However, for those with social anxiety disorder, also known as social phobia, routine interactions can cause considerable stress. As a result, social anxiety disorder leads to an avoidance of social situations that disrupt everyday life and significantly impact a person’s well-being.

In this article, we explore social anxiety disorder and how trauma, particularly childhood trauma, plays a role in developing the condition in later life.

What Is Social Anxiety?

Common, everyday experiences pose a significant challenge to those suffering from a social anxiety disorder. These individuals fear being negatively perceived, judged, and scrutinised. This fear is primarily associated with unfamiliar people or strangers. However, some sufferers find social interaction immensely challenging, even with close friends and family members.

Although social anxiety typically begins in adolescence, it can sometimes arise in early childhood or develop in adults. With up to a 12% lifetime prevalence, it is one of the most prevalent anxiety disorders. This is notably high compared to 7% for post-traumatic stress disorder, 6% for generalised anxiety disorder, 5% for panic disorder, and 2% for obsessive-compulsive disorder.^[1]

The types of experiences that sufferers may find hard to endure include, but are not limited to, the following:

• Attending social gatherings and parties
• Initiating or engaging in conversations
• Going to school or work
• Interacting with strangers
• Making eye contact
• Going on dates
• Meeting friends of friends
• Entering a room in which people are already seated or in conversation
• Returning items to a store
• Eating in front of others
• Using a public restroom
• Using public transport

The severe stress these social interactions cause impacts daily routines, employment, school, relationships, and hobbies. Whilst avoiding anxiety-inducing situations will ease a person’s discomfort in the short-term, long-term avoidance only exacerbates the issue.

Social anxiety disorder can become a chronic and debilitating mental health issue. Recognising the signs and symptoms of the condition and seeking early treatment is paramount for allowing the individual to find confidence and develop skills to allow for stress-free social interaction.

Symptoms of Social Anxiety

Comfort levels in social situations vary significantly from person to person. Feelings of unease, discomfort, or shyness are not necessarily signs of social anxiety. Neither is a lack of interest or enthusiasm for unfamiliar social situations or large groups of people.

Instead, our responses to situations largely depend on our personality traits, life experiences, and upbringing. Some people are naturally more reserved or introverted, whilst others are more extroverted and outgoing.

In contrast to understandable nervousness, social anxiety disorder provokes strong feelings of fear, intense anxiety, and avoidance that interfere with all aspects of a person’s life and render them powerless.

Signs and symptoms of social anxiety disorder may include:^[2]

• Fear of situations in which you may embarrass yourself or be negatively judged.
• Extreme fear when talking with strangers.
• Intense anxiety surrounding social or public situations.
• Avoidance of social or public situations.
• Excessive anxiety in anticipation of an activity or event
• Catastrophising or expecting the worst possible outcome at the event
• Physical symptoms, such as trembling, shaking, blushing, sweating, upset stomach, racing heart, muscle tension, and a shaky voice.
• Poor verbal communication skills when faced with a stressful situation.
• An inability to think clearly.
• Over-analysis of performance and perceived flaws and judgements post-event.
• Reduced self-esteem, self-worth, and a lack of self-confidence.

Among children, symptoms could be displayed through extreme clinginess to their caregiver, crying, temper tantrums, or refusing to speak.

Social anxiety disorder symptoms often present differently at specific periods. They may even alter over time. If a person is experiencing stress or going through challenging life changes, the symptoms will likely flare up and escalate.

The Implications of Trauma

Research has evidenced that the development of social anxiety disorder is more prevalent among those who have experienced trauma and chronic stress. Some of the traumatic events understood to have predictive value for the onset of social anxiety include:^[3]

• Childhood abandonment or neglect
• Physical, sexual, or emotional abuse
• Bullying
• Family or relational conflicts, such as divorce, custody cases, and domestic violence
• Loss of a loved one
• Postnatal depression or stress during pregnancy or infancy

Studies have demonstrated a direct correlation between childhood traumatic experiences and the onset of severe social anxiety, general anxiety, depression, and low self-esteem among individuals who struggle with social anxiety disorder.^[4]

Social Anxiety and the Brain

As noted above, social anxiety emerges from a convergence of factors, including childhood experiences, genetic predisposition, trauma, and unusual brain functioning.

Studies on the brain of social anxiety disorder sufferers have shown hyperactivity in the region of the brain called the amygdala. The amygdala is responsible for the activation of our threat response system triggering fight or flight.

