Personality Disorder

Personality Disorder

Personality disorders are conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others.

NHS Website

We agree that sadly, there remains stigma in society generally against people with mental health issues. But many people who have a diagnosed mental illness are good parents. If you are worried about how your mental health will be perceived in care proceedings, you might be interested in our post about parents with mental health difficulties.  You might also find something helpful in our links and resources page

Until fairly recently, there were a limited number of identified ‘mental illnesses’ which were clearly defined and considered quite extreme. There has been a shift towards recognising as mental illnesses some less extreme and more subjectively defined ‘disorders’. There has been  an increase in identified mental disorders from from 106 in 1952, to 297 in 1994.

 

Debate over why and how we are diagnosed with a mental illness

This causes concern to some:

Such subjective “disordering” of what some might think “normal” behaviour already results in it being possible to diagnose more than a quarter of the population with some form of personality disorder and be at risk of losing their children…

The emphasis on ‘diagnosing’ a particular problem may mean we lose sight of what is happening for the person who is the subject of the diagnosis. As Dr Lucy Johnston said:

In essence, instead of asking ‘What is wrong with you?’, we need to ask ‘What has happened to you?’,” … Once we know that, we can draw on psychological evidence to show how life events and the sense that people make of them have led to the current difficulties.

However, its important to understand the implications of being diagnosed with a personality disorder – they  are often a feature of care proceedings as they can have a serious negative impact on how people parent.

It is clear that many parents find it difficult to understand what is meant by a ‘personality disorder’ or what they can do to change the way they think and act to make their lives easier and better.

 

What is a personality disorder?

‘Personality’ is the word to describe what makes us who we are – how we think, feel and behave. Personalities are usually developed by the time we are in our teens, therefore if someone is going to have problems with their personality, it often becomes noticeable around this time.

You may be told you have a ‘personality disorder’ if you have ways of thinking and acting that are getting in the way of you living your life happily. This is because the way you react to negative feelings or difficult times in your life, can make it difficult for you to form healthy and happy relationships with those close to you – such as your partner or your children.

Dr George Stein, a Consultant Psychiatrist at the Priory Hospital describes it in this way:

We all have a personality and some of us are odd; for example an eccentric and obsessional barrister might be considered ‘an abnormal personality’ in a statistical sense but this is not the same as a personality disorder. Schneider defined personality disorder as ‘an abnormal personality who brings harm to themselves and to others by virtue of their personality’.

They are a common mental health condition – about 1 in 20 adults in England is estimated to have a personality disorder. They can range in seriousness from mild to moderate to severe. A mild personality disorder may only cause you problems in times of particular stress and worry, and otherwise you may find little or no impact on your day to day life.

 

The Royal College of Psychiatrists describes it in this way:

For whatever reason, parts of your personality can develop in ways that make it difficult for you to live with yourself and/or with other people. You don’t seem to be able to learn from the things that happen to you. You find that you can’t change the bits of your personality (traits) that cause the problems. These traits, although they are part of who you are, just go on making life difficult for you – and often for other people as well.

Other people will often have noticed these traits from your childhood and early teens. For example, you may find it difficult to:

  • make or keep close relationships
  • get on with people at work
  • get on with friends and family
  • keep out of trouble
  • control your feelings or behaviour
  • listen to other people

Why do some people develop a personality disorder?

Probably both genetics and environment have something to do with this. If you had to grow up in a stressful or abusive environment as a child this may make you more vulnerable to developing a personality disorder later in life and this vulnerability could be increased by genetic factors.

 

Types of personality disorder

There are a number of different personality disorders . They are grouped into three ‘clusters’ according to the different traits people demonstrate.

  • Cluster A Schizoid/paranoid – people who are often isolated and withdrawn but not psychotic;
  • Cluster B Anti-scocial/borderline – more extroverted types who may be involved in crime or are emotionally unstable;
  • Cluster C Avoidant/anxious/dependent – not often seen in care proceedings.

Those whose personality disorder falls within Cluster B, such as those with  borderline personality disorder (BPD), are at serious risk of losing their children in care proceedings.  This is because the traits that identify them as suffering a BPD, such as explosive reactions to others, often mean they lack support from family or a partner.

BPD is not a particularly helpful label – it got its name because it used to be thought that people with this disorder were on the ‘borderline’ between neurosis (mentally distressed but aware of reality) and psychosis (finds it hard to distinguish reality and delusion).

Now it is agreed that a more helpful way of understanding borderline personality disorder is to look at it as a condition that causes problems with the way people feel and how they interact with others.

 

What’s the impact of a personality disorder on parenting?

Parents have described having a PD as very challenging, not just for them but for anyone they live or work with. Life can seem like a ‘battle’ everyday and people can feel empty and worthless, rejecting other people before they get rejected.

