Personality Disorders include a number of different ways people can think, feel, and behave very differently from the average person. People with personality disorders do not necessarily remain constant and stable with their personality and can fluctuate in mood and behaviour. Because of the symptoms of a personality disorder and the impacts on day to day life, other mental health problems such as depression, anxiety, and substance misuse can develop.
What types of personality disorder are there?
There are many personality disorders, but the most commonly diagnosed can be split into three main clusters:
Cluster A – Odd or Eccentric
- Paranoid – irrational suspicion, tend to hold grudges, interpret other people’s motivations as malicious
- Schizoid – lack of interest in things, social isolation, prefers own company, restricted emotional expression
- Schizotypal – discomfort interacting with others, distorted thoughts and perceptions, eccentric behaviour
Cluster B – Dramatic, Emotional, and Erratic
- Antisocial or dissocial – easily frustrated, impulsive, irresponsible, disregard for other people’s rights, no guilt
- Borderline – unpredictable, difficulty controlling emotions, fears of abandonment and isolation, fluctuating moods
- Histrionic – dramatic, over-reactions, changing emotions, self-centred, attention-seeking, easily influenced by others
- Narcissistic – self-importance, superior to others, arrogant, dreams of success, crave attention, envious of others
Cluster C – Anxious and Fearful
- Obsessive-Compulsive – perfectionist, rule-bound lifestyle, sticks to routines, restrained and rigid, desire to be in control, sensitive to criticism, conscientious
- Avoidant or anxious – very anxious or tense, hesitant, self-conscious, insecure, have to be liked or accepted, extremely sensitive of what others think about them
- Dependent – seek constant reassurance from others, submissive, a need to be taken care of by others, lack of self-confidence, fear of being abandoned
How does a personality disorder get diagnosed and treated?
It is not clear what causes personality disorders, but there are some known causes and triggers:
Causes may include:
- Genes inherited from parents
- Problems with brain development
- Childhood environment
- Neglect, physical abuse, sexual abuse
Triggers may include:
- Mental health problems
- Drug misuse
- Significant life events
- Relationship problems
- The death of a loved one
With professional support and the appropriate treatment plan, it is possible for a personality disorder to change and improve.
Somebody who believes they have signs of a personality disorder should go to their GP, who will then provide immediate care and refer for specialist assessment and treatment.
Professional treatment plans vary depending on the specific diagnosis. Usually, a community mental health team (CMHT) provide day to day support and treatment.
Treatment for a personality disorder can include medication and therapy. Therapeutic approaches include Dialectical Behaviour Therapy (DBT), Therapeutic Communities (TC’s), Mentalisation-based therapy (MBT) and Arts Therapies.
There are a few ways to determine a cancer diagnosis which requires reasonable adjustments:
- Even if the employee does not wish to, or have to, disclose their personality disorder, an employer can focus on making reasonable adjustments, rather than seeking to determine the precise disability their employee has.
- Given that mental health can fluctuate, regular communication with the employee who has a personality disorder, especially if they have only recently returned to work, is key.
What reasonable adjustments are possible with cancer?
Employers have a legal duty to make reasonable adjustments for employees with personality disorders if they know, are aware of, or could ‘reasonably be expected to know’ that the employee has, or has had, a personality disorder. Most employees will tell their employer what reasonable adjustments they need. They often involve simple changes in the way an employer might usually do things.
If the employee does not disclose a health issue or disability which may affect their performance upfront, an employer should broach the subject sensitively if they suspect that there may be a disability behind the employee’s reduced performance. Reasonable adjustments can then be made in accordance with the employee’s needs, including, in the case of cancer:
- Extra time to complete tasks to accommodate difficulties the person may have juggling work tasks and intrusive or anxious thoughts.
- A structured working day to allow the employee to concentrate more easily.
- Providing regular, sensitive feedback and reassurance, so that an employee with depression who may come across particularly vulnerable to criticism, or stressed in a work environment, can stay abreast of what they are doing well, or what they could improve on.
- Time off to attend appointments, so that the person can work on recovery while staying in work.
- Flexibility regarding working from home if the employee is having a particularly difficult period depression-wise and they would find it easier to work without the added commute, dress code, etc.
- Raising awareness so that colleagues understand the employee’s depression and can help ensure the employee feels comfortable at work. This might involve learning more about the condition to gain a better understanding of what the employee might be facing day-to-day.
Personality Disorder Signposting
Personality Disorder – a website with information and resources on personality disorders and those with a personality disorder.
Mind – mental health charity with resources and advice to support someone with depression and the impact this may have on their wellbeing (0300 123 3393).