Tag Archives: personality disorder

Myth#5 People with personality disorder aren’t really ill

Welcome to my mini series of myth busting blogs, this one is all about personality disorders. Find links to the others at the bottom, please read and share, we need to break down these inaccurate beliefs in order for people with mental illness to stop being discriminated against.
Let’s set this one straight immediately – Personality Disorders are listed as mental illnesses in the DSM 5 and the ICD 10 – the 2 most widely used diagnostic manuals.
Personality disorders (PD) are unique and highly misunderstood, this leads to people receiving poor treatment and falling through the gaps in services.
Even mental health institutions are getting this one wrong when they say things like “treat patients with enduring mental illness and personality disorder”, this says personality disorders are separate from mental illnesses. This is taken directly from the details of a hospital site:

I understand it’s important to mention it specifically as there are lots of places who would support people with mental illness and complex care needs but would not admit people with personality disorder, however, this would be simple to fix, they could put “…complex care need INCLUDING personality disorder”.
There are 10 classifications of personality disorder which fit into 3 clusters, they each have criteria that must be met in order for the diagnosis to be given. Diagnosis is a complex process of gathering information about the patient’s history and the difficulties they face. Read more about the specifics on this post from Psychology Today.
All too often I’ve seen individuals with this diagnosis fall through the gaps in services; personality disorders are complicated and misunderstood, general community mental health services are not specialised enough and the specialised services are a rarity and (where they do exist) under funded.
A fundamental symptom of personality disorders is a difficulty in maintaining healthy relationships, this includes professional relationships and as such, specialist services with adequately qualified professionals, are vital. (Expecting the community mental health team to support and manage people with personality disorder is like expecting GPS to do brain surgery.)
It is possible for sufferers to manage their condition, it takes a lot of hard work and a lot of support, because the symptoms are so varied and complex but it is possible for individuals to develop a life worth living.
I have seen inexperienced and under qualified professionals see the label ‘personality disorder’ and see this as permission to ignore, give up on or treat the individual badly.
I have also seen people who do not meet the criteria for a diagnosis of personality disorder, be given it because their symptoms and behaviour are proving challenging and labelling them as ‘PD’ is an excuse to discharge them from care (and give up on them).
Giving up on psychiatric patients is so far beyond unacceptable, there are no words to express my anger and frustration when I see this.
If the professionals don’t even understand these unique disorders and are seen to give up on their patients, we will never be able to break down the stigma and discrimination that exists with the general public.
We’re making good progress with understanding and accepting illnesses such as depression and anxiety but we’ve got a long way to go for public to understand personality disorders, by sharing blogs like this, we will make more progress.
Myth#1 – Mental illness is a sign of weakness
Myth#2 – Men need to get in touch with their feminine side to show their emotion
Myth#3 – Bipolar is more serious than depression and it’s preferable to have anorexia over bulimia
Myth#4 – If someone harms themselves they’re just attention seeking

Myth#3 Bipolar is more serious than depression and it’s preferable to have anorexia over bulimia

Welcome to part 3 of my mental health myth busting series.
In this one I want to address the unwritten, but most definitely alive and kicking, mental illness hierarchy!
All mental illnesses can be mild or severe, at the severe end, any mental illness can lead to suicide.
It depends how you’re measuring severity so making comparisons is unhelpful.
On a number of occasions I have been in conversation with people who make the distinctions and imply that one illness is ‘worse’ than another. For example, I was in a conversation about recovery and someone said ‘but I’ve got bipolar so, of course, I’ll be on medication for life’, I didn’t want to dismiss her statement about being on medication for life, as it may be true but there’s no ‘of course’ about it.
I’ve known people with schizophrenia and bi-polar come off medication and manage the condition (which has seen them into multiple hospital admissions with life risking behaviour) with diet, exercise and lifestyle choices that benefit their well being.
Equally, I’ve seen people (including myself) try coming of medication (for the perceived ‘lesser’ diagnosis of depression or anxiety) but it’s not been possible. Despite putting every therapy skill and lifestyle technique into action.
Whether a condition is managed with medication for life or by other means, anyone who’s been ill will need to vigilant for symptoms returning or getting worse. Some people will need to manage their symptoms constantly, others may be symptom free; this is independent of diagnosis.
Some illnesses are more common than others, this does not make them less severe.
Some illnesses lead to people behaving more outside the norm e.g. responding to unseen stimuli in psychosis, but that does not mean they are more unwell than someone who experiences symptoms that are more relatable, such as low mood.
An elated, high, manic or psychotic person may or may not put their life at risk. Someone experiencing extreme low mood or generalized anxiety may experience suicidal thoughts daily.
Some people judge mental illnesses by what causes them. This is unhelpful as some are reactive, caused by stress or childhood trauma where others are unrelated to life events – neither is worse than the other, the brain is complicated.
Anorexia is perceived as ‘the one where you’re in control’ and bulimia and binge eating disorder (BED) considered ‘the ones where you’re out of control’. Neither of these statements is true but it doesn’t stop people with bulimia or BED wishing they had anorexia. At times when I’ve binged and purged I’ve worried I’m not ‘doing anorexia right’ and I didn’t think I should be getting treatment. The truth is, all eating disorders are life threatening illnesses, none is more or less severe or concerning than the others. People can die from chemical imbalances caused by binging and/or purging, just as people die from malnutrition caused by restriction.
Holding onto inaccurate beliefs leads people to believe they’re not ‘ill enough’ or deserving of treatment, this is dangerous – early intervention is the most important factor in recovery from any mental illness.
It seems that as awareness is raised about mental illness, some seem to be more ‘acceptable’ than others. For example, someone is more likely to ‘come out’ as having depression, anxiety, bipolar or anorexia than they are about having schizoaffective disorder, emotional unstable personality disorder or binge eating disorder.
The mental health world is indebted to people in the public eye who’ve shared their experiences. We just need a few celebs to speak about their experience of depersonalization, avoidant personality disorder or pre-mensural dysphoric disorder and we’ll start talking about these, no more or less serious but, rarer illnesses.
Our aim must continue to be to make all mental illness understandable and as easy to talk about as any physical illness. It wasn’t long ago that people talked about ‘The Big C” as though saying cancer out loud was taboo and dangerous for some reason. People started to be able to say the word ‘cancer’ and now, there are people making a living out of discussing the most taboo of the all – bowel cancer!
So, there’s hope, we will get there!

