Relationships - Personality disorders
I was recently having a discussion with a colleague in London about the difference I had noted between my student days there and the current state of mental health in the UK. "From my perspective," I said, "I noted an increase in mental health...
I was recently having a discussion with a colleague in London about the difference I had noted between my student days there and the current state of mental health in the UK. "From my perspective," I said, "I noted an increase in mental health problems, particularly an increase in personality disorders and problems related to anger and violence".
Simultaneously, I was constantly asking myself about how mental health problems in Malta have changed over the years. Relationship problems in particular became increasingly complex as individual mental health deteriorated. The same "progress" in the UK has been noted in Malta as well. As I converse with the different colleagues I collaborate with I realise that problems have similarly taken a different dimension. Personality disorders in particular are featuring more predominantly and are increasingly becoming related to drug abuse, alcoholism, depression, relationship difficulties and so on.
Personality disorders are a group of disorders that include a variety of severe problems associated with rational, emotional and behavioural instability, with particular difficulties in maintaining healthy and functional relationships, particularly, but not only, intimate relationships.
These problems are tackled in many professional publications. There's a whole list of different types of specific personality disorders. Some of these conditions and patterns emerge early in one's life, others come to the fore later in life. I am calling them patterns and not disorders simply because I don't like medicalising. Nonetheless, such patterns can be very well ingrained in one's life and relationships.
For example, someone who consistently depends on others around him or her can find it very hard to do things on one's own. So one might depend on others for a host of daily chores including not making decisions, avoiding doing things on one's own, and so on. This is often mitigated by the other side of the pattern - a relative who gives in and does everything for the dependent party.
These conditions consist of deeply ingrained and enduring patterns, often affecting the level of functionality of the person. Such patterns manifest themselves as inflexible responses to a broad range of personal and social situations. Remember that because you might experience some of the symptoms you might read about does not necessarily mean you suffer from a personality disorder.
The variety of response patterns are grouped under different personality disorders. There are some which are very popular, such as the paranoid type of personality disorder which translates into a tendency to excessive suspiciousness, excessive sensitivity to setbacks, bearing grudges, refusal to forgiveness, and self-centredness. The patterns are inflexible because even hard evidence might not be enough for the person to change one's mind about an event.
Another type of personality disorder, which I think is on the increase, is the borderline personality disorder characterised by instability in interpersonal relationships, self image, confusing feelings and marked impulsivity. Another important feature of the borderline disorder is the problematic boundaries, which are often too lax. Such people may be very intrusive, have an all or nothing response, and have a skewed sense of love and loving. People suffering from such a condition cannot really empathise with others and may appear egoistic and demanding, because of the constant need of testing the limits of the others' love.
There are other conditions, of course, which one may have a look at on other sources, including the internet. What I want to emphasise here is the impact that personality disorders have on families and relationships, as well as the persons themselves.
For example, people suffering from personality disorders are more likely to suffer from alcohol and drug problems. In fact, the UK experiences the highest concentration of personality disorders within prison walls. My experience in local drug and alcohol services has similarly been marked by personality disorders in combination with alcohol and drug issues. Eating disorders have also been associated with personality disorders.
People with personality disorders suffer great problems in relationships too. It is very difficult for people to live with someone with a personality disorder, often because of the great demands and strain they put on the relationship. Because of this too, persons with personality disorder can have difficulties with long-term employment and friendships.
Because there is no specific psychiatric or psychological treatment for personality disorders, sufferers are likely to endure their condition for a long time. Symptoms can be treated individually and it is only recently that some form of psychological treatment has been developed. It requires clinicians to develop particular skills. For staff working with personality disorders, frequent supervision is a must as burn-out and turn-over rates are both quite high.
Because of its complexity, people with personality disorder and their relatives often don't realise there is a problem unless some of the most dangerous symptoms emerge, for example self harm. They may spend years of anguish and suffering before they are given a diagnosis. Sufferers themselves often don't accept the need for treatment and some relatives also refuse. This often leads to exhaustion and fatigue.
Another common result of personality disorder which goes unnoticed is separation. Personality disorder often squeezes relationships to their limit. When one partner changes over the years and the other sticks to old patterns of the relationship, it is quite obvious that the two will find themselves very distant to each other. Persons with personality disorder might have extreme reactions to problems, for example, threaten suicide. This might keep the other partner in place but only for a while.
Personality disorder is devastating and awareness is needed particularly for those who haven't still committed themselves to marriage. Understanding what personality disorder is becomes extremely valuable to those who live with people suffering from it. Seeking professional help is also important for both the sufferer and the relatives.
