Personality related issues are characterised by significant differences in the way we might perceive, think, feel, act, and relate. Although we all might differ along specific dimensions of personality these patterns don’t tend to cause us difficulty. However, with a personality disorder these long-standing patterns of thinking, behaviour, and emotion can become dysfunctional. As a result these patterns can cause significant disruptions to a person’s life, there sense of self, and how they relate to others.

When we consider personality we often take a bio-psycho-social perspective. That is there can be a combination of temperamental, psychological and developmental factors, alongside the broader social context and culture that can shape who we become or how we develop.

Personality disorder treatment is often (but not always) a lengthy process aimed at shifting these ingrained patterns, building and internalizing greater security in attachment relationships, and shifting dysfunctional defence patterns. Each of the diagnoses or patterns of traits below are often simply adaptations to the world. When we explore our own personality we might often identify some of the traits below which make up a persons character.

Developmental growth and maturation occurs throughout the lifespan. We all start at different places in terms of the skills that we might be given or the burdens we might carry. For some this might be improving mutuality and equality in our relationships. For others, this could be about attaining boundary with others or greater capacity for emotion regulation. Some seemingly small shifts in how we operate in the world can sometimes be our biggest accomplishments. Therefore, if you are looking for treatment for a personality disorder in Melbourne read through to learn more.

The traditional diagnostic models often define personality in to three broad clusters. Cluster A defined odd, eccentric, and paranoid personality styles (schizoid, schizotypal, and paranoid). Cluster B defined overly-emotional, dramatic, and unpredictable personality styles (narcissistic, borderline, histrionic, antisocial), while Cluster C defined anxious and fearful personality styles (avoidant, dependent, obsessive-compulsive personality). More recent classification systems still utilise these broad categorical diagnoses. Furthermore, nowadays we tend to consider dimensions of personality traits. An exploration of personality style is often a component of anyone’s treatment.

Perhaps a more contemporary model of understanding personality is through the lens of attachment and psychodynamic theory. That is, the experiences we have developmentally influence the sets of defences and relational patterns that come in to being. Personality traits can be conceived of broad sets of strategies that we use to adapt and function in the world. When there have been significant ruptures or traumas in our upbringing some of those traits become accentuated and get reinforced.

For example, a client with borderline personality disorder might experience prolonged, intense, and unstable emotional reactions that are difficult to extinguish. From a developmental perspective we might see an environment that was intensely unstable and inconsistent. The child doesn’t experience safety and soothing from a parent. As a result their emotional reactions tend to amplify and intensify.

Conversely the client with narcissistic personality traits might use grandiosity and devaluing or dismissing others as a strategy to regulate self-esteem and bolster their showing socially. This might mask a vulnerability for rejection or loss. When we explore deeper into that person’s development we might see parents who were harshly critical and rejecting of anything less than perfection.

Borderline personality disorder is characterised by an over-arching pattern of unstable emotions, relationships, and behaviour. At the core is often a deep sense or fear of abandonment. Situations that might echo rejection or abandonment (or conversely too much closeness or intimacy) tend to trigger strong and palpable emotional reactions often of terror, anger, or helplessness. As a consequence, relationships tend to be intense and unstable, fluctuating between poles of idealization and devaluation or closeness and distance.

A person with BPD might experience intense fluctuations in emotion that are difficult to soothe. Furthermore, there are typically patterns of impulsivity (e.g. food, sex, substance use), risk taking behaviour, and mood swings. With these intense shifts in emotion comes the opposite patterns of hypo-arousal such as dissociation, numbing, detachment, and derealization. Issues with identity, self-worth, and self-perception. Another characteristic is suicidal, self-harming, or self-destructive patterns of behaviour.

BPD is often misunderstood and carries a lot of stigma. However, BPD can often be treated effectively allowing people to grow and change for the better. Common therapies include Transference-focused approaches, Dialectical Behaviour Therapy (DBT) and Schema Therapy.

Narcissistic personality disorder is characterised by patterns of grandiosity, superiority, or self-importance. There is frequently a preoccupation with being successful, powerful, smart, loved, or more attractive than others. However, usually underlying the narcissistic patterning and defences is a deeper vulnerability, woundedness, and fragile sense of self-worth.

Interpersonally, there is a tendency to either idealize or devalue and dismiss other people. There can be a lack of emotional empathy and willingness to take advantage of or exploit others. Coupled with this is a sense of entitlement or desire to only associate with high status people and a heightened need or demand for admiration and recognition.

Narcissistic personality disorder treatment often involves a combination of transference-informed approaches. with a willingness to experience underlying emotions such as shame and vulnerability the hard narcissistic mantle can gradually and safely be reduced.

Antisocial personality disorder is characterised by a tendency to disregard the law or rights of others. There are usually patterns of callousness, disrespect, impulsivity, manipulation, and deceit in relationships.