This automatic survival response activates an avalanche of symptoms, including increased respiratory action, rapid heart rate, muscle tension, digestive discomfort, a surge in blood sugar, and an overwhelming sense of stress and anxiety as your body prepares itself to flee or fight. ^[5]

Individuals with social anxiety perceive social interactions as legitimate threats triggering this evolutionary danger detection system resulting in a state of hyper-vigilance and stress.^[6]

Fortunately, the brain is remarkably adaptive and can form new connections and neural pathways at any stage of life through effective treatment. ^[7] With effective treatment, those with social anxiety disorder can reorientate their brains to react in a calmer, more rational state during social encounters that pose no real threat.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

[1] Unlocking-Potential.Co.Uk, 2021, https://www.unlocking-potential.co.uk/wp-content/uploads/2019/06/Statistics-relating-to-Social-An

[2] Purdon, Christine et al. “Social Anxiety In College Students”. Journal Of Anxiety Disorders, vol 15, no. 3, 2001, pp. 203-215. Elsevier BV, doi:10.1016/s0887-6185(01)00059-7. Accessed 3 Nov 2021.

[3] Schmidt, Louis. “Social Anxiety Disorder: A Review Of Environmental Risk Factors”. Neuropsychiatric Disease And Treatment, 2008, p. 123. Informa UK Limited, doi:10.2147/ndt.s1799. Accessed 3 Nov 2021.

[4] Kuo, Janice R. et al. “Childhood Trauma And Current Psychological Functioning In Adults With Social Anxiety Disorder”. Journal Of Anxiety Disorders, vol 25, no. 4, 2011, pp. 467-473. Elsevier BV, doi:10.1016/j.janxdis.2010.11.011. Accessed 3 Nov 2021.

[5] “What Is ‘Fight, Flight Or Freeze’?”. North West Boroughs Healthcare, 2021, https://www.nwbh.nhs.uk/healthandwellbeing/Pages/Fight-or-Flight.aspx.

[6] Sladky, Ronald et al. “Disrupted Effective Connectivity Between The Amygdala And Orbitofrontal Cortex In Social Anxiety Disorder During Emotion Discrimination Revealed By Dynamic Causal Modeling For Fmri”. Cerebral Cortex, vol 25, no. 4, 2013, pp. 895-903. Oxford University Press (OUP), doi:10.1093/cercor/bht279. Accessed 3 Nov 2021.

[7] Månsson, K N T et al. “Neuroplasticity In Response To Cognitive Behavior Therapy For Social Anxiety Disorder”. Translational Psychiatry, vol 6, no. 2, 2016, pp. e727-e727. Springer Science And Business Media LLC, doi:10.1038/tp.2015.218. Accessed 3 Nov 2021.

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Internal Family Systems is a model that was first developed in the 1990s by Dr. Richard Schwartz. Schwartz conceptualised a core self, one that is at the essence of a person and is undamaged by external circumstances. Schwartz believed that along with the core self, there are also different sub-personalities, known as Exiles, Managers, and Firefighters^[1].

The idea of a person containing different aspects of the self was not new to Schwartz. In the 50s, Freud developed the concept of the ego, superego and the id, all as functional parts of the self. Eric Berne’s Transactional Analysis considered the parent ego state, the adult ego state, and the child ego state as they relate to our interactions with others.

Exiles, Managers and Firefighters

Exiles are the parts of ourselves we have suppressed. They are commonly associated with feelings of guilt and shame. They are the parts of the self that are wounded. These parts are placed in exile by the managers and firefighters, who prevent these wounded parts from rising to the conscious mind.

Managers are the parts of ourselves which are responsible for daily functioning. They direct our behaviour by orienting us away from potentially being hurt, perhaps by becoming too dependent on another person or by being rejected. They make decisions for us based on potential dangers and influence how we relate to others.

Firefighters are involved in survival or avoidant behaviours, such substance abuse, sexual risk-taking, compulsions, and self-harm. These behaviours happen when an exile begins to rise to the surface, perhaps triggered by a person, place or memory.

When we experience a trauma – like an attachment injury – we carry extreme beliefs and emotions, known in the IFS model as burdens. Guilt and shame are examples of burdens that are carried by the exiles.

When we assume that a part is a burden itself, it makes sense that other parts will go to war against it. Parts are not burdens, they carry burdens.

