Paranoid personality disorder

The thoughts, feelings and experiences associated with paranoia may cause you to:

• find it hard to confide in people, even your friends and family
• find it very difficult to trust other people, believing they will use you or take advantage of you
• have difficulty relaxing
• read threats and danger (which others don’t see) into everyday situations, innocent remarks or casual looks from others.

This might become such a big problem in your life that you are given a diagnosis of paranoid personality disorder. See our page on paranoia for more information.

“I suffer from extreme paranoia and most people find this extremely irritating and become angry with me when I’m paranoid.”

Schizoid personality disorder

Many people with schizoid personality disorder are able to function fairly well. Unlike in schizophrenia or schizoaffective disorder, you would not usually have psychotic symptoms. However, as a result of the thoughts and feelings associated with this diagnosis you may:

• find difficulty forming close relationships with other people
• choose to live your life without interference from others
• prefer to be alone with your own thoughts
• not experience pleasure from many activities
• have little interest in sex or intimacy
• have difficulty relating to or are emotionally cold towards others.

Schizotypal personality disorder

Everyone has their own eccentricities or awkward behaviours. But if your patterns of thinking and behaving make relating to others very difficult, you may receive a diagnosis of schizotypal personality disorder.

Unlike in schizophrenia, you usually would not experience psychosis. However, you may:

• experience distorted thoughts or perceptions
• find making close relationships extremely difficult
• think and express yourself in ways that others find ‘odd’, using unusual words or phrases, making relating to others difficult
• believe that you can read minds or that you have special powers such as a ‘sixth sense’
• feel anxious and tense with others who do not share these beliefs
• feel very anxious and paranoid in social situations, finding it hard to relate to others.

See our pages on schizophrenia or schizoaffective disorder for more information on the feelings and symptoms associated with schizoid and schizotypal personality disorders.

“I always feel rather ‘thrown’ when someone doesn’t do what I expect them to do. Knowing there are lots of ways in which the problem could be approached would have made me feel a lot more prepared for what came next.”

Antisocial personality disorder

It is natural to sometimes put our own needs, pleasure or personal gain before those of others around us. However, if these actions occur very frequently and you struggle to keep stability in your life, or you regularly act impulsively out of anger or lack of consideration for others, this could lead to a diagnosis of antisocial personality disorder.

You may:

• put yourself in dangerous or risky situations, often without thinking about the consequences for yourself or other people
• behave dangerously and sometimes illegally (you may have a criminal record)
• behave in ways that are unpleasant for others
• feel very easily bored and act on impulse – for example, you may find it difficult to hold down a job for long
• behave aggressively and get into fights easily
• do things even though they may hurt people – to get what you want, putting your needs and desires above other people’s
• have problems with empathy – for example, you may not feel or show any sense of guilt if you have mistreated others
• have had a diagnosis of conduct disorder before the age of 15.

This diagnosis includes ‘psychopathy’ and ‘sociopathy’. These terms are no longer used in the Mental Health Act but a ‘psychopathy checklist’ questionnaire may be used in your assessment.

Borderline personality disorder (BPD)

Borderline personality disorder (BPD) is also known as emotionally unstable personality disorder (EUPD).

We can all experience difficulties with our relationships, self-image and emotions. But you might get a diagnosis of BPD/EUPD if these feel consistently unstable or intense and cause you significant problems in daily life.

You may:

• feel very worried about people abandoning you, and either do anything to stop that happening or push them away
• have very intense emotions that can change quickly (for example, from feeling very happy and confident in the morning to feeling low and sad in the afternoon)
• not have a strong sense of who you are or what you want from life, with your ideas about this changing significantly depending on who you’re with
• find it very hard to make and keep stable relationships or friendships
• act impulsively and do things that could harm you (such as binge eating, using drugs or driving dangerously)
• have suicidal thoughts
• self-harm
• feel empty and lonely a lot of the time
• get very angry, and struggle to control your anger
• struggle to trust other people
• experience other mental health problems alongside BPD, including anxiety, depression, eating problems and post-traumatic stress disorder.

When very stressed, sometimes you might:

• feel paranoid
• have psychotic experiences, such as seeing or hearing things that other people don’t
• feel numb or ‘checked out’ and not remember things very well after they’ve happened (known as dissociation).

BPD is currently the most commonly diagnosed personality disorder. You can read more about it on our pages on borderline personality disorder (BPD).

“BPD is like having no emotional buffer. I can go from nothing to suddenly extremely overwhelming emotions and I struggle with expressing them healthily.”

