Telehealth for Personality Disorders

Telehealth for Personality Disorders

Personality disorder (PD) is a type of mental disorder where a person thinks, behaves and interacts with others in a way that is different to what is expected by the cultural norms around them. Having a personality disorder can mean that it is difficult to build or sustain meaningful relationships, that a person isn’t able to adapt and fit into a community or that they struggle or experience distress with significant change in their life such as when moving or starting a new job. Personality disorders usually become noticeable in a person during adolescence. 

If your way of thinking, behaving and feeling is very rigid and causing you to have difficulties in everyday life it may be worth considering if you have a personality disorder. 


Types of Personality Disorders

There are several classifications for personality disorders with these disorders typically existing on a spectrum, like regular personality features, from insignificant to prominent. As a result of these disorders existing on a spectrum some people may exhibit only some symptoms of a personality disorder or they may display symptoms for multiple types of personality disorders.

One of the most common methods used to categorise personality disorders splits these disorders into three distinct "clusters." At the root of this classification is the definition that a personality disorder is a permanent and inflexible pattern of thinking that causes considerable suffering or impairment in day to day life. To be counted as a personality disorder there should be no evidence that the impairment is the result of substance abuse or another medical condition.

Cluster A (odd or eccentric disorders)

People suffering from this type of personality disorder are often described as having “strange” or “weird” ideas or behaviours:

  • Paranoid personality disorder: People with this disorder are suspicious and distrustful of others. They tend to consider other people's motives as harmful. They may be aggressive or emotionally disconnected.
  • Schizoid personality disorder: This disorder causes people to be uninterested in social connections and react unemotionally to social interactions.
  • Schizotypal personality disorder: This can cause a person to behave or dress strangely, have weird or abnormal views and beliefs, feel uncomfortable in social circumstances, and struggle to build intimate connections.

Cluster B (dramatic, emotional or erratic disorders)

This category is distinguished by unstable emotions and dramatic or impulsive behaviour. 

  • Antisocial personality disorder: this disorder can lead to disrespect for the law or the rights of others, as well as lying, theft, hostility, violence, or other criminal behaviour. A person with this disorder will typically not experience remorse for hurting others.
  • Histrionic personality disorder: people with this disorder are very emotional and theatrical, have an overwhelming desire for attention and acceptance. They may also be obsessed with their appearance.
  • Borderline personality disorder: this is characterised by a fear of abandonment, intense emotional outbursts, unstable relationships, wilful self-harm or self-destructive behaviour, and a fragile sense of self or identity.
  • Narcissistic personality disorder: presents as an excessive sense of self-esteem, a desire for adulation, a lack of empathy or care for others, and illusions of success, power, or beauty.

Cluster C (anxious or fearful disorders)

This category is distinguished by anxious and scared thoughts and behaviour as follows:

  • Avoidant personality disorder: People with this type of personality disorder avoid social connection and are particularly sensitive to unfavourable judgments from others; they may be shy and socially isolated, with feelings of inadequacy.
  • Obsessive-compulsive personality disorder: people with this disorder are focused on rules and orderliness, prioritising work above other parts of their lives. They are perfectionists and need to be in control of everything in work and life. This is not the same as obsessive-compulsive disorder (OCD).
  • Dependent personality disorder: This is characterised by a fear of being alone, a desire to be cared for, and trouble parting from loved ones or making autonomous decisions. People with this disorder tend to be passive and accept violent or dominant relationships.


Symptoms of Personality Disorders

The symptoms of personality disorder vary according to the type of personality disorder however, many of the symptoms of overlap.

Common signs of a personality disorder include:

  • strange or erratic behaviour
  • suspicion and distrust in relationships
  • taking risks
  • extreme mood swings (angry outbursts)
  • difficulty with relationships
  • problems engaging or achieving at school or work
  • need for instant gratification


It is important to note that as with any mental health disorder, many people will exhibit some of the symptoms and characteristics of a personality disorder without actually having one. 


Causes of Personality Disorders

The exact cause of personality disorder is not conclusively known. Scientific research suggests that there are a variety of potential causes and risk factors that may increase the likelihood of a person having a personality disorder.

In general, personality is created in childhood. It is defined by a mix of how you are born and your early childhood influences. There is therefore a connection of personality disorder with your genetics and childhood. People who have experienced childhood abuse, trauma, or neglect are more likely to develop a personality disorder. There are a range of genes that are responsible for different personality traits and at the moment research is insufficient to conclusively say which genes can create a predisposition to a personality disorder.


Diagnosis of Personality Disorders

Many people have many personalities and may behave a certain way without having a personality disorder. However if someone displays the symptoms in a way that is affecting their ability to form meaningful relationships, their ability to perform at work or succeed in other important aspects of work it is important to speak to a doctor. If you are a friend or family member seeing this behaviour in another it is important to encourage them to speak to a doctor. It is possible for a person with a personality disorder to be unaware that their behaviour is unusual or causing them everyday difficulties as the behaviour or way of thinking seems normal to them. Be gentle when recommending that another person seek help.

To diagnose a personality disorder a doctor may inquire about current symptoms and behaviours, ways of thinking, previous mental health concerns, family history of mental health, experience in relationships, medical history, and any drug or alcohol problems. The doctor may also perform a physical examination and blood tests to rule out any medical concerns. They may require additional evaluation or therapy from a psychiatrist or psychologist if they think it is necessary.


Treatment of Personality Disorders

The end goal of proper treatment and support for a personality disorder is to help a person learn to control unhelpful symptoms in order to be able to maintain healthy relationships, and have a meaningful and rewarding life. Learning to trust a doctor or therapist might be challenging for someone with a personality disorder however establishing a solid relationship with a healthcare professional is a vital step towards treatment. The type of treatment will differ depending on the type of personality disorder and any other disorders that may also be present. 

Common forms of treatment:

  • Psychotherapy. This involves working with a psychologist, psychiatrist, or psychotherapist to understand the patients ideas, motives, and feelings in order to develop strategies to assist in managing symptoms and reducing unhelpful behaviours. Some specific methods include:
    • Cognitive behaviour therapy (CBT)
    • Dialectical behaviour therapy (DBT)
    • Psychodynamic psychotherapy
    • Psychoeducation
  • Medication. There is no specific medication for the treatment of personality disorder but some types of medication such as antidepressants, antipsychotics or mood stabilisers may be beneficial for managing symptoms. Medication typically works best when combined with psychotherapy.
  • Group, family or couples therapy. This may use psychotherapy techniques and aims to maintain healthy relationships due to the additional strain that a personality disorder may create in understanding others ways of thinking or behaving.
  • Crisis management. In some cases people with a personality disorder may have difficulty coping with stressful circumstances and may require assistance in a crisis. For example a person with a personality disorder may develop suicidal thoughts and behaviours and require hospitalization or other in-patient treatment to assure they are not an immediate danger to themselves. Crisis management is not usually an effective long term treatment. 

If you think you might be suffering from a Personality Disorder or are in need of a mental health professional to help you in your treatment give us a call at Inner Psych today. Our professionals can provide a comprehensive online assessment of your condition and personalise an ongoing treatment to help you take back control of your life.

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