The Self in the Internal Family System

Other than exiles, managers, and firefighters, we have a core self that retains its essence despite external circumstances^[2], like trauma related to neglect or abuse. The self is not a visible, compartmentalised aspect of the person; it is the ‘I’ that witnesses thoughts, feelings, behaviours, memories, and judgments.

Related to the self are positive attributes, such as confidence, compassion, connectedness, wisdom, acceptance, perspective, and leadership.

In IFS, the aim is to identify the exiles, managers, and firefighters and recognise them as parts of the self, not the full self. The therapist and client work together to address the burdens that parts are carrying and attempt to unburden them, restoring these wounded parts with a sense of trust and harmony alongside the rest of the internal system.

IFS believes that the self, when present, is able to speak to these burdened parts in a way that promotes release and healing, ultimately achieving harmony across the internal family system.

Who can benefit from IFS?

IFS is used in the treatment of psychological wounds and other mental health conditions. In particular, IFS may be used to treat those who have experienced childhood abuse or neglect, where a part of the self has come to believe it was inherently bad, shameful, or unworthy of love.

IFS has been used in the treatment of issues such as^[3]:

• Psychological trauma.
• Various forms of abuse (physical, emotional, sexual).
• Depression.
• Anxiety.
• Issues with body image.
• Fears and phobias.
• Substance abuse.

What happens in IFS Therapy?

The structure of an IFS session is similar to that of traditional talk therapies, whereby a person relays their thoughts and feelings through a narrative. But, IFS also involves guidance towards noticing one’s internal environment in relation to how they feel, whilst paying attention to any ‘parts’ that are carrying a particular burden^[4]. For example, a person who suffers from an eating disorder may be guided towards paying attention to the part of the self that wants to binge.

The client is then asked to identify how they feel towards that part. Their response may involve feelings of fear, hatred, guilt, or shame, to name just a few.

Communication is then encouraged between the self and the wounded part. With a clear mind cultivated and developed through mindful awareness, clients can begin to listen attentively to the part of themselves that is carrying the burden and potentially hear it explain its behaviour. With the guidance of an attained therapist, the part can be asked to take on safer, more effective coping mechanisms to deal with its pain.

Untangling the Parts, Finding the Self

IFS works by identifying and addressing the parts of ourselves that carry our burdens, and uncovering the deeper, unaffected self to help those parts heal from their pain. For healing to occur, those parts are guided towards letting go of the protective (yet simultaneously destructive) roles they have taken on as a result of difficult experiences. The result is a harmonious internal family system that is led by the confident, calm, connected, and curious self.

Get in touch

If you have a client, or know of someone who is struggling to heal from psychological trauma and could benefit from Internal Family Systems Therapy, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Ifs-institute.com. n.d. The Internal Family Systems Model Outline | IFS Institute. [online] Available at: <https://ifs-institute.com/resources/articles/internal-family-systems-model-outline> [Accessed 7 August 2020].

^[2] Ifs-institute.com. n.d. The Internal Family Systems Model Outline | IFS Institute. [online] Available at: <https://ifs-institute.com/resources/articles/internal-family-systems-model-outline> [Accessed 7 August 2020].

^[3] Leading Edge Seminars. n.d. Clinical Applications Of Internal Family Systems (IFS) – Leading Edge Seminars. [online] Available at: <https://leadingedgeseminars.org/event/clinical-applications-of-internal-family-systems-ifs/> [Accessed 7 August 2020].

^[4] Goodtherapy.org. 2018. Internal Family Systems Therapy. [online] Available at: <https://www.goodtherapy.org/learn-about-therapy/types/internal-family-systems-therapy> [Accessed 7 August 2020].

The post Internal Family Systems Therapy appeared first on Khiron Clinics.

Equine therapy involves the use of horses, used in treatment by rehab centres, veteran’s therapy groups, and trauma recovery centres, and is always led by a licensed professional.

Equine therapy offers benefits to those suffering from a wide range of psychological health issues, including^[1]:

• Substance addiction.
• Eating disorders.
• Grief.
• Trauma and PTSD.
• Depression.
• Anxiety.
• Mood disorders.

For a long time, horses have been great partners in the development of human society. They have allowed us to farm, travel, and hunt effectively. More recently, research has found they can also help us to heal from our trauma-induced wounds.

