DIAGNOSIS AND TREATMENT FOR PERSONALITY DISORDERSThe behaviours, experiences and feelings associated with Personality Disorders often appear in adolescence, reaching a peak in late adolescence or early adulthood.
What is a Personality Disorder?
Our personality makes us unique. An expressive part of ourselves that is thinking, feeling, doing and expressing. It is what makes us different to others and helps us to connect in relationships.
Our experiences develop over our life time. They are influenced by many things, our families, our experiences, our exposure to traumatic events, our education, our experiences of others, our home and our families. We are also greatly influenced by our genetic make-up or the parts of us that are inherited at birth. We are also influenced by our culture and the rules or norms that we have developed within. A Personality Disorder is a way of thinking, behaving and feeling that causes distress and difficulty functioning. Personality Disorders are evident in patterns of behaviour and internal experiences that cause long lasting distress, upset and social concerns.
Personality Disorders and Young People
The behaviours, experiences and feelings associated with Personality Disorders often appear in adolescence, reaching a peak in late adolescence or early adulthood.
Personality Disorders will affect at least two of the following areas:
- The way I think about myself and others.
- The way I respond emotionally.
- The way that I interact and relate to other people.
- The way in which I control my behaviour.
Sometimes, parents, families, partners and educators may notice difficulties and attribute them to usual young adult development. Personality Disorders are enduring and very different from the exploration and refining of personality that is apparent during early adulthood.
It is sometimes difficult for the young person or adult with symptoms to reach out for help. Often, symptoms have been developing for a long time prior to treatment. Treatment by a team of psychiatrists, medical professionals and therapists can help with both symptoms, management, and functioning. The Wave Clinical Team are available to help and advice on appropriate treatment options.
What are the type of Personality Disorders?
There are ten types of Personality Disorders. All ten share some features, particularly around functioning and difficulty ‘fitting in’. In other ways they present very differently. When you arrive at The Wave, we will help you to explore both the background and pattern of your behaviours, thoughts and feelings. This will help us to understand how your Personality Disorder affects your day to day functioning and offer the most appropriate help.
- Antisocial Personality Disorder
- Avoidant Personality Disorder
- Borderline Personality Disorder
- Dependant Personality Disorder
- Narcissistic Personality Disorder
- Histrionic Personality Disorder
- Obsessive-compulsive Personality Disorder
- Paranoid Personality Disorder
- Schizotypal Personality Disorder
- Schizoid Personality Disorder
What Causes Personality Disorders?
There is no one cause of Personality Disorders. Whilst research continues, we can see that both genetics and environmental factors may play a significant role in the development of the symptoms that present together. Current research is continuing to explore the links between Childhood Trauma (Trauma), Childhood Abuse (verbal, physical, sexual and financial), bullying, unstable environments, family breakdown, multiple changes to the environment (schools, carers, home, mental illness in the family and drug and alcohol use in the family home.
Those with personality disorders often have a difficult time accepting responsibility or for feelings and behaviours. Sometimes they will blame others for their problems. It is important to remember that there is help available and remaining stuck in the problem is a choice. Treatment is available to help.
Personality Disorders present with the following signs and symptoms.
Whilst not all of them may be present, if more than three are evident, you should seek the advice of a mental health professional.
Up to 15 % of gamers meet the World Health Organization’s criteria for gaming addiction. If a person struggles to control how long and how often they spend gaming; prioritizes gaming over healthy activities like sports, spending time with friends and self-care; and continues these behaviours despite negative consequences, she or he is struggling with a gaming addiction.
Affecting at least 8% of the population (some reports suggest a staggering 38%), internet addiction is defined when excess use interferes with daily life, whether that’s work, relationships or school. This can encompass social media use, smartphone use, gaming, online shopping, online dating and/or online gambling.
Sex and Relationships
Using prostitutes; obsession with online dating apps, porn or sex games; chemsex parties; compulsive masturbation; and/or frequent engagement in casual sex with multiple partners: these behaviours all equate to intimacy disorders and can all cause severe physical and mental health issues.
Process addictions are made up of a compulsive behaviours that can be related to any area of life; from internet to exercise, food to gambling. They share many similarities with other addictive behaviours including substance use. The process or behaviour causes a temporary high or relief from the discomfort or unpleasant internal feelings and sensations. Process addictions can be seen alongside other mental health disorders and addiction to drugs and alcohol.
If a person struggles to limit money or time spent on online or offline gambling, poker, the use of casino apps, and/or sports betting, leading to difficulties for themselves, their loved ones or their community, they have a gambling addiction
When using pornography becomes compulsive and you continue to engage despite negative consequences on your relationships and life; it can be seen to follow a similar pathway to many other addictions. Compulsive use, obsessive behaviours and a desire to engage in pornography for extended periods of time. Engaging, despite using interfering with other aspects of your life or prevents you from engaging in ‘real world’ relationships or tasks can cause significant problems at home, in relationships and at work. Cravings to use maybe similar to those experience in addiction to drugs and alcohol, with impaired control making attempts to cut down use or control the activity fail despite many attempts. There may be increased isolation as use increases; further damaging relationships.