Children need safe environments from an early age to learn how to handle their own emotions. If a child doesn’t get that, he or she is more likely to grow up and develop abnormal patterns of behaviour. A study of prisoners with personality disorders showed that they reported adverse childhood experiences and victimisation more frequently than those who did not have a personality disorder (see the Journal of Forensic Psychiatry and Psychology vol 19 Issue 4 Dec 2008).

Minna Daum of the Anna Freud Centre described the impact on parenting in this way:

‘Personality disorder is a disorder of social relationships…Parents have had traumatic backgrounds where they have not been held in mind. They therefore feel unsafe in all their relationships. It is therefore a HUGE challenge to become a parent and enter a relationship that they cannot duck out of, or become angry and aggressive in’

What’s the impact of personality disorder on care proceedings?

Impact on working with professionals

The problems that parents with PD can have interacting with people can then be made worse if they have to deal with social workers who don’t know much about mental illness. If the professionals lack understanding, the parents can feel ‘put on trial’ – which is likely to make parents feel frightened, increase their defensiveness and block understanding and a good working relationship. Warmth and compassion are good traits for a professional to demonstrate when trying to build a relationship with a parent who has a PD.

One of our contributors describes it in this way:

Many people with a diagnosis of personality disorder manage well as parents. However, some parents with diagnoses of personality disorder do need some help. Most people with a diagnosis of personality disorder have a history of childhood abuse or neglect, and some may therefore need guidance in understanding how to keep their own children safe and cared for. Many people with a diagnosis of personality disorder struggle to manage relationships and emotions, and some may therefore need support in responding to the behaviour of their children. Some people with a diagnosis of personality disorder cope with stress in self-destructive ways such as by self-harm, substance abuse, eating problems or sexual risk-taking, and these people may need help in ensuring that their children are not affected by their behaviour. It is this latter category – those parents who are harming themselves, and whose children are witnessing them harming themselves or whose unborn children are affected by them harming themselves – who are most likely to attract the concern of professionals.

However, before allowing a Social Worker to remove a child from a parent with a personality disorder, the court must ensure that everything possible has been done to help and support the parent. In the past, personality disorders were regarded as ‘untreatable’ and some people with diagnoses of personality disorder may still be told they are ‘untreatable’: however, this attitude is now recognised as discriminatory and does not remove from statutory services the legal obligation to try and help. There is help and support available for people with diagnoses of personality disorder: treatments such as mentalisation-based therapy (MBT), dialectic behaviour therapy (DBT), cognitive analytic therapy (CAT) and therapeutic communities have been demonstrated as reasonably effective. Therefore, unless a person with a diagnosis of personality disorder is refusing all help, their Social Worker must do everything possible to find them the support they need before considering whether to take their children away.

These kind of cases may be ones where it is ‘necessary’ to instruct an expert to help the court understand what kind of help is available, how long it will take and how much it will cost.  See section 13 of the Children and Families Act 2014 which determines when the court can seek an expert report.

 

Impact on timescales – what happens in the care proceedings if I need treatment for PD?

It used to be thought that personality disorders couldn’t be treated and that most people would see an improvement in how they functioned as they got older. However, doctors now believe that personality disorders can be treated by either ‘talking therapies’ or medication.

People with personality disorders need help to change their maladaptive patterns of behaviour and to develop new ways of coping with stress. Often, acting impulsively is a problem. Dialectical Behavioural Therapy is recommended by the Department of Health; it’s a type of cognitive behavioural therapy which teaches skills to cope with stress, regulate emotions and improve relationships with others.

For further discussion about ways to treat BPD, visit the NHS website.

The big problem when personality disorders are part of care proceedings is that the treatment on offer might not be easily accessible via the NHS or it might be argued that successful treatment would take too long and your child cannot wait for you to complete the treatment. It is therefore very important to establish as soon as you can what is the nature and seriousness of your personality disorder and what treatment is available.

Funding for treatment is often  a problem. There is a helpful article here discussing funding options either through the NHS or the LA.

The Haven Project identified the necessary building blocks to engage with and help parents with PD.

  • a sense of safety and building trust
  • feeling cared for
  • a sense of belonging and community
  • learning boundaries
  • containing experiences and developing skills
  • identifying hopes, dreams and goals
  • achievements
  • transitional recovery

Anti depressants may help some people, particularly those with ‘explosive’ traits.

 

Further information, help and support

Association for Family Therapy and Systemic Practice –  members work with children, young people and adults, couples, families and individuals, enabling them to build on strengths and understandings and find ways forward in their lives.

Emergence – personality disorder website – aims to make life changing differences for everyone affected by personality disorders through education and support.

Counselling Directory- find a counsellor or psychotherapist near you.

Mind – mental health charity, providing advice and support to empower anyone experiencing a mental health problem. Campaigns to improve services, raise awareness and promote understanding.

Rethink Mental Illness – operating since 1972, helping people living with conditions like schizophrenia, bipolar disorder, personality disorders and more to recover a better quality of life.

Parental Mental Health and Child Welfare Network [2010] A report ‘Living with Personality Disorders, Supporting Better Parenting’.