Major Type of Personality Disorder
- Paranoid personality disorder is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
- Schizoid personality disorder is a pattern of detachment from social relationships and a restricted range of emotional expression
- Schizoid personality disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour
- Antisocial personality disorder is a pattern of disregard for, and violation of, the rights of others
- Borderline personality disorder is a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity
- Histrionic personality disorder is a pattern of excessive emotionality and attention seeking
- Narcissistic personality disorder is a pattern of grandiosity, need for admiration and lack of empathy
- Avoidant personality disorder is a pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
- Dependent personality disorder is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of.
- Obsessive-compulsive personality disorder is a pattern of preoccupation with orderliness, perfectionism and control
If a person is committed to learning ways to reduce emotional dysregulation and improving distress tolerance, adult mental health may offer time-limited assessment to develop a formulation, which can help patients’ understanding of their difficulties and direct them towards better ways of coping and managing risk. This may be enough for some people who are not otherwise wanting or currently able to engage in more intensive therapy. The steps below are recommended:
- Treat any anxiety and depression:
- People should be offered standard talking treatments for anxiety/depression if they have clear symptoms of this as well as any emotional dysregulation.
- A trial of antidepressants may also be helpful, but these should be ceased if there is no benefit, and also people should be warned about the risk of worsening suicidal ideation in some people in the first couple of weeks.
- Pathways exist for complex trauma via the Rivers Centre: Survive and Thrive groups, Drop-in Advice Clinic – see the next section
- If the person is committed to learning ways to reduce emotional dysregulation and improving distress tolerance, then there are a variety of options available
- A short time-limited assessment /intervention can be helpful in developing a formulation, which can help patients’ understanding of their difficulties and direct them towards better ways of coping and managing risk– this may be enough for some people who are not otherwise wanting or currently able to engage in more intensive therapy.
- Patients may access the above option without a formal diagnosis by Psychiatry, which in itself may not always be as helpful as a formulation-based approach. Some patients may benefit from a diagnosis (for example if their level of risk is sufficient to consider a referral to the DBT Team). A diagnosis requires both the presence of a range of symptoms AND significant impact on many areas of a person’s life. A diagnosis cannot be made if only traits are present. Note that no guidelines recommend medication as a primary treatment for personality disorders.
- DBT (Dialectical Behavioural Therapy) may be provided for patients with a diagnosis of Emotionally Unstable Personality Disorder who are at most risk or serious self harm/death, but these referrals are made by Mental Health Services after assessment.
- The emergence of clear psychotic symptoms or sustained / pervasive depressive symptoms in someone with a diagnosis of personality disorder should be assessed and treated., and so should be referred by the guidance for these symptoms found in other headings.