Borderline Personality Disorder
- Rage and uncontrollable anger
- Frequent mood changes
- Unstable self-image
- Difficulty in relationships
- Suicidal thoughts, gestures and actions
- Fears of Abandonment or rejection
- Unstable personal relationships
- Fear of others, some paranoia
- Feelings of being disconnected from your body
- Food and Body image issues
- Self-Harming Behaviours
Anti-Social Personality Disorder
- Lack of concern, remorse of or regret for distress in others
- Difficulty in long term relationships
- Seems unable to learn from mistakes
- Anger and Rage
- Braking rules, laws and violating the space of others
- Conduct Disorder is adolescence
- Irresponsible, disregarding social norms
- Manipulate, exploit or violate the rights of others
Histrionic Personality Disorder
- Shows disdain if not the centre of attention
- Provocative dress, inappropriately seductive and flirtatious
- Rapid changes in emotional states
- Dramatic responses where one appears to be acting as if on stage, inauthentic or shallow
- Overly concerned with physical appearance
- Needs reassurance and approval from others most of the time
- Easily influenced and may not use appropriate reasoning
- Feels before thinking
- Self-centred and can ignore the needs of others
- Suicidal thoughts and discussions with others
- Difficulty maintaining relationships
Narcissistic Personality Disorder
- Grandiose. A heightened sense of self importance
- Fantasies of power, brilliance, beauty, fame or money.
- Belief that they can only associate with or be understood by others who are equally important
- Need for excessive admiration
- A sense of entitlement
- Exploitative of others and situations
- Lacks empathy
- Jealousy or Envy or believing that they are envied by others
- Arrogant, dismissive or disinterested in others not perceived as special.
Dependant Personality Disorder
- Difficulty in decision making.
- Feels that others need to provide reassurance most of the time
- Does not assume responsibility for actions or decisions
- Difficulty initiating projects and tasks
- Goes to great lengths to receive support from others
- Dislikes being alone
- Preoccupied by fears of having to take care of one’s self
- Replaces relationships that end quickly and can become preoccupied with doing so
- Find it hard to voice opinions that may disagree with others
Obsessive-Compulsive Personality Disorder
- Preoccupation with orderliness, perfection and rules
- Lack of flexibility and spontaneity
- Controlling behaviours of self and others
- Rigid with self and others
- Difficulty expressing feelings
- Difficulty forming and maintaining relationships with others
- Social isolation
- Anxiety, depression, anger
Paranoid Personality Disorder
- Reluctant to trust others
- May feel threatened by others, deceived or cheated
- Unforgiving and hold resentments for long periods
- Find it difficult to accept other’s viewpoints
- Suspicious of those close to them
- Having difficulty relaxing
- Prime to stress, anxiety and depression
- Act with anger when they feel personally under attack
- Read or look for hidden meanings in ordinary situations
Avoidant Personality Disorder
- Low self esteem
- Avoiding situations that require social interaction
- Fears rejection by others
- Feels inferior to others
- Difficulty making relationships or connecting with others
- Avoiding conflict - people pleasing
- Avoiding intimate relationships
- Fearful of ‘getting it wrong’
Schizoid Personality Disorder
- Prefers own company, avoids activities or interaction with others
- Difficulty experiencing pleasure
- Emotionally flat. May seem cold or emotionless to others
- Lack of motivation or direction
- Little desire for intimate or sexual relationships
- Little desire for close or romantic relationships
- Difficulty accepting praise from others
- Finds humour difficult to understand or engage in
Schizotypal Personality Disorder
- Prefers to be alone. Small social circle outside of family
- Difficult interpretation of events and situations. May find personal meaning where there is none.
- May be describes as eccentric, or have unusual mannerisms or beliefs
- May be seen to be dressed in an unusual manner.
- Believes in special powers; telepathy or superstitious beliefs.
- May ’sense’ things, such as the presence of unseen others
- Social anxiety
- Vague, unusual or tangential speech patterns
- Limited emotional responses
- Suspicious or paranoid, dousing the motives of others
Treatment for Personality Disorders at The Wave.
Treatment programs at The Wave have been created for young adults, teenagers and families who have been living with affects or traits of Personality Disorders. Often families approach The Wave when other treatment methods or residential treatments have been unsuccessful. The Wave has an enviable record for reaching those young people for whom other treatment modalities have failed to help. Treatment for Personality Disorders and the associated symptoms, together with other mental health conditions that can often be present alongside Personality Disorders; depression, anxiety, self-harm, eating disorders or food and body issues, anger, rage and addiction can be a slow process. The Wave will help you to understand your objectives and plan goals for treatment and beyond. Residential Care is often recommended for the treatment of personality disorders which can affect the ability to function in daily life task, relationships, home, work and education.
