressed by:

• Generalised suspicion
• You experience other people as malicious and offensive
• You often react with anger

The essence of schizoid personality disorder is that contact with others is perceived as being much too overwhelming. It therefore causes discomfort and anxiety. It is often expressed by:

• A lack of interest in socialising
• Isolation
• A cold attitude towards others.

The essence of a dissocial personality disorder is the absence of empathy. You have typically had a childhood with neglect and therefore have no positive expectations of others. A dissocial personality disorder is often expressed by:

• Great impulsivity, often in the form of crime committed without any thought as to whether it affects other people
• Lack of a conscience.

We do not offer treatment for dyssocial personality disorder in the psychiatric services in Central Denmark Region, as we do not have treatment options for this particular personality disorder.

The essence of emotionally unstable personality disorder is the fear of being abandoned. This anxiety expresses a feeling of only being something by virtue of others. Therefore, you feels a deep longing to be one with another person. It is often expressed by:

• Fear of abandonment
• Uncertainty about your own identity
• Self-destructive and impulsive behaviour
• Strong emotional fluctuations (all depending on whether the other person is perceived as being with you or against you)
• Internal emptiness
• Black-and-white thinking (either/or).

The essence of histrionic personality disorder is a fear of not having the other person’s attention. This results in an experience of not being anything. It is often expressed by:

• A great need to be the centre of attention
• Rapidly changing, strong and dramatic expressions of emotions
• Flirting and sexualisation of contact with others (without necessarily having sexual intentions).

The essence of obsessive-compulsive personality disorder is the fear of not being perfect. It is often expressed by:

• Preparation of lists, rules and schedules
• Perfectionism
• A great need for control
• Stubbornness.

The essence of anxious-evasive personality disorder is the fear of being embarrassing as well as of criticism and rejection. A deep desire for closeness is also seen. It is typically expressed by:

• Anxiousness in social situations
• A feeling of inadequacy
• Excessive inhibition of behaviour.

The essence of dependent personality structure is a fear of not being able to cope, without help and guidance. It is often expressed by:

• Practical and emotional dependence on others
• Generalised lack of independence.

The essence of narcissistic personality disorder is the fear of not being seen and recognised. It is typically expressed by:

• A need for excessive recognition and admiration
• Excessive self-esteem
• Arrogance and self-absorption.

This designation is not an expression of any specific type. The person meets the general criteria for a personality disorder, but does not match a specific type.

This designation is used if a person has symptoms that relate to several different personality disorders.

Psychotherapy may be either individual or in a group. In some cases, both types can be combined. The therapy consists of consultations. Relationship patterns, perceptions of social situations and views of yourself and others are examined in these consultations.

The purpose of both the individual therapy and group therapy is to strengthen your ability to handle difficult emotions. In this way, you can help to develop a sense of greater inner security. The more successful this is, the more robust you will become when faced with adversity, and the better your relationships with others will be.

Psychoeducation is an important part of the therapy. Here you learn what it means to have a personality disorder. You review what lies behind a personality disorder, how the disorder manifests itself and how it is treated.

Patterns of attachment or the ability to deal with emotions cannot be treated with medication. Therefore, there are no specific medication for personality disorder. Sometimes, however, it is possible to try to alleviate some of the symptoms. For example, mood stabilisers can be tried in some cases. It may diminish violent emotional fluctuations between anger, sadness and other feelings.

Some people have symptoms of anxiety or depression. In some cases, these symptoms can be treated with antidepressants. Antidepressants can be used against both depression and anxiety. If you experience racing thoughts, difficulty sleeping or perceptions of unreality, you may, in some cases, benefit from very low-dose antipsychotics.

Often, the medication will have little or no effect on the symptoms. This is because the symptoms stem from the underlying personality patterns. If you develop anxiety or depression (independently from your personality disorder), the medication will be more effective against the symptoms.

• Seek out knowledge about personality disorders. For example, participate in psychoeducation if it is offered to relatives, or participate in theme evenings organised by Central Denmark Region’s psychiatric information centre PsykInfo Midt.
• If the person who has a personality disorder reacts in ways that seem excessive or violent, try not to take it personally. Remember: these reactions are due to the personality disorder.
• Remember to take care of yourself. Being close to someone with a personality disorder can take its toll. If you need to provide long-term support and help to a person close to you who has a personality disorder, it is important that you also take care of your own needs.
• You must accept that you will not always have the energy to help. No one can be present, positive and available all the time.
• Consider getting in touch with patient-and-carer organisations such as SIND (the Danish Association for Mental Health) or Bedre Psykiatri, which can help you with advice and support.
• In emergency situations, for example if the person close to you is self-harming or has suicidal thoughts, you can contact your doctor, a psychiatric emergency department or the psychiatric advisory hotline.