Histrionic personality disorder

Most people enjoy being given compliments or positive feedback about their actions. But if you depend very heavily on being noticed, or are seeking approval so much that this affects your day-to-day living, you might get a diagnosis of histrionic personality disorder.

You may:

• feel very uncomfortable if you are not the centre of attention
• feel that you have to entertain people
• constantly seek, or feel dependent on, the approval of others
• make rash decisions
• flirt or behave/dress provocatively to ensure that you remain the centre of attention
• get a reputation for being dramatic and overemotional
• be easily influenced by others.

“After being told my diagnosis I was then able to understand how and why I behaved the way I did: my life made a little bit more sense.”

Narcissistic personality disorder

It is human nature to be aware of our own needs, to express them, and to want others to be aware of our abilities and achievements. These are not bad traits. However, if these thoughts, feelings and behaviours are very extreme and cause problems in relating to others, you may get a diagnosis of narcissistic personality disorder.

You may:

• believe that there are special reasons that make you different, better or more deserving than others
• have fragile self-esteem, so that you rely on others to recognise your worth and your needs
• feel upset if others ignore you and don’t give you what you feel you deserve
• resent other people’s successes
• put your own needs above other people’s, and demand they do too
• be seen as selfish and dismissive or unaware of other people’s needs.

Avoidant personality disorder

We all have things, places or people we don’t like, or which make us anxious. But if these things cause so much anxiety that you struggle to maintain relationships in your life, you may get a diagnosis of avoidant personality disorder (sometimes also called anxious personality disorder).

You may:

• avoid work or social activities that mean you must be with others
• expect disapproval and criticism and be very sensitive to it
• worry constantly about being ‘found out’ and rejected
• worry about being ridiculed or shamed by others
• avoid relationships, friendships and intimacy because you fear rejection
• feel lonely and isolated, and inferior to others
• be reluctant to try new activities in case you embarrass yourself.

See our pages on anxiety and panic attacks for more information on how to cope with anxiety.

Dependent personality disorder

It is natural to need other people to care for us or give us reassurance sometimes. A healthy balance involves being able to both depend on others as well as being independent from others sometimes. However, if feelings and thoughts about needing others become so overwhelming that they impact your daily life and relationships, you may get a diagnosis of dependent personality disorder.

You may:

• feel needy, ‘weak’ and unable to make decisions or function day-to-day without help or support from others
• allow or require others to assume responsibility for many areas of your life
• agree to things you feel are wrong or you dislike to avoid being alone or losing someone’s support
• be very afraid of being left to fend for yourself
• have low self-confidence
• see other people as being much more capable than you are.

Obsessive compulsive personality disorder (OCPD)

Obsessive compulsive personality disorder (OCPD) is separate from obsessive compulsive disorder (OCD), which describes a form of behaviour rather than a type of personality.

However, similarly to OCD, OCPD involves problems with perfectionism, the need for control, and significant difficulty being flexible in how you think about things.

You may:

• need to keep everything in order and under control
• set unrealistically high standards for yourself and others
• think yours is the best way of doing things
• worry about you or others making mistakes
• feel very anxious if things aren’t ‘perfect’.

See our page on self-care for obsessive compulsive disorder (OCD) for information about managing the symptoms of OCD. You can also find more information about OCPD on the OCD UK website.

What causes personality disorders?

Just as everybody’s experience of a personality disorder is unique to them, the causes will be unique as well.

There’s no clear reason why some people develop the feelings and behaviours associated with personality disorders, and others don’t. Most researchers believe that a complex mix of factors seems to increase the risk of developing or triggering these experiences, including:

• environment and social circumstances
• early life experiences
• genetic factors.

Environment and social circumstances

The environment and social circumstances we grow up in and the quality of care we receive can affect the way our personality develops. You may experience difficulties associated with personality disorders if you’ve experienced:

• an unstable or chaotic family life, such as living with a parent who is an alcoholic or who struggles to manage a mental health problem
• little or no support from your caregiver – this may be especially hard if you’ve experienced a traumatic event or situation
• a lack of support or bad experiences during your school life, peer group or wider community, such as bullying or exclusion
• poverty or discrimination
• some form of dislocation, such as migration from abroad.

“I have narcissistic borderline personality disorder. At first it was difficult to accept that the problem was essentially me, my personality. But then being able to put it into perspective as a developmental flaw was much easier to accept – that it was simply the way I’d developed in response to my environment and the situations I’d experienced.”