The Treatment Programs at The Wave have been designed by Therapists with a specialist interest in Personality Disorders. The Therapeutic Day provides a variety of opportunity to work through both current and past issues, in group and individual sessions. Working with Young Adults, teenagers and families is our passion.
We understand the needs in treatment of young people and have ensured that our treatment programs fulfilled the unique challenges face by this age group. Opportunities to explore creative therapies, Art, Dance and Drama with our master’s Level creative and expressive Arts Therapy team or Animal Assisted therapy, exploring responsibility, care, compassion and connection at the stables or on veterinary management programs. The week is varied with team building activities centred around therapeutic goals, structure and care, all taking place in a nurturing environment.
- Dialectical Behavioural Therapy (DBT)
- Cognitive Behavioural Therapy (CBT)
- Interpersonal Therapy (IPT)
- Internal Family Systems Therapy (IFS)
- Family Focused Therapy
- Animal Assisted Therapy
- Expressive Arts Therapy
- Psychodynamic Psychotherapy
Our Treatment Programs offer an intensive approach to care. With the support of our resident psychiatrists and nursing team, we are able to review any current medication and support you to establish a medication plan which works to alleviate your symptoms. Whilst there are no FDA approved medications for Personality Disorders and there is no ‘cure’, there are many medications that can work to reduce some of the most unpleasant or prominent symptoms.
Antidepressants - Can prove to be helpful for the feelings of anger, irritability, hopelessness and depression often described alongside Personality Disorders. SSRI’s and Tricyclic antidepressants are some of the most commonly used for managing symptoms.
Antipsychotic Medications- Sometimes antipsychotics can help if there is an indication of loss of reality (Psychosis). They can also be useful in instances where there has been a history of self-harm or where other severe mental health conditions run in tandem.
Mood Stabiliser Medications - Medications known was mood stabilisers are often used where there are traits of Personality Disorder or a diagnosis made by a medical professional. These medications can help with many of the symptoms seen in Borderline Personality Disorder, particularly, irritability, mood swings, rage, volatility and some impulsive behaviours.
Anti-Anxiety Medications - Always prescribed with care and to be taken under the guidance of a medical professional. Anti-Anxiety medications can be useful in the management of personality disorders; however, they are highly habit forming and will need to be managed by a Psychiatrist. Due to the risk of addiction these may not be prescribed for young people with cooccurring substance use disorder or those who have reported issues with addiction in the past.
Prescription medication often provide some temporary relief from the symptoms. However, they should always be used under the guidance of a medical provider. Medication in conjunction with intensive Psychotherapy. DBT, CBT, Art Therapy, Equine Therapy and Group Therapy have all shown to be effective in the treatment of personality disorders. Our Young People are given the opportunity to take part, give back through service to others and learn skills for living life to the full.
Outpatient Personality Disorder Treatment
The Wave Psychiatry and Psychotherapy offers regular clinics for the treatment of Personality Disorders in the community. Our Psychiatrists with a specialist interest I Personality Disorders are able to provide regular outpatient appointment for those who live within travelling distance of our central Kuala Lumpur Clinic.
Our International Team of therapists are also available and schedule both group and individual sessions on an outpatient basis. This service is also available to our Secondary Care Clients.
Secondary care is transitional living, for those who have completed at least 12 weeks of primary care treatment either at The Wave Kuala Lumpur or at a treatment centre, hospital or facility able to provide a referral letter recommending transitional care/supported living.
Don't suffer alone
We often see personality disorders and drug and alcohol use appearing at the same time. Sometimes, young people will attempt to quash the uncomfortable experiences and feelings by numbing them with substances or using substance to alleviate some of the anxiety or fears that can be associated with many types of personality disorders. Unfortunately, this often has pronounced negative consequences. Treatment for substance use disorder and Personality Disorder are usually treated together in residential treatment settings.
Young People with Borderline Personality Disorder are at an increased risk of completing suicide. Gestures, talk, thoughts or threats of suicide should never be ignored. Assessment by a mental health professional is essential and treatment should begin as soon as possible.
Behaviours that present in conduct disorder are often described by professional as antisocial behaviours. Indeed, conduct disorder can often be the precursor to antisocial personality disorder, if it remains without treatment. A diagnosis of Anti-Social personality Disorder cannot be made until the period following the 18th birthday. Therefore, conduct disorder may have been diagnosed at an earlier point.
Whilst there is no definite answer, we are able to conclude from current research that Personality disorders along with other mental health concerns do appear to have a genetic link. In most mental health conditions, the risk of developing mental health problems increases if a close family member has also been diagnosed previously.
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Recovery is not a journey that should be taken alone.
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