Personality disorders: What to do if you suspect one

Does someone you know cause you emotional pain? Can anything you say or do be twisted against you? Are you the focus of intense irrational, aggressive behaviour and at other times perfectly normal behaviour? Are you lied to, bullied and manipulated? Does this person see things in black and white but nothing in between? Can you never do anything right? Are you and your point of view not valued? Are you accused of doing things you never did or saying things you never said? Are you constantly walking on eggshells? Do other people not believe you when you tell them this?

The person you are thinking of could have a personality disorder. It could be a loved one or a difficult person at work.

A personality disorder is where the personality traits of that person seem to cause problems, either for them or for others, in day-to-day activities and relationships. This person's personality traits could cause significant distress and disruption in their lives.

People with personality disorders must be diagnosed by a specialist psychiatrist. It is important for you not to make that diagnosis yourself just by reading this article.

People with personality disorders actually have no psychiatric symptoms but have abnormal behaviour in a situation of normal reasoning - your own reaction would be different to theirs in the same circumstances.

Symptoms of a personality disorder can start in early childhood or by late adolescence and are increased in times of stress.

The two most common types are borderline personality disorder and antisocial or psychopathic personality disorder.

Two per cent of the general population suffers from borderline personality disorders, compared with 10 per cent of mental health patients and 20 per cent of psychiatric hospital patients.

Some of the traits are mildly present in adolescence already - this is why it is dangerous for a non psychiatrist to attempt to make the diagnosis.

These unfortunate people have problems with relationships, their own identity, and control of emotions and behaviour. Some of them have recurring self harm or suicidal tendencies. They can have anger or depression, or both.

They can also have difficulty with impulsiveness and so end up spending too much, having too much sex, struggling with substance abuse, shoplifting, engaging in reckless driving and binge eating. They will often present with inappropriate or intense anger.

Because these people have a tendency to depression or substance abuse they can have a mortality of up to 45 per cent.

They often have real or imagined abandonment issues. Because they do not believe that they have a problem they will not tend to accept treatment and so these people are difficult to help.

The psychopath or antisocial personality disorder is known to have a gene associated with it. This gene will only lead to criminality in this person if they have also had an abusive childhood.

In this condition the brain chemistry is known to be affected. These people will be calm in response to a fearful situation and feel no emotions in response to situations like love or death. They do not feel guilt or empathy.

People with psychopathic personality disorders can be charming, articulate, amusing and witty - therefore they can present as a good con artist.

They can be selfish, ruthless and manipulative, callous, remorseless, self centred and have no conscience. A prominent recent example of this is Josef Fritzl, who imprisoned and enslaved his daughter.

These people do not care about their family and can even abandon them. When something goes wrong they will blame others, including their victims.

They can tell unbelievable stories, may brag, be arrogant and shameless. They are good at exploiting the vulnerabilities of others.

In some cases they crave increasing thrills and so they take risks like dangerous driving, extreme sports and violence.

Having said that, most are not violent and - as mentioned - can present as shady business people or con artists.

Many can appear forceful and confident because of intense eye contact and encroachment into your personal space. They can be excessive flatterers, larger than life and initially exciting.

People with psychopathic personality disorders can be criminal and form 25 per cent of the prison population.

The causes of personality disorder in general are genetic and upbringing influences.

The latter can include a stressful childhood and sexual or other abuse. Seventy per cent of personality disorders have a history of abuse/neglect/invalidation. Seventy per cent are female.

So, what can you do if you suspect a loved one or someone at work has this problem?

At work, if you suspect one of your co-workers is behaving abnormally, bullying people or seems to be excessively manipulative, it is important to keep a record of all the events and to get support from your manager or boss.

- Dr Frances Pitsilis
drfrances.co.nz