Early life experiences

Our experiences growing up can affect our personality in later life. If you had a difficult childhood, you might have developed certain beliefs about the way people think or act and how relationships work. This can lead to developing certain strategies for coping which may have been necessary when you were a child, but which aren’t always helpful in your adult life.

If you have been given a personality disorder diagnosis you are more likely than most people to have experienced difficult or traumatic experiences growing up, such as:

• neglect
• losing a parent or experiencing a sudden bereavement
• emotional, physical or sexual abuse
• being involved in major incidents or accidents
• often feeling afraid, upset, unsupported or invalidated.

Not everyone who experiences a traumatic situation will develop these problems however. Your unique reactions, as well as the consistency and quality of support and care you received, will make a difference.

Similarly, not everyone who develops a personality disorder will have had a traumatic experience.

Genetic factors

Personality is very complex and researchers currently don’t know much about what makes up our personalities and to what extent genes play a part in this.

Some elements of our personality are likely to be genetic. We are born with different temperaments – for example, babies vary in how active they are, their attention span and how they adapt to change.

While some experts believe genetic inheritance may play a part in the development of personality disorder, others point out that it is difficult to know whether similarities in temperament and behaviour have been handed down the generations genetically or through the behaviour children were modelled as they grew up. More research needs to be done in this area.

Why is it controversial?

Our understanding of mental health problems is constantly evolving. So is the language we use when talking about them. The diagnosis of ‘personality disorder’ can be controversial because:

• specialists disagree about how to understand personality disorders
• it doesn’t take social context into enough account
• the term itself can be stigmatising.

Some people with this diagnosis hold the view that their feelings and behaviours are a reasonable, human reaction to going through difficult life experiences. So it’s unhelpful and upsetting to call it an illness or ‘disorder’ in their personality. They argue that professionals should consider what in their life may have contributed to their difficulties, and help with these. Not focus on finding problems in them as an individual.

On the other hand, some people find that getting this diagnosis helps them to name and understand their experiences, to explain themselves to other people, and sometimes get treatment and support they otherwise might not.

Mind is committed to ensuring that voices on all sides of this debate are heard. This includes those who:

• understand their experiences and behaviours as a disorder
• think of them as a natural reaction to adversity
• reject the personality disorder label
• do not fully agree with the label but accept it being as a way to access support.

If you have been diagnosed with a personality disorder but you’re concerned that this isn’t right for you, we have information on what you can do if you think your diagnosis is wrong.

Specialists disagree about how to understand personality disorders

The system of personality disorder diagnosis we list on our page on types of personality disorder is the one psychiatrists tend to use in the UK. However, some psychiatrists disagree with its use and find it unhelpful because:

• Most people who are diagnosed with a personality disorder do not fit any one category, and may be diagnosed with more than one.
• Some people believe the focus should instead be on what each person needs in order to deal with their problems and discover new ways of living, not what category they are in.

It doesn’t take social context into enough account

• Experiencing trauma in childhood (such as abuse or neglect), or trauma that lasted for a long time.
• Issues to do with your situation and environment, such as poverty and social deprivation, or having to move home to a totally new place or culture.
• Experiencing stigma and discrimination, like racism, sexism, homophobia, biphobia or transphobia.
• If people have treated you badly in past relationships (including your parents or carers).

The term itself can be stigmatising

Some people feel that the term ‘personality disorder’ can sound very judgmental. Being given a diagnosis or label of personality disorder can feel as if you’re being told there’s something wrong with who you are. You may feel upset, insulted and excluded. Language evolves and it may be that a different term will be used by professionals in future.

“Stigma can sometime come from the professionals themselves, whether intentionally or not.”

It’s important to remember that you’re not alone – there are other people out there experiencing what you are. However you choose to make sense of your difficulties, you deserve to be treated fairly. Here are some options you can consider:

• Show people this information to help them understand more about what your diagnosis really means.
• Get involved in your treatment – our pages on seeking help for a mental health problem and advocacy provide guidance on having your say in your treatment, making your voice heard and steps you can take if you’re not happy with your care.
• Know your rights – our pages on legal rights provide more information.
• Take action with Mind – see our campaigning page for details of the different ways you can get involved in helping us to challenge stigma.

That said, it takes energy to challenge stigma. When you are particularly unwell you may not have the capacity to do any of these things. Be kind to yourself and try not to put yourself under pressure to do anything other than rest and recover when that is what you need.