Is it a diagnosis, a label or an identity?

I’ve had a number of conversations over the years about the language used around mental illness – it’s complicated matter, made more complicated by people not knowing the power behind their words.

“I am not my illness”

A gentleman I cared for explained he detested being called “schizophrenic”,  because, he explained “you wouldn’t say someone is a cancer”. What he was trying to express was that he is not his illness, he did not identify with his illness, he did not want to be labelled in this way and I really respected this.

Even professionals use words derogatorily

If I said someone “is diabetic” I would not have any opinion or judgement on their personality or any other characteristics. However, I recently heard a paramedic say this patient “is schizophrenic” with so much power, bitterness and judgement, I could tell he was casting aspersions on this person’s character (and appeared to be suggesting he be treated as lesser in some way). I had presented my service users as a “56 year old gentleman with [a number of medical complaints] and schizophrenia” as information that may lead to conclusions about the current presenting complaint. While one person may be able to say someone “is schizophrenic” without any preconceived judgements, this paramedic was not one of them.
Stigma in society is strong, it’s people who are being stigmatised that suffer, those doing the stigmatising don’t realised a subtle language change could have a powerful impact. With this small change, a person is not labelled as their illness but someone who has an illness.

“I am more than my illness”

Mental illness can have a negative impact on one’s identity. When I was diagnosed with anorexia I could have let this be my identity… i could have felt, I am not Frances anymore, “I am anorexic”. I have seen people so consumed by their illness, they may as well say “I am anorexia” – I am not a person anymore, I am an illness. But I did not want to label myself in this way, although it was true I was “anorexic” I preferred to see myself as “a person with anorexia”, then my character and personality traits could exist alongside my illness.
It has been proven that assumptions about what it means to be mentally ill such as incompetence and inadequacy (commonly held) will lead to a vicious cycle of impoverished sense of self and low self esteem, ceasing to try and work or fit into society and poorer psychosocial outcomes and sustained symptom severity. (Read the full article here.) It follows that, if you identify as your illness, you identify as incompetent and inadequate, whereas if you consider yourself to have an illness, you are not your illness, you can distance yourself from these negative characteristics.

Of course, this is down to the individual and if saying “I’m bi-polar” or “I’m schizophrenic” does not impact on their ability to see themselves as separate from the illness that’s their prerogative. Or, if they want to be identified as their illness, that’s also, up to them. Perhaps I’m saying, from within a mental illness it can be very difficult to see the path to recovery, how you see yourself in relationships with your illness can be the turning point. In my opinion, recovery and turning away from being consumed by mental illness is possible for everyone (recovery may not mean cure – but that’s a subject for a different blog).
When is a diagnostic label unhelpful?

I’ve had other conversations with people who think we should do away with mental illness diagnoses all together as the words can have such a negative impact on the experience. It can be very confusing when some words can be used by the general population, for example feeling depressed or anxious are valid and appropriate emotions, however, clinical depression and anxiety disorder are very different experiences, in some ways a million miles away from the basic emotion.

For other diagnoses there are other problems e.g. the use of derogatory terms, such as “schizo” which has been used to mean “unpredictable criminal”. Personality disorder is a confusing term, we think (as society) we understand what is meant by personality so if someone’s personality is disordered, surely, their core being is fundamentally altered/damaged? Well, no, personality disorders are extremely complex (usually with relational difficulties) and there is much discussion about changing the label to fit the experience better.

Of course, diagnoses are an essential part of communicating. It’s helpful if a collection of symptoms has a name so that treatment can be targeted appropriately. However, I have also had the experience of an inaccurate diagnosis being used which then had a negative impact on the treatment I received.

In the end, once I was on medication to control my symptoms, it didn’t matter what my diagnosies were – the therapy I needed was for someone to sit with me while I discovered who I was and grappled with emotions I’d never allowed myself to experience.

Language changes, this is normal

The word spastic used to mean “muscle spasms”, a common symptom of cerebral palsy – it is now an offensive term, because of how it was used, and has fallen out of use. The media may hide behind “the dictionary definition”, but if we follow this through, we can still use the word spastic, but we don’t. The “dictionary definition” of “schizophrenic” is “a person with schizophrenia” or “contradictory or frantic and disjointed” but this is as at odds with the definition of diagnosis. Many people still think someone with schizophrenia has a split personality or they are violent (which is an inaccurate belief). Continuing to use the word in different contexts perpetuates this misunderstanding of the illness.

Just hoping people think about what they say…

It’s not hard to change, “schizophrenic person” to “person with schizophrenia”.

Breaking down stigma is vitally important in a cruel and judgemental world. Not realising the power behind our words can have a negative impact on those affected by the illness by perpetuate societies misunderstanding, judgements and stigma. Even if you do not mean offence by the words you use it can have more of an impact than you realise.