“Grace under Pressure: personality disorder and society” was the topic presented by Dr Steve Pearce at the Trust’s Health Matters event on 29 January 2013.  Dr Pearce who is a consultant psychiatrist with the Trust’s Complex Needs Service, specialising in the diagnosis and treatment of personality disorder, outlined some of the features of this neglected area of mental health practice.

So what is a personality disorder you might ask and how it is defined? The answer is not that simple. Personality disorder is a common but misunderstood psychiatric category.  It’s a type of mental illness in which you have trouble perceiving and relating to situations and to people – including yourself.  It can affect the way a person sees and interacts with the world, from attitudes to relationships to their behaviour.  These disorders may be caused by a genetic predisposition or environmental factors such as child abuse or child neglect or a combination of the two.  Some people are less resilient but some are more resilient to a particular situation.  So we could say that those people who have got low resilience and who had an adverse childhood experience are more likely to suffer from a personality disorder.

Dr Pearce explained that there were ten specific types of personality disorders that were grouped into three clusters.

• Cluster A includes disorders that are characterised by odd or eccentric behaviour. People feel paranoid; they have few social relationships, limited range of emotional expression or have magical thinking and believe in their special powers.
• Cluster B includes disorders that are characterised by dramatic or erratic behaviour. It is the most famous of the three clusters and is defined by antisocial, borderline or narcissistic behaviour.  Antisocial personality disorder (ASPD) is closely linked with criminal behaviour.  People who fall under this category have no remorse for the harm or crime they have committed.  Borderline personality disorder (BPD) includes people on the borderline between psychosis and neurosis.  It is a disorder in which a person has a pattern of unstable personal relationships and poor impulse control. Narcissist behaviour (NPD) is the other famous one and includes people who love themselves too much or act selfishly, which is probably a defence against a very fragile person inside.
• Cluster C includes disorders that are characterised by anxious or fear-driven behaviour.  It is a less known cluster and is defined by obsessive-compulsive behaviour.  People in this category have got poor collaboration and have persistent and repetitive behaviour.  These people can be perfectionists to some extent and could become good academics or accountants.  Dependent Personality Disorder (DPD) is rare in its pure form and will often overlap with others.  People in this category feel incapable of being by themselves and lack the ability to live independently.  The last category in this cluster is Avoidant Personality Disorder (APD).  It is rarely a stand-alone disorder and includes people with chronic social phobia, low self-esteem and extremely sensitive to criticism.

Dr Pearce then went on to explain how common personality disorder is.  To put this into numbers, five percent of the population suffer with a personality disorder.  That is five times more common than schizophrenia.  Between 20-30% of those people will be diagnosed by their GP.  Approximately 45% of homeless people will suffer with a personality disorder as will more than 70% of prisoners.  So, are people with personality disorder bad people? They are absolutely NOT but this is why it so stigmatised compared to other mental disorders and is portrayed as antisocial or dangerous in the media.   Yes, maybe 70% of criminals will have a personality disorder.  Let us not forget though about the vast majority of sufferers who have not committed a crime but live much of their lives in a constrained or miserable way, not establishing the connections and satisfactions most of us take for granted.

The evening concluded with a Question and Answer session that gave the public an opportunity to ask further questions on this very interesting and important subject. 

If you have been affected by this subject or would like any further information, please email enquiries@oxfordhealth.nhs.uk

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We hope you will join us on 26 February 2013 for our next Health Matters event, where Dr Anne Stewart will talk about eating disorders in young people.  For more information about this and other OHFT events please visit https://www.oxfordhealth.nhs.uk/news/whats-on/

Dr Steve Pearce speaking at the Health Matters event on 29 January 2013

Dr Steve Pearce speaking at January’s Health Matters event