How do horses help?

Coping with feelings is a difficult challenge faced by those of us who have experienced a trauma and are suffering from mental health issues or struggling with addiction. Feelings and thoughts can be so powerful and upsetting that those suffering may turn to destructive, avoidant behaviours to distract themselves or find relief from these feelings. Accessing these feelings intellectually can be hard because very often they are buried underneath layers of denial or blame. In equine therapy, the focus is not on intellectualisation of one’s feelings, but on being honest and authentic enough about them to be in connection with the horse.

Horses often demonstrate an emotional attunement and sensitivity, a skill developed over their evolution as prey animals. The horse often reflects our inner environment. Therefore, by observing and paying attention to the horse, we can gain insight into our own state of being.

Horses teach us honesty and vulnerability is more effective than authority and distance.

How does Equine Therapy help us to be vulnerable?

Horses read our non-verbal communication and they react to it. They know if you are arrogant or aggressive, pregnant, or sick, and provide clear feedback to the client’s emotional state.

When we have experienced trauma – either a single experience or as a series of events – it can be extremely difficult to talk about it. This is one of the challenges faced in traditional talk therapies. Equine therapy offers a unique opportunity for clients to think about and process their difficult feelings.

Simply watching a horse, and how it behaves around other horses in a given situation, can allow clients to relate to a horse’s experience. Three horses might play in an arena with two behaving aggressively, while the other shies away timidly. Upon seeing this, a client might be able to relate the experience of the shy horse to their own experience -among violence in the family, for example. This provides a safe, non-threatening opportunity to process one’s feelings.

Benefits of Equine Therapy

Anxiety

For those suffering from anxiety disorders – such as Generalised Anxiety Disorder, Panic Disorder, or Social Anxiety Disorder – worries and fears about the past or the potential future can be overwhelming and disrupt daily life.^[2] Horses can help those suffering from anxiety by requiring them to ‘stay present and focused on the task at hand’^[3], as explained by anxiety expert, Dr. Robin Zasio.

PTSD

Equine therapy is seeing an increase in popularity in assisting treatment of PTSD in combat veterans.^[4] PTSD significantly impacts a person’s ability to form strong connections with others, as it is often accompanied by a lack of trust and an inability to be open and vulnerable. In working with horses, many veterans with PTSD have found the ability to bond and connect with another is still within them, as it had been invited to the surface in relationship with the horse as a therapeutic partner.^[5]

Autism Spectrum Disorders

In assisting therapy for children with autism spectrum disorders, equine therapy was found to^[6]:

• Improve self-esteem.
• Increase self-confidence.
• Create a sense of empowerment.
• Create a sense of presence.
• Provide feelings of freedom.
• Provide a sense of independence and competency.

Addiction

Addiction treatment typically involves treating co-occurring disorders, like depression and anxiety^[7]. Equine therapy is linked to a reduction in both. Those struggling with addiction also regularly deal with challenges in interpersonal relationships. Equine therapy cultivates and encourages trust, vulnerability and honest communication, improving a client’s abilities in those areas.

A Complementary Approach to Healing

Equine Therapy is an effective complementary therapy when used in conjunction with traditional psychodynamic psychotherapies. It promotes authenticity of self and encourages open and honest communication as when these attributes are lacking, a relationship with the horse cannot be properly formed.

Throughout history, horses have been prey animals so they are familiar with anxiety. Their vigilance and keen eye for threat gives them a sense of understanding and awareness. Anxiety is comorbid with an extensive list of other conditions, and those who suffer with it often find a mutual understanding of anxiety between themselves and their therapeutic partner horse.

Overall, equine therapy provides an opportunity to heal where traditional approaches often miss the mark.

Get in touch

If you have a client, or know of someone who is suffering with mental health issues, and who could benefit from equine therapy, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Goodtherapy.org. 2017. Equine–Assisted Therapy. [online] Available at: <https://www.goodtherapy.org/learn-about-therapy/types/equine-assisted-therapy> [Accessed 7 August 2020].

^[2] US National Library of Medicine. General anxiety disorder. Updated March 2018.

^[3] Clarke, J., n.d. Equine Therapy As Mental Health Treatment: How It’s Used. [online] Verywell Mind. Available at: <https://www.verywellmind.com/equine-therapy-mental-health-treatment-4177932#citation-4> [Accessed 7 August 2020].

