Blog by Dr Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.
Co-author Dr Djuna Hallsworth, Peer Worker at One Door Mental Health djuna.hallsworth@onedoor.org.au.
Understanding personality disorders: types, impacts, and treatments.
The current medical approach views mental illness as being primarily located in the brain. More specifically, illnesses like schizophrenia, bipolar disorder and major depression are thought to arise from a chemical imbalance in the brain. Contemporary psychiatric approaches to treating these conditions often involve taking specific medication to address this imbalance. There is a role to play in activities like exercise, social interaction and psychological treatment such as cognitive behavioural therapy (CBT), but the essential approach may be termed “biogenetic”.
This biogenetic approach is, however, less suitable for understanding and treating personality disorders.There are ten personality disorders identified in the DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders). These are:
- Antisocial personality disorder
- Avoidant personality disorder
- Borderline personality disorder
- Dependent personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Obsessive-compulsive personality disorder
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
A summary of these disorders can be found here.
The differences between these conditions, and how they manifest across populations, sex, and age, remain quite ambiguous: categories and descriptions have changed greatly over time and continue to be revised, and terms like “narcissistic” and “antisocial” are often misused colloquially.1 The key characteristic underpinning all personality disorders is persistent, maladaptive patterns of thinking, relating and behaving which impact a person’s life.2 As personality disorders produce, by definition, thoughts and actions that are perceived to deviate from guiding cultural norms, they often affect a number of areas, from friendships to the workplace to one’s self-image. By the same token, people with personality disorders can be very good at “masking” and might function extremely well in certain areas while struggling in others.
It is unclear how many people in Australia are experiencing a personality disorder. The most recent national survey from 19973 estimated this figure as 6 per cent of the population, and suggested that obsessive-compulsive personality disorder is the most prevalent, though more recent estimates suggest that up to 6 per cent of Australians experience borderline personality disorder alone.4 Given that 2020-2022 National Study of Mental Health and Wellbeing5 excluded a number of conditions, including personality disorders, there is a clear need for more up-to-date data to ensure clinicians, communities, and people experiencing mental health conditions have adequate support.6
Although people with personality disorders may not see great improvement from medication, evidence suggests that behavioural therapy can be very effective.7 In fact, Dialectical Behavioural Therapy (DBT) was developed by a psychiatrist who had personally received a diagnosis of borderline personality disorder: Marsha Linehan. Linehan’s framework involves developing skills in key areas of functioning, including emotion regulation, interpersonal effectiveness and distress tolerance. Other forms of psychotherapy are thought to improve symptoms associated with other personality disorders as well, including:
- Psychoanalytic/psychodynamic/transference-focused therapy
- Cognitive behavioural therapy
- Group therapy
- Psychoeducation
Some people may think that these conditions may not be as “serious” as those treated by psychiatrists with psychopharmaceuticals, or that personality disorders are simply a problem with someone’s personality. For people who have lived experience of such a condition – as someone living the disorder, or a person close to them – the symptoms can be intense and debilitating. Crucially, though, personality disorders can be treated and people with these conditions do experience recovery.
The resources below provide some more information about personality disorders and their treatment:
https://www.headtohealth.gov.au/finding-help/personality-disorders
https://www.sane.org/information-and-resources/facts-and-guides
https://www.bpdfoundation.org.au/index.php
1https://www.abc.net.au/news/2024-08-05/the-rise-of-the-term-narcissist/104075888
2https://icd.who.int/browse/2024-01/mms/en#37291724
3https://www.mentalhealthcommission.gov.au/sites/default/files/2024-04/understanding-how-best-to-respond-to-the-needs-of-australians-living-with-personality-disorder_0.pdf
4https://www.bpdcommunity.com.au/static/uploads/files/prevalence-paper-wfezibxxitlm.pdf
5https://www.bpdfoundation.org.au/national-consensus-statement.php
6https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release#data-downloads
7https://www.bpdfoundation.org.au/images/Research/Grenyer%20et%20al%202017%20Personality%20Disorder%20A%20Mental%20Health%20Priority%20Area.pdf
8https://www.healthdirect.gov.au/personality-disorders