I generally feel uneasy talking about client’s problems using diagnosis, as I don’t think this necessarily helps clients make sense of their difficulties. However, I’m also aware that sometimes clients find comfort in receiving a diagnosis, something that instantly materialises their internal struggle; seeing their difficulties becoming real and “finally out”, not just in their head.
However, before start talking about Personality disorder let’s look at what we mean by personality. In Psychology, the term personality refers to patterns of thinking, feeling and behaving. Essentially what makes a person different from other people? An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. Personality disorder describes an individual’s way of thinking, feeling and behaving that are rigid, enduring, deviates from the expectations of the culture and causes distress or problems functioning.
There are many types of personality disorders, common to all of them is a long-term pattern of behaviour and inner experience that differs significantly from what is expected. Disorders of personality may begin in childhood; however, these are more frequently noticed by late adolescence or early adulthood when distress and problems in functioning become more apparent. Without treatment, behavioural and relational patterns and experience is inflexible and usually long-lasting. These patterns are seen in at least two of these areas:
Way of thinking about oneself and others
Way of responding emotionally
Way of relating to other people
Way of controlling one’s behaviour
In my experience, it’s rare for clients presenting in therapy complaining to have a personality disorder; more often the chief complaints include chronic feelings of depression, anxiety or feelings of emptiness or disconnection. Further regular complaints may include low self-esteem, interpersonal difficulties drugs and alcohol misuse, self-harming or other risk taking behaviour.
Possibility signs of a Personality disorder
Some signs that might point to the possibility of a Personality disorder may include the following:
A client, or a significant other reporting: “I/he/she has always been in this way” Persistent not compliance with the treatment, always signals a need for further exploration of personality traits.
Therapy coming to a sudden stop for no apparent reason.
The client appears totally unaware of the impact of his/her behaviour on others. Client’s reports response of others but fail to address any provocation or dysfunctional behaviour that they might contribute.
The client expresses interest and motivation to change but fails to follow through on agreed actions. The importance of change is acknowledged but the client managed to avoid making any actual changes.
The client’s personality problems appear to be acceptable and natural as if core part of who they are: “I always been like this”; “I can’t imagine being any other way”.
Due to the enduring pattern and complexity of personality disorders, the strategies needed to work effectively can be conceptualised as a tripartite approach aiming to address: cognitive distortions, dysfunctional behaviours and emotional dysregulation by using three components in treatment: cognitive, expressive and relational.
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