We have repeatedly emphasized in our previous articles: as long as proper treatment is undergone, the vast majority of mental illnesses can be well controlled, and even reach clinical cure.
Therefore, mental illness itself is not actually scary, what’s frightening is when mental illness collides with personality disorders, which escalates the difficulty of treatment for the illness.
So, the question arises—
What is a personality disorder?
Personality, also known as character, refers to a person’s fixed behavioral patterns and habitual ways of dealing with and relating to others in daily activities. A person with a healthy personality often has the correct values, is optimistic and proactive, friendly to others, has empathy and a sense of responsibility, can calmly analyze situations and handle them sensibly.
On the other hand, individuals with personality disorders have noticeably deviated cognitive, thinking, and behavioral patterns from the norm. Therefore, they appear out of sync with their environment, causing chaos in interpersonal relationships, making themselves and those around them feel very distressed.
There are many types of personality disorders. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies them into paranoid, schizoid, schizotypal, borderline, antisocial, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive types, each with different characteristics.
Research both domestically and internationally shows that the co-occurrence of mental illness and personality disorders in an individual is relatively high.
Borderline personality disorder has a lifetime comorbidity rate as high as 82.7% with mood disorders.
Avoidant personality disorder has a comorbidity rate of 32.3% with depressive disorders.
The “combination” of mental illness and personality disorders can become a “roadblock” on our path to recovery.
Encountering a personality disorder is a big problem!
Personality disorders can have negative impacts on the treatment and prognosis of mental illnesses:
Personality disorders can affect:
The treatment compliance of individuals with mental illnesses
Due to the lack of understanding of personality disorders, many individuals are unaware that they are unwell. They mistakenly consider their unusual behaviors and thought patterns as a display of “personality,” so individuals with personality disorders often seek medical help infrequently.
Even if some patients seek medical help, due to their character traits such as being “sensitive and suspicious” and prone to impulsivity, they may not follow the doctor’s instructions for effective treatment. When the treatment outcome is unsatisfactory, they may blame the doctor, believing the doctor’s competence is at fault, leading to frequent changes in doctors and ineffective implementation of treatment plans, ultimately reducing the treatment efficacy.
Personality disorders and mental illness
When present together, the severity of a patient’s symptoms increases
Studies have shown that compared to psychiatric patients without personality disorders, comorbid patients experience more severe symptoms and higher levels of social impairment. The more severe the social impairment of patients with mental illnesses, the more challenging the treatment becomes, often requiring a longer treatment duration.
In conclusion, the presence of a personality disorder alongside a mental illness increases the difficulty of treatment. If you or a family member’s condition is continuously unresolved, especially when displaying emotional instability, impulsiveness, and suspicion simultaneously, consider the possibility of co-occurring personality disorders.
How to determine if it’s a personality disorder?
Various mental illnesses have their preferred types of personality disorders.
Schizophrenia is often comorbid with schizoid and paranoid personality disorders.
Depressive disorders are commonly comorbid with borderline, dependent, and obsessive-compulsive personality disorders.
Panic disorder in anxiety disorders is often comorbid with obsessive-compulsive and paranoid personality disorders.
Next, let’s take a look at the characteristics of these personality disorders~
Paranoid Personality Disorder
Main features: Paranoia, hypersensitivity
In the eyes of others, individuals with paranoid personality disorder are often extremely stubborn and rarely heed others’ opinions. In interactions with others, they exhibit mistrust and suspicion, easily misinterpreting others’ goodwill as malevolent intentions, constantly suspecting others of intending harm or deception, with baseless suspicions of infidelity in their partners and placing restrictions on their interactions with the opposite sex.
Borderline Personality Disorder
Main features: Emotional and behavioral instability, unstable interpersonal relationships
Individuals with this disorder often experience erratic mood swings and unpredictable behavioral changes. From one moment being involved in endless arguments, to the next moment feeling depressed, such emotional volatility is usually overwhelming for others.
Their perceptions of interpersonal relationships are also unstable; one day they see all your strengths, the next day they see only weaknesses and have no respect for you. However, they are usually afraid of being abandoned and cannot bear loneliness, thus desperately seeking companionship.
Additionally, these individuals often act impulsively without planning, and they disregard consequences.
Obsessive-Compulsive Personality Disorder
Main features: Excessive meticulousness, perfectionism, lack of security
Individuals with obsessive-compulsive personality disorder are excessively concerned about details and demand high standards for everything. They repeatedly check and verify their plans, fearing any oversights that might undermine the completion of their tasks on time.
These individuals prioritize work outcomes excessively, without considering their own gains or others’ feelings. When collaborating with others, they often insist that tasks be done strictly according to their methods. If they hold leadership positions, they tend to micromanage, lacking trust in others’ abilities.
Statistics show that about 70% of patients with OCD had obsessive-compulsive personality disorder before their illness.
Dependent Personality Disorder
Main features: Excessive reliance, fear of abandonment, low decision-making ability
Individuals with dependent personality disorder often feel anxious and helpless when alone, fearing being abandoned by close relations. They refrain from making reasonable requests to the individuals they depend on. In the eyes of others, they lack independent judgment, requiring assistance in making most major decisions.
Split Personality Disorder
Main features: Emotional detachment, chaotic interpersonal relationships
Individuals with split personality disorder exhibit a propensity for schizophrenia. They prefer solitude, enjoy isolation, have few close relationships, and are indifferent to both praise and criticism from others. Their ideas often diverge significantly from mainstream and subculture norms, leading them to wear unconventional attire and behave inappropriately.
Of course, determining whether someone has a personality disorder cannot solely rely on these symptoms, requiring the judgment of a professional healthcare provider. Even if someone is diagnosed with a personality disorder, there is no need for excessive concern; as long as we follow the doctor’s guidance, progress patiently and systematically during treatment, we can believe that good treatment outcomes are achievable in the end~
References:
[1] Hao W, Lu L. Psychiatry (8th Edition). Beijing: People’s Medical Publishing House.2018.
[2] Pu Lirong, Wang Min, Li Zhixiong, et al. Research Progress on Borderline Personality Disorder and Co-occurrence of Mental Illness. Chinese Journal of Neurology and Psychiatry, 2019, 45(4):4.
[3] Cai Yanyu, Zhong Yuanhui, Fu Meihua, et al. Investigation of Co-occurring Personality Disorders in Homeless Psychiatric Patients. Chinese Journal of Health Psychology, 2016.
