Personality Disorders

LET’S TALK ABOUT PERSONALITY DISORDERS

Cat MacGregor, Female Enhanced Engagement and Relational Support Worker from the Bluebird Service at Women in Prison, introduces us to personality disorders.

Personality Disorders (PD’s) are hugely varied, and like all mental health difficulties they are completely unique to each individual. It’s estimated that around 1 in 20 people in the UK have a personality disorder of some kind and there are several categories of PD’s. Some of the most common are: Emotionally Unstable or Borderline Personality Disorder, Antisocial Personality Disorder, Narcissistic Personality Disorder and Paranoid or Schizoid Personality Disorder. BUT WHAT ARE PERSONALITY DISORDERS AND HOW DO THEY DEVELOP?

Our personalities and sense of selves develop from when we are born, through our childhood, and into adulthood. Many external factors affect how we come to see ourselves and others.

ATTACHMENT AND TRAUMA

From when we are born, our caregiver is meant to be our main source of safety, nourishment and connection to the world. If we are brought up in a safe environment where our needs are met, we relate to the world and the people within it in a more trusting way with a general sense that things will be OK in times of difficulty.

For some people, however, this process is disrupted and their attachment to their caregiver can become disordered, with their general sense of safety broken. This could be the result of traumatic experiences such as abuse, neglect, witnessing violence, or losing a loved one. These experiences are then programmed into our development and affect how we come to see the world.

We now know that trauma has a huge impact on us and can cause the brain to develop in lots of different ways. For example, for some people, experiencing trauma as a child can cause the ‘fight or flight’ part of their brain to become overactive. This is the mind’s way of trying to protect that person, but it can also mean that when they grow up into an adult, they may respond to situations in a reactive and instinctive way. It can be hard for us to think clearly in emotionally stressful situations if our minds connect a current experience to an earlier stressful and traumatic situation. RELATIONSHIPS TO OTHERS

Attachment difficulties and trauma can also make it harder for someone to regulate their emotions.. This means that someone’s emotions can become very intense and change very quickly in response to difficult feelings because their previous negative experiences have altered their brain to

respond in this way. It can be very difficult to be on the receiving end of this kind of response, but it’s important to remember that difficulties with emotional regulation are a sign of distress, and that these responses often come from a place of pain, fear and self-preservation.

If we are taught as a child not to trust our loved ones because they haven’t kept us safe, it is very hard to re-wire the fear that you will be hurt by other people in later life. If you have experienced previous trauma, you may grow up to expect traumatic things to happen to or from people you care about. This means that personality difficulties can develop as we struggle to relate to ourselves and to others.

As we get older, our patterns of behaviour, ways of relating to others, and emotional regulation become so in built that they shape who we are and we don’t even notice them. However, for people with Personality Disorders, hearing others describe them as ‘manipulative’ or ‘demanding’ can be hard to hear, as they are just acting on the ways they’ve learnt to protect themselves from danger.

If we think about how all our behaviour is a mirror of the past, we can understand that there is often more being communicated in our responses than is seen on the surface. For example, Maya experienced a lot of neglect as a child. Maya is now an adult and her friend has suddenly changed plans at the last minute. To some people this may seem like no big deal, but for Maya this ignites a fear of being abandoned or unloved; feelings she felt at times as a child. In response, Maya may react in a way which to her friend, may seem extreme, but to Maya, this is a learned reaction to protect herself from the emotional pain of past experiences.

TREATMENT AND SUPPORT

Alongside medication, there are a number of different therapies that people can access: l Mentalisation Based Therapy (MBT) – focuses on the way we create our thought patterns, reactions, and emotional responses to situations and other people. l Dialectical Behavioural Therapy (DBT ) - Focuses on the triggers to difficult or painful situations and helps develop useful coping strategies to apply when they happen. l Art therapy - Uses art making to explore and express emotions, thoughts and experiences by externalising them in a way that can make it easier to reflect on, and ignite creative thinking. l Group Therapy - Shared and unique experiences can be explored in a way that allows for thinking about the dynamic between individuals and the group. SELF CARE

l Recording your moods in a diary can help you spot patterns in what triggers difficult experiences for you, or help you notice early signs that they are beginning to happen so that you can get help. l You could also make a note of what is going well and is helpful to you. It is really important to be kind to yourself, and recognise the difficult steps you’ve taken, or new things you’ve tried. l If you are feeling less well, you might not be able to tell people that you need help or the kind of help you want, so it can be helpful to plan ahead. Inform people you trust about the methods that help you when you are struggling.

The Bluebird Service is a Women in Prison project funded by NHS England and HMPPS. For women to access this support they need to be returning to a London Probation team and either be on the Offender Personality Disorder Pathway or have criteria where they can be screened in. For more information, please contact your probation officer, or contact us at Women in Prison.