^[4] Shelef A, Brafman D, Rosing T, Weizman A, Stryjer R, Barak Y. Equine assisted therapy for patients with post traumatic stress disorder: A case series study. Mil Med. 2019;184(9-10):394-399. doi:10.1093/milmed/usz036.

^[5] Clarke, J., n.d. Equine Therapy As Mental Health Treatment: How It’s Used. [online] Verywell Mind. Available at: <https://www.verywellmind.com/equine-therapy-mental-health-treatment-4177932#citation-4> [Accessed 7 August 2020].

^[6] Tan, V.‐X.‐L. , & Simmonds, J. G. (2018). Parent perceptions of psychosocial outcomes of equine‐assisted interventions for children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(3), 759–769. 10.1007/s10803-017-3399-3.

^[7] Quello, Susan B et al. “Mood disorders and substance use disorder: a complex comorbidity.” Science & practice perspectives vol. 3,1 (2005): 13-21. doi:10.1151/spp053113.

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Our bodies record everything that we experience throughout the whole of our lives translating each event to store in our mind and memory through the medium of our senses. As individuals who carry trauma, we each have our own experiences that remind us of the event.

The DSM -1V classification defines Borderline Personality Disorder (BPD) as a ‘pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity’. Presentation of the disorder typically involves a history of chaotic interpersonal relationships, unstable mood and self-image disturbances, self-injurious behaviours and other maladaptive coping behaviours (Antai-Otong 2003). It has been said that the extent of disability associated with the disorder ‘involves a terrible way to experience life’ (Gunderson 2001:13). Symptoms of BPD include significant emotional distress and impaired interpersonal and occupational functioning (Zanarini et al. 1998).  Also, to be diagnosed, a person must have at least five of the identified symptoms which are grouped into three clusters according to the DSM –IV (APA 2013) Classification.

There is some divergence between ICD-10 World Health Organisation WHO (1992) and DSM-IV (APA 2013) as to whether BPD can be diagnosed in adolescence younger than eighteen years of age.  The ICD-10 (WHO1992) sets out a criteria and classifies overall groups of disorders of adult personality and behaviour, whereas the DSM-IV (APA 2013) specifies that adolescents with BPD can be diagnosed if the features of the disorder have been present for at least one year (NICE 2008).  BPD is difficult to define and although a high percentage of people in a mental health setting may have been diagnosed with such a disorder, professionals are still undecided in their approach. It is very important to understand the above symptoms and borderline personality itself, as it can easily be misdiagnosed as another mental illness – particularly mood disorder (Arntz 1999). BPD is more likely to develop in women than men. It should also be noted that drug and alcohol use often occurs with personality disorders and also appears more apparent in those suffering with borderline personality disorder.

The cause of borderline personality disorder is still suggested as a grey area and complex. A strong thought is that the cause of BPD could arise from childhood abuse, neglect, separation from loved ones or caregivers. These are seen to be major contributing factors particularly if the abuse is severe and sustained (Leib et al, 2004). However, another school of thought is that BPD could run in families or that it may be related to a chemical imbalance in the brain (Alper 2001). Leib et al, (2004) agrees that  genetic components and adverse childhood experiences may cause childhood dysregulation leading to dysfunctional behaviours and conflicts later on in life. It is important to note that the United Kingdom is the only country in the world to have a health service in which personality disorders are considered to be of great importance. As a result, during 2003, it was decided to include the treatment of personality disorders as part of the service. The development of these services remains inconsistent and in some cases undeveloped (NICE 2008).

The implementation of relevant legislation and guidelines has been set out in England and Wales to support all who meet the criteria of BPD. The National Institute for Health and Clinical Excellence (NICE 2008) draft consultation document has commissioned a clinical guideline for anyone that has developed this disorder. Aims set out by this document include the evaluation of specific psychosocial and pharmacological interventions regarding treatment, whilst providing choice, best practice and advice for care and treatment of the individual. Raising the Standard: The Revised Adult Mental Health National Service Framework and an Action Plan for Wales (WAG 2005) sets out guidelines relating to the diagnosis of BDP using the DSM- 1V (APA 2013) and criteria to combat over- diagnosis. These guidelines lay down paramount importance on the delivery of client centred care. If the usual treatment is not sufficient, the drug treatment must be tailor made to meet the individual’s needs with BDP and then combined with psychotherapy or behavioural strategies to be effective. All team members involved must be educated fully in the presentation of BDP and it is vital that the team approach is integrated to provide consistency.

