Dr John Stevens MB BS MRCPsych
Medico-Legal and Expert Witness Practice
A distinctive set of traits, styles of thinking, and patterns of behaviour together make up our character or individuality. How we perceive the world, our attitudes and assumptions, are all part of our personality.
People with healthy personalities are able to cope with normal stresses and have little or no trouble forming relationships with family, friends, or colleagues at work.
What is a Personality Disorder?
A personality disorder is an ingrained, inflexible pattern of relating, perceiving and thinking, serious enough to cause distress or impaired functioning. Personality disorders are usually recognisable by adolescence, continue throughout adulthood but may become less obvious in middle age.
Those who struggle with a personality disorder have difficulties in dealing harmoniously with other people and may be unable to respond to the changes and demands of life. Although many feel that their behaviour patterns are "normal" or "right", people with personality disorders tend to have a narrow view of the world and find it difficult to enjoy stable relationships or to participate in social activities except on their own terms.
What Causes a Personality Disorder?
Evidence from many sources is that adverse events occurring in early childhood exert a powerful influence upon behaviour and personality development later in life.
Such adverse events may include abandonment, neglect and/or abuse: physical, emotional and/or sexual.
Attachment Theory provides a coherent framework for understanding these processes. There is also evidence that people may be genetically predisposed to personality disorders.
Types of Personality Disorder
There are several diagnosable personality disorders, each with its constellation of behaviours and symptoms. Individuals may show traits of several personality disorders without fulfilling the diagnostic criteria for any single personality disorder.
Certain people with personality disorders may experience associated psychiatric conditions, such as Eating Disorders or Bipolar Affective Disorder (previously known as Manic-Depressive Illness).
Other related serious psychological difficulties can include Alcohol Dependence and/or the misuse of psychoactive drugs, prescribed or illicit.
The assessment of Personality Disorder relies not only on current behaviour or relationship difficulties, but also on an overview of the individual's longterm emotional development.
Rating Scales may be employed as part of the assessment process. Often favoured by lawyers and courts, such scales confer the appearance of certainty in an uncertain diagnostic environment.