What are personality disorders?

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The term ‘personality trait’ refers to a person’s individual patterns of thinking, feeling, and behaving. These patterns of thinking and behaving usually begin in childhood and continue through to adulthood. Our personality traits make us who we are – they are what make each of us unique. However, personality traits can become problematic when they cause difficulties with relationships, education or employment, and sometimes with the law. If patterns of thinking, feeling, or behaving are creating lots of problems in many areas of a person’s life, they may have a personality disorder [10, 162].

Personality disorders are highly stigmatised conditions, even within mental health and healthcare more broadly. As such, it is vital that any communication regarding clients with possible personality disorders – whether the communication involves the client, loved ones or other healthcare providers – remains respectful, non-judgemental, compassionate and client-centred. As mentioned in the introduction of these Guidelines, the language used in this section and throughout this document is intended to provide workers with the functional knowledge to identify conditions and communicate with other areas of health (e.g., mental health services). As such, we have used diagnostic and classification terminology as included in the DSM-5-TR and ICD-11. However, we also make reference to resources that workers may find useful when communicating with their clients, or with broader audiences.

A wide range of personality disorders are currently recognised by the DSM-5-TR (see Table 17). All involve pervasive patterns of thinking and behaving, which means that the patterns exist in every area of a person’s life (i.e., work, study, home, leisure, and so on). The most significant feature of personality disorders is their negative effect on personal relationships. A person with an untreated personality disorder often has difficulty forming long-term, meaningful, and rewarding relationships with others. A person with a personality disorder may not necessarily become upset by their own thoughts and behaviours but may become distressed by the consequences of their behaviours [163].

AOD use disorders may cause fluctuating symptoms that mimic the symptoms of personality disorders (e.g., impulsivity, dysphoria, aggressiveness and self-destructiveness, relationship problems, work dysfunction, and dysregulated emotions and behaviour) making it difficult to determine whether a person has a personality disorder.

It is important to note that there is a great deal of contention as to the utility of the DSM-5-TR’s current approach to diagnosing personality disorders, and DSM-5-TR itself has proposed an alternative model for personality disorders (see Section III of DSM-5-TR; [10]) which is more aligned with the ICD-11 classification [164]. The ICD-11 approach first assesses whether a person meets general criteria for a personality disorder, establishes severity (mild, moderate, or severe), and then describes the main features that contribute to the personality disturbance based on trait domain qualifiers. These include negative affectivity, detachment, dissociality, disinhibition, and anankastia. A borderline pattern is also available, which corresponds to DSM-5-TR BPD.

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