"Could we start calling them trauma responses and not personality deficits?”
― Dr. Nicole LePera
COMMON PERSONALITY DISORDERS
For a lot of the suffering of human life, the cause or name may not always be found and need not be found. Personality disorders refer to deep-rooted and long-term behavioural patterns that can be severely disruptive and harmful in a wide variety of life situations. These behaviours differ from the expectations of the cultural environment of how to perceive, think, feel, and especially relate to other people. In personality disorders, social and professional functioning is often at a sub-optimal level. Therefore in some cases it might be beneficial to name the suffering in order to find effective ways of coping and overcoming daily recurring barriers.
The currently identified personality disorders are divided into three categories.
F60.0 Suspicious (paranoid) personality
F60.1 Isolated (schizoid) personality
This group is characterized by an intermittent decline in the person's sense of reality. A suspicious personality is manifested by very suspicious and at times almost paranoid mindsets, as well as unforgivingness. If this personality disorder makes it difficult to cope in social relationships, for example in working life, it is worth seeking treatment. Again, the isolated personality is characterized by the client's self-undisturbed withdrawal and disinterest in human contact. Symptoms can be severe and significantly interfere with daily coping.
F60.2 Antisocial personality
F60.3 Borderline personality disorder
F60.4 Attention-seeking personality disorder
This group is characterized by repeated conflicts with society and / or loved ones. The disorder can cause suffering to those close to you and the environment, and often help is needed for anxiety or depression caused by interpersonal conflicts. An antisocial personality is characterized by impulsivity as well as disregard for law and morality, due to which he is easily exposed to conflicts with everyone. A borderline personality on the other hand, includes difficulty to regulate moods and commit to plans as well as presenting high impulsivity, which often results in relationship turmoil and depressive symptoms. An attention-seeking personality seeks to gain attention through a variety of means, and exposes itself to relationship conflicts or even bodily symptoms.
F60.5 Demanding personality
F60.6 Inhibited personality
F60.7 Dependent personality
F60.8 Other Personality Disorder
Personality disorders in this group most often cause anxiety and depression symptoms to the patient, narrow the life span, and may also lead to underachievement in life. The demanding personality approaches obsessive-compulsive disorder and manifests itself in perfectionism, punctuality, and stubbornness, among other things. An inhibited personality is characterized by a tendency to organize life in a way that avoids social contacts and talking about personal matters. The person is reserved and distant in human relationships, suffers from constant feelings of inadequacy, and is hypersensitive to criticism. This disorder is highly underdiagnosed as they all are. The dependent personality needs support in even small life tasks and decisions and is at the mercy of the approval of others just like demanding personality in part but for different reasons. In narcissistic personality (under "Other Personality Disorders"), the goal is to gain appreciation, and is often marked by unrealistic notions of one's own abilities. The narcissistic personality is characterized by different fantasies of greatness, a strong need for admiration, and lack of empathy. A person feels entitled to special treatment, is jealous or arrogant, and can exploit others unscrupulously. People with narcissistic personality disorder are often perceived as cold, although they may at first seem warm or even charismatic. Narcissistic personality disorder is a kind of long-term disorder of the self-esteem and self regulatory system. Other disorders listed under "Others" include immature personality, passive-aggressive personality and psychoneurotic personality.
We can all experience difficulties with our relationships, self-image and emotions. Common to all personality disorders are debilitating disruptions in at least two of the following areas of life: conscious behavior, emotional life, impulse control, and interpersonal relationships. At the cognitive conscious level, it translates into how a person perceives and interprets things, people and events, what are his or her attitudes toward other people, and how he or she forms images of him or -herself. Emotional-level difficulties are reflected in the range of emotional life, it's intensity and appropriateness of expression. Impulse control refers to how well a person is able to control his or her various stimuli and behaviors, as well as how well he or she endures frustrating situations.
The disorders usually begin in childhood or adolescence and continue through adulthood. There is a strong link between sub-optimal emotional growth conditions in childhood and the developing of personality disorders. The effect of an invalidating emotional environment has been identified as particularly harmful on a child's psyche, and the child begins to formulate alternative inner perceptions, working models and strategies in order to feel safe.
WHEN YOUR NEEDS ARE NOT MET
Early maladaptive schema refers to a theme or pattern originating in childhood and recurring in adulthood that includes memories, emotions, thoughts and bodily sensations related to oneself or interaction with others. Early maladaptive patterns arise when a child’s core emotional needs have not been adequately met. Core needs include the need to feel safe and loved, and to receive adequate care, attention and acceptance. In a positive growth environment, the reactions of parents and caregivers are consistent and predictable. To develop into a healthy adult, a child needs the empathy, guidance, and protection of his or her caregivers. It is important that his feelings and needs are validated, taken seriously and their relevance is confirmed and demonstrated in real time. In a way the child is shown how to take up space in this world. A child who has received too little emotional care, understanding, guidance, and protection from his or her caregivers, likely develops a maladaptive; that is: harmful, emotional deficit. He or she often experiences emptiness and loneliness, and feelings of not being liked by others. He or she tries to protect themselves from these painful feelings and beliefs by building alternative coping strategies that more often than not, are also maladaptive.
When a person is threatened by some danger, he tries to survive by fighting, fleeing, or surrendering. When a person's experience in his or her current life situation evokes his or her childhood maladaptive adjustment scheme, the coping strategies associated with it become active at the same time. It has been suggested that personality disorders might also simply be called trauma responses. In adulthood, the strategies of adult survival are needed, not those that made survival possible in childhood. These patterns are identified in therapy and re-imagined to better meet current needs, similarly to trauma therapy.
How Therapy for Personality disorders Can Help
The point in schematic work is to address the pain of the inner child and strive to create alternative effects that his or her maladaptive schemas have in his or her daily functioning. Often there's profound imagery work involved, in which I as your therapist will act as your healthy adult self, consoling and caring for you in a way that you should have been cared for as a child. Your inner child work flows according to your internal modes that, beyond your wounded child, can also manifest as eg. boundary-seeking impulsive child or opposition-seeking punitive parent. With practice, you will be able to apply what you have learned in therapy to the rest of your daily life and experience living more from your authentic self.
In Dialectical Behavioural Therapy, change-centered work involves the simultaneous acceptance and understanding of a person's symptoms, as well as the active enabling of change through awareness and -skill training. DBT is found especially useful in group settings, which we can also refer to in order to complement individual therapy when needed. Generally, the goal of therapy in personality disorders is mostly the same as with any other disorder: to enhance your psychological well-being, overall quality of life and relationships.