One last message is don't panic. What I find true is that when people read about some disorder they inevitably start identifying themselves in the disorder. It is not necessarily the case and professionals might clarify that for you. Unfortunately, this is the double-edged nature of knowledge!
• Dr Azzopardi is a systematic family psychotherapist.
Simultaneously, I was constantly asking myself about how mental health problems in Malta have changed over the years. Relationship problems in particular became increasingly complex as individual mental health deteriorated. The same "progress" in the UK has been noted in Malta as well. As I converse with the different colleagues I collaborate with I realise that problems have similarly taken a different dimension. Personality disorders in particular are featuring more predominantly and are increasingly becoming related to drug abuse, alcoholism, depression, relationship difficulties and so on.
Personality disorders are a group of disorders that include a variety of severe problems associated with rational, emotional and behavioural instability, with particular difficulties in maintaining healthy and functional relationships, particularly, but not only, intimate relationships.
These problems are tackled in many professional publications. There's a whole list of different types of specific personality disorders. Some of these conditions and patterns emerge early in one's life, others come to the fore later in life. I am calling them patterns and not disorders simply because I don't like medicalising. Nonetheless, such patterns can be very well ingrained in one's life and relationships.
For example, someone who consistently depends on others around him or her can find it very hard to do things on one's own. So one might depend on others for a host of daily chores including not making decisions, avoiding doing things on one's own, and so on. This is often mitigated by the other side of the pattern - a relative who gives in and does everything for the dependent party.
These conditions consist of deeply ingrained and enduring patterns, often affecting the level of functionality of the person. Such patterns manifest themselves as inflexible responses to a broad range of personal and social situations. Remember that because you might experience some of the symptoms you might read about does not necessarily mean you suffer from a personality disorder.
The variety of response patterns are grouped under different personality disorders. There are some which are very popular, such as the paranoid type of personality disorder which translates into a tendency to excessive suspiciousness, excessive sensitivity to setbacks, bearing grudges, refusal to forgiveness, and self-centredness. The patterns are inflexible because even hard evidence might not be enough for the person to change one's mind about an event.
Another type of personality disorder, which I think is on the increase, is the borderline personality disorder characterised by instability in interpersonal relationships, self image, confusing feelings and marked impulsivity. Another important feature of the borderline disorder is the problematic boundaries, which are often too lax. Such people may be very intrusive, have an all or nothing response, and have a skewed sense of love and loving. People suffering from such a condition cannot really empathise with others and may appear egoistic and demanding, because of the constant need of testing the limits of the others' love.
There are other conditions, of course, which one may have a look at on other sources, including the internet. What I want to emphasise here is the impact that personality disorders have on families and relationships, as well as the persons themselves.
For example, people suffering from personality disorders are more likely to suffer from alcohol and drug problems. In fact, the UK experiences the highest concentration of personality disorders within prison walls. My experience in local drug and alcohol services has similarly been marked by personality disorders in combination with alcohol and drug issues. Eating disorders have also been associated with personality disorders.
People with personality disorders suffer great problems in relationships too. It is very difficult for people to live with someone with a personality disorder, often because of the great demands and strain they put on the relationship. Because of this too, persons with personality disorder can have difficulties with long-term employment and friendships.
Because there is no specific psychiatric or psychological treatment for personality disorders, sufferers are likely to endure their condition for a long time. Symptoms can be treated individually and it is only recently that some form of psychological treatment has been developed. It requires clinicians to develop particular skills. For staff working with personality disorders, frequent supervision is a must as burn-out and turn-over rates are both quite high.
Because of its complexity, people with personality disorder and their relatives often don't realise there is a problem unless some of the most dangerous symptoms emerge, for example self harm. They may spend years of anguish and suffering before they are given a diagnosis. Sufferers themselves often don't accept the need for treatment and some relatives also refuse. This often leads to exhaustion and fatigue.
Another common result of personality disorder which goes unnoticed is separation. Personality disorder often squeezes relationships to their limit. When one partner changes over the years and the other sticks to old patterns of the relationship, it is quite obvious that the two will find themselves very distant to each other. Persons with personality disorder might have extreme reactions to problems, for example, threaten suicide. This might keep the other partner in place but only for a while.
Personality disorder is devastating and awareness is needed particularly for those who haven't still committed themselves to marriage. Understanding what personality disorder is becomes extremely valuable to those who live with people suffering from it. Seeking professional help is also important for both the sufferer and the relatives.
One last message is don't panic. What I find true is that when people read about some disorder they inevitably start identifying themselves in the disorder. It is not necessarily the case and professionals might clarify that for you. Unfortunately, this is the double-edged nature of knowledge!
• Dr Azzopardi is a systematic family psychotherapist.