Usually there is a history of recklessness, rule breaking, boundary crossing, and run ins with the law. People with antisocial personality disorder might tend to be physically aggressive, lie, and blame others for their problems. Furthermore, a person might show a lack of empathy or remorse for actions that hurt others.

Histrionic personality disorder (HPD) is marked by unstable emotions, a distorted self-image, and an overwhelming desire to be noticed. A person with histrionic personality might show behaviour that is excessively dramatic, emotional, flirtatious, or inappropriate in order to secure attention. Furthermore, there is often a preoccupation with appearance, dramatic or vague speech, and emotionality that is either shallow, rapid, or exaggerated.

When not the centre of attention a person can readily feel underappreciated or depressed. In conjunction with this, there is a tendency to become bored and frustrated easily needing instant gratification. Interpersonally, a person with histrionic personality disorder might tend to think relationships are closer than they actually are. As a consequence of these traits there can often be difficulty maintaining relationships.

Avoidant personality disorder is characterised by avoidance of social situations due to fear of rejection, humiliation, or being judged by others. This fear of rejection, hypersensitivity to criticism, or fear of doing something wrong can lead to a life of isolation, with few close friends or contacts. This can also lead to a reluctance to take on new challenges or enter situations where there is too much contact. Individuals with APD might tend to be shy, awkward, and self-conscious Furthermore, they tend to see themselves as being inadequate or inferior to others.

Obsessive-compulsive personality disorder (OCPD) is characterised by an extensive preoccupation with perfectionism, organization, and control. An individual with OCPD might be fixated on details, rules, lists, order and organization. Oftentimes, there is an excessive devotion to work and productivity at the expense of leisure and relationships. Furthermore, there is often a degree of indecisiveness, doubt, and caution to avoid failure, mistakes, and criticism.

The OCPD patterning is characterised by rigid beliefs and inflexibility about how things should be done. These exacting standards and inability to compromise can negatively impact relationships.

People with dependent personality disorder (DPD) often feel helpless, submissive, or incapable of taking care of themselves. They tend to avoid taking responsibility and have trouble making every day decisions. Conversely, the needs of caregivers or partners are often put above their own. They might also nee excessive amounts of reassurance and support to make minor decisions. People might experience considerable pessimism and lack self-confidence and self-reliance to move forward in life. At the core of there might be sensitivity to criticism, rejection, and abandonment.

Schizotypal personality disorder (STPD) is characterised by odd or eccentric speech, behaviour, mannerisms, and appearance. A person might describe unusual or eccentric perceptive experiences, magical beliefs, superstitions, or views of reality. For example, they might think they have paranormal powers or that situations have special meaning to them (e.g. ideas of reference). There is also a degree of social anxiety, difficulty with interaction, paranoia, or suspiciousness of others actions and intentions. As a result they might have few close friends or contacts beyond family members.

Schizoid personality disorder is characterised by a consistent pattern of detachment from and disinterest in social relationships. There is often a lack of desire or enjoyment from close relationships. Furthermore, there is little or no desire for sexual intimacy. In terms of detachment there might be a limited or restricted range of emotional expression (or indifference) when interacting with others. As a consequence, a person with SPD tends to seek out hobbies, activities and jobs that are solitary in nature.

Paranoid personality disorder (PPD) is marked by a pattern of distrust and suspicion of others. There is often hyper-vigilance and a tendency to be on guard, believing that others are constantly trying to demean, harm, deceive, or threaten. Relationally a person with PPD might be hostile, stubborn, cold, distant, or argumentative. Furthermore, they tend to doubt the commitment, loyalty, trustworthiness, or faithfulness of others (including close partners). There can be a reluctance to confide in others or reveal personal information because they’re afraid the information will be used against them. There might also be a tendency to be unforgiving, hold grudges, act controlling or jealous to avoid being betrayed.

If you are looking for personality disorder treatment in Melbourne there are many potential options and services available. Services such as Spectrum BPD, BPD Foundation, or the Melbourne Clinic provide valuable resources and input. I provide therapeutic input for clients not experiencing ongoing day to day crisis. My approach helps individuals to explore features of personality that limit and restrict a person’s life.

There are a range of specific treatments available to help ameliorate and change patterns in a persons personality. Often times the treatment is longer-term and involves a degree of commitment to turn things around. In saying that, sometimes aspects of personality can be modified reasonably quickly when there is a willingness to try something new. Furthermore, sometimes therapy simply provides an additional layer of support to navigate the world and deal with stressors.

Treatment often aims to recognise modes of the psyche that are causing difficulty. For example, by learning to soothe child parts, or tame inner tyrants growth and change can be fostered. Below are common treatment approaches that are utilised in shifting personality patterns.

a. Dialectical Behavioural Therapy (DBT)

b. Attachment-informed therapies

c. Transference Focused Therapy

d. Mentalization Based Therapies.

e. Cognitive-behavioural Therapy

f. Schema therapy

g. Accelerated Experiential Dynamic Psychotherapy.