Personality Disorders and Their Impact — A Summary from the Personality Disorders Foundation

This summary of the impact of personality disorders was produced by the former Personality Disorders Foundation at the University of Connecticut.

The Impact of Personality Disorders

Many of us know someone with a personality disorder. They may have great difficulty controlling their impulses and emotions, and often have distorted perceptions of themselves and others. As a result, these individuals may suffer enormous pain and have significant difficulty functioning at home, work, and in relationships.

Families commonly endure episodes of explosive anger and rage, extreme depression (e.g., person rarely gets out of bed), self-mutilation (self-inflicted cuts and burns), and suicide attempts by family members with personality disorders. These individuals are often referred to treatment by loved ones who recognize a troubling pattern, or who have reached their personal limit in trying to cope with them.

Cynthia K is 37 years old, married, and the mother of two children. She experiences unstable moods, and has repeatedly cut herself, usually when feeling very stressed or abandoned. She often feels empty and bored. She has abused alcohol and drugs in the past. She is extremely sensitive to criticism, and angrily reacts to perceived rebuffs.

Individuals with personality disorders, particularly Antisocial Personality Disorder and Borderline Personality Disorder, are more likely to abuse drugs and alcohol. Use of illegal drugs and alcohol have been found to be closely associated with violent crimes, including murder, rape, assault, and child and spousal abuse. A 3-year study conducted by the National Center for Addiction and Substance Abuse of Columbia University showed that illegal drugs and alcohol contributed to the imprisonment of 4 out of every 5 inmates in our nation’s prison system. Over half of those individuals in the criminal justice system have severe personality disorders, particularly Antisocial Personality Disorder or Borderline Personality Disorder.

Stanley C is 46 years old, twice divorced, and currently unemployed. He has worked for most of his adult life, and at one time owned a business. Mr. C has a history of intense, unstable relationships, and has been violent toward his wives and his children. He experiences periods of rage and frequent fighting. Usually the fights are verbal, but occasionally they are physical. When a neighbor spoke to him rudely, he shot and seriously wounded his neighbor. Mr. C is in prison at this time.

People with severe personality disorders are high-cost, persistent, and intensive users of mental health services. One in every 20 individuals suffers with a personality disorder. Up to 10% of those in outpatient mental health treatment clinics have a personality disorder, and almost 15% of individuals in inpatient psychiatric care have a severe personality disorder.

Individuals with personality disorders usually present for therapy with presenting issues other than personality problems, most often with complaints of depression and anxiety. For example, among patients with Borderline Personality Disorder, major depression has been observed in up to 74% of these individuals, and Panic Disorder has been found to occur in 10% to 25% of these individuals.

Individuals with personality disorders are also more likely to have an eating disorder, or a history of significant trauma. About one-third of people who frequently use general health services (and for whom no clear medical diagnosis is found) have severe personality disorders.

Individuals with personality disorders are more likely to be stigmatized and blamed for their illness, relative to other psychiatric and medical disorders. Relative to other psychiatric disorders, personality disorders have been less understood and recognized, and treatment options and appropriate supportive housing have been less available.

Concerns about “stigmatizing” the client sometimes leads clinicians who recognize a personality disorder in a particular patient to not assign this diagnosis because the label “personality disorder” often suggests more frustrating challenges for the clinician. Significant problems with clinical management and treatment compliance often emerge. The length of treatment, frequency of treatment sessions, treatment strategies used, and goals and expectations for both therapist and patient need to be changed when a patient has a personality disorder.

Individuals with a personality disorder often require a longer time in treatment, and more energy and time from the therapist without the same rate of gain as with patients whose problems are not complicated by personality disorders. However, personality disorders are definitely treatable!

There has been an increase in research that clearly supports the underlying neurobiology of these disorders, and increased demonstrations of the effectiveness of different types of medications and psychotherapies. The linkages for treatment of substance abuse and personality disorders are growing, and programs for effective community diversion in the criminal justice system for non-violent personality disordered offenders are being established.

A century ago, tuberculosis, or “consumption,” was believed due to a “Consumptive Personality” until the tubercle bacillus and effective treatment was discovered. The opportunities for the treatment of severe personality disorders continue to evolve, but further steps are needed to improve access to currently available treatment both for those individuals with personality disorders, and their families. Additional early recognition/intervention programs and support for continued research into the neurobiology and treatment of personality disorders are also needed. In this way, individuals like Mrs. K and Mr. C can get the help they very much need.

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References

Beck, A.T., Freeman, A. & Associates (1990). Cognitive Therapy of Personality Disorders. New York: The Guilford Press.

Coccaro, E.F., & Siever, L.J. (1995). The neuropsychopharmacology of personality disorders. In F.E. Bloom & D.J. Kupfer (Chief Eds.), Psychopharmacology: The Fourth Generation of Progress. New York: Raven Press, Ltd.

Kirrane, R., & Siever, L.J. (1998). Biology of personality disorders. In A.F. Schatzberg & C.B. Nemeroff (Eds.), The American Psychiatric Press Textbook of Psychopharmacology (2nd Ed.). Washington, DC: American Psychiatric Press.

McGhee, D.E., & Linehan, M.M. (1997). Cluster B personality disorders. In D.L. Dunner (Ed.), Current Psychiatric Therapy II. Philadelphia: W.B. Saunders Company.

Stone, M.H. (1997). Cluster C personality disorders. In D.L. Dunner (Ed.), Current Psychiatric Therapy II. Philadelphia: W.B. Saunders Company.

Trestman, R.L., Woo-Ming, A.M., deVegvar, M., & Siever, L. J. (1998). Treatment of personality disorders. In A.F. Schatzberg & C.B. Nemeroff (Eds.), The American Psychiatric Press Textbook of Psychopharmacology (2nd Ed.). Washington, DC: American Psychiatric Press.

Young, J.E. (1999). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach (Third Ed.). Sarasota, FL: Professional Resource Press.

Zale, C.F., O’Brien, M.M., Trestman, R.L., & Siever, L.J. (1997). Cluster A personality disorders. In D.L. Dunner (Ed.), Current Psychiatric Therapy II. Philadelphia: W.B. Saunders Company.