See our advocacy page and useful contacts page for more information if you need support with having a say in your treatment.

“The stigma of being violent and dangerous is the worst for me. I am a caring and empathetic soul who would do anything for the people I love.”

How can I help myself?

If you experience a personality disorder, every day might feel like a struggle and there may be times when everything seems too much to cope with. There are coping strategies that can help though. Below are some ideas of things you can do to help yourself both now and in the longer-term.

Different things work for different people at different times so try to be kind to yourself if some things don’t work for you. We are all unique so things you find helpful when you are struggling may be really personal to you, and may change over time.

• What can I do now?
• What can I do in the longer-term?

What can I do now?

If you’re experiencing lots of difficult feelings and are particularly overwhelmed it can be useful to break things down and focus on one thing at a time. Below is a list of tips and techniques which might help you through difficult periods and over time you might develop your own techniques to add to this list.

“Not everyone finds the same things helpful. It’s possible for people to find their own coping methods. Using techniques I don’t find helpful is actually very distressing, as is being told I have to do them.”

What can I do in the longer-term?

Taking some time to make your wellbeing a priority can make a big difference to how you’re feeling. Here are some ideas:

“All my life I have felt different, alienated and completely alone. It is only since my diagnosis of BPD that I began to understand why and, with help, to realise that I could actually do something to change those feelings and feel that I can achieve a life worth living.”

Talking therapies

More research needs to be done into which talking therapies can help people with personality disorders. The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – suggests that the following kinds of talking therapies may be helpful:

• Dialectical behaviour therapy (DBT) – a treatment specifically developed for borderline personality disorder (BPD). It uses individual and group therapy to help you learn skills to manage your emotions. See our pages on DBT for more information.

“The one-to-one sessions I received were invaluable. My therapist was able to help me understand the DBT skills I was learning and help me to apply them to my life. My greatest lesson was to learn to fail and to accept that this and continued practise was the key to using DBT.”

• Mentalisation-based therapy (MBT) – a long-term talking therapy which aims to improve your ability to recognise and understand your and other people’s mental states, and to help you examine your thoughts about yourself and others to see if they’re valid.

“Mentalisation is best summed up as “thinking about thinking”. It is being able to understand our own mental state and that of other people, and how this effects our behaviour. I identified with it immediately, as I really struggle with identifying what my emotions are and where they come from.”

NICE says that other types of talking therapy could also potentially be helpful, including the following:

• Cognitive behavioural therapy (CBT) – aims to help you understand how your thoughts and beliefs might affect your feelings and behaviour. See our pages on CBT for more information.
• Cognitive analytic therapy (CAT) – combines CBT’s practical methods with a focus on building a trusting relationship between you and your therapist who will help you make sense of your situation and find new, healthier ways to cope with your problems.
• Other talking therapies – such as schema-focused cognitive therapy, psychodynamic therapy, interpersonal therapy or arts therapies. See our pages on talking therapies and arts therapies for more information.

Therapeutic communities

Therapeutic communities are programmes where you spend time in a group supporting each other to recover, with the help of a facilitator. Most therapeutic communities are residential (often in a large house) where you might stay for all or part of the week. Activities can include different types of individual or group therapy, as well as household chores and social activities. The Consortium for Therapeutic Communities provides a directory of therapeutic communities in the UK.

“I spent 18 months as part of a Therapeutic Community, and I’m not exaggerating when I say it’s changed my life. My mood swings are far less frequent, and it’s rare that they reach the extremes that they used to.”

Medication

There are no drugs specifically licensed for the treatment of personality disorders. Many people with personality disorders also have other mental health diagnoses though, such as depression, anxiety or psychosis, and may be prescribed medication for these.

These medications could include antidepressants, antipsychotics or mood stabilisers.

Can I go private?

Waiting times for talking treatments on the NHS can unfortunately be long. If you feel that you don’t want to wait and you can afford the expense, or would like to see a therapist who specialises in the types of experiences you have had, you may choose to see a counsellor or psychotherapist privately.

See our pages on seeking private sector therapy for more information.

Talking about borderline personality disorder (BPD)

Lechelle and Debbie talk about having borderline personality disorder and how a combination of medication and dialectical behaviour therapy (DBT) has helped them develop the skills to manage it.

How can I have a say in my treatment?

A really important factor in your treatment is the relationship you form with the professionals who are helping you – whether they are a social worker, psychiatric nurse, therapist or psychiatrist. Having good treatment also depends on you being actively involved in it and having your say. You should expect to:

• Have your say in treatment – your GP or psychiatrist should discuss all your treatment options with you, and your views and preferences should always be taken into account when making decisions about your treatment. See our pages on seeking help for a mental health problem for more information on having your say.
• Be involved in your care plan – a care plan is an agreement between you and the professionals you’re working with, about what you want to get out of your treatment. It should include the problems you want help with, any treatments you may need and planning for a crisis.

“It was only when I met some dedicated professionals willing to go that extra mile that I started to change and believe in myself. I was able to begin therapy and develop a good trusting relationship which has been consistent and secure.”

If somebody you know is diagnosed with a personality disorder, their thoughts, feelings and behaviour might make it hard for them to always maintain a good relationship with you.

Sometimes you may find it hard to know what to say or how to help. But there are lots of positive things you can do to support them:

• Try to be patient – if your loved one is struggling to deal with their emotions, try not to get involved in an argument in the heat of the moment. It could be better to wait until you both feel calmer to talk things through.

“I have become very aware of my feelings and emotions but I often find it really hard to control them, like someone’s taken over my head for a short time I then feel overwhelmingly embarrassed of my actions, and push people away to try and make myself feel better.”

• Talk to them compassionately and calmly – when someone is experiencing difficult thoughts and feelings, their behaviour may be unexpected or upsetting, and you may feel unsettled. Try to understand what they’re experiencing and what’s affecting their thoughts, feelings and behaviour – this can help you to stay calm.
• Don’t judge them – try to listen to them without telling them they should feel the way they do or that they’re being overly sensitive. You may not understand why they feel like this, but it can mean a lot to acknowledge and value how they’re feeling.

“Validate and try to be understanding – don’t question my thoughts or views. Put yourself in my shoes. If those were the thoughts and feelings you were experiencing, how would they make you feel?”

• Remind them of other aspects of their personality – a diagnosis of personality disorder doesn’t stop someone being likeable, intelligent, funny, kind, highly motivated or creative. It can be reassuring to remind them of the other things you see in them, particularly if they struggle to see these themselves.
• Try to both set clear boundaries and expectations – it can be helpful to make sure you both know where the boundaries of your relationship are, and what you expect from each other. This can help you both manage difficult feelings and situations. Agreeing how you expect to speak to each other, be spoken to or what you are or aren’t able to help with could be useful things to clarify.

“Tell me a problem you’re having, let me be there for you for a change. Don’t hold back sharing difficulties in your life, I am your friend after all. It will make me feel valuable and useful.”

• Plan ahead – it can be scary if you’re worried someone you care about is hurting themselves, or is struggling with suicidal thoughts. Ask them how you could help when things are difficult. See our pages on supporting someone who is self-harming and supporting someone who feels suicidal for more information.
• Learn their triggers – talk to your loved one and try to work out what situations or conversations make them think or feel negative thoughts and emotions.
• Learn more about personality disorder, and help to challenge stigma – personality disorder is a complicated diagnosis, and your loved one may have to deal with other people’s misconceptions on top of coping with their own mental health problem. Our pages about personality disorders and different types of personality disorder contain more information.
• Help them seek treatment and support – see our pages on how to support someone to seek help for more information.
• Help them find an advocate – see our pages on advocacy for more information.
• Take care of yourself – supporting a loved one who is struggling can be really difficult. Try to remember that your own mental health is important as well. See our pages on coping when supporting someone else, managing stress and maintaining your wellbeing for more information on how to look after yourself.

“Sometimes, when we don’t know who we are, we don’t know why we are doing what we are doing, it just takes a person with hope to see something behind those eyes, something we cannot see ourselves, to save us and tell us that we can be okay.”

Other organisations

The Consortium for Therapeutic Communities

therapeuticcommunities.org
Online directory of therapeutic communities across the UK.

FRANK

0300 123 6600
talktofrank.com
Confidential advice and information about drugs, their effects and the law.

The National Association for People Abused in Childhood (NAPAC)

0808 801 0331
support@napac.org.uk
napac.org.uk
Supports adult survivors of any form of childhood abuse. Offers a helpline, email support and local services.

National Institute for Health and Care Excellence (NICE)

nice.org.uk
Produces guidelines on best practice in healthcare.

NHS UK

nhs.uk
Information about health problems and treatments, including details of local NHS services in England.

The Prison Reform Trust

0808 802 0060 (Prisoners helpline)
prisonreformtrust.org.uk
Charity working to create a just, humane and effective penal system.