Still to this day psychotherapeutic treatment of this patient group remains one of the most challenging for our mental health professionals. The underlying dynamics of this complex disorder and common lack of understanding leave patients diagnosed with BPD extremely difficult to engage and work with. Clients with BPD continue to significantly utilise medical and psychiatric care. Their symptoms of self-destruction, anger, mood instability and impaired interpersonal relationships can hinder their development of a therapeutic alliance and successful treatment outcome. When dealing with this group of individuals staff may have feelings of stress, anxiety, confusion, loss of achievement and  may find it difficult to move away from what is familiar to them or to the unknown (Marquis and Huston 2006). 

However, In more recent years the development of therapeutic models by practitioners such as Meares (Meares et al. 1999) and Linehan (1993a; 1993b) has provided a basis for focused therapy for which there is increasing evidence of successful outcomes. Effective treatment strategies for BPD with a central focus on the implementation of interventions using the concepts of Dialectical behavioural therapy (DBT) has been proven to build effective coping strategies and skilful behavioural responses for improved quality of life. According to the American Psychiatric Association (2013) practice guidelines, DBT is a psychotherapeutic approach that has been shown to be effective in randomised trials.

The Welsh Assembly Government (WAG) (2005) state that support should be in place for all staff at all levels to help cope with this challenging group of clients. As research continues and more sufferer’s of BPD continue to experience a better quality of life armed with more robust coping skills, the future for this client group and the expansion of DBT services appears brighter.

If you have a client, or know of someone who is struggling to find the right help for borderline personality disorder, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

References

Alper, G Peterson S J (2001) Dialectical Behavior Therapy for Patients with Borderline Personality Disorder. Journal of Psychosocial Nursing and Mental Health Services. 39 10.

American Psychiatric Association (2000) Diagnostic and Stastisical Manual of Mental Disorders. (4^th edn.) DSM-IV. Washington DC: APA.

Arntz A (1999) Do personality disorders exist? On the validity of the concept and its cognitive-behavioural formulation and treatment. Behaviour Research and Therapy.37 97- 134.

Crane J.T (2017) The Trauma Heart. Florida: Health Communications, Inc.

Gunderson, J G & Kolb J E (2008) Discriminating features of borderline patients. American  Journal of Psychiatry. 135 792-796 Lieb, K Zanarini, M C Schmahl, C

Linehan, M Bohus M (2004)  Borderline Personality Disorder. The Lancet: 364, 9432, RCN Edition: Pro-Quest Nursing and Allied Health Source. 453

Marquis, B L & Huston (2006) Leadership Roles in Management Functions in Nursing. (6^thedn.). Philadelphia: Lippincott: Williams & Wilkins.

National Institute of Clinical Excellence (2008) Borderline Personality Disorder: Treatment and Management. A draft Consultation.

http//www.nice.org.uk/guidance/index.jsp?action=folder&o=4039 Accessed 16/06/08.

Otong.A (2003) Evidence-Based Care of the Patient with Borderline Personality Disorder. 2016 Jun; Vol. 51 (2), pp. 299-308.

Welsh Assembly Government (2005) Raising the Standard: The Revised Adult mental Health National Service Framework and Action Plan for Wales: Welsh Assembly Government. Linehan M (1993) Cognitive Behavioral Therapy of Borderline Personality Disorder. New York: Guildford Press

World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.

Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL. (1989). The Revised Diagnostic Interview for Borderlines: discriminating BPD from other axis II disorders. J Personal Disord.: 3:10–18.

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A diagnosis of a personality disorder can affect how we cope with aspects of life such as relationships and emotional attachments. Those with a personality disorder often find themselves fixed in a pattern of beliefs and life skills regarding ways of dealing with daily life which is difficult to change. Emotions may be particularly intense and problematic to control. In turn, this can prove to be a distressing experience for both the person diagnosed and others close to them. It is common for those with a personality disorder to experience secondary mental health problems such as anxiety or depression. Self-harm is also prevalent alongside the comorbidity of alcohol and substance misuse. These behaviours can be used as coping strategies. Coid and Ullrich state that personality disorders are reasonably common[1]. Whilst the NHS claim that approximately five percent of people are living with a type of personality disorder[2].

The primary guidelines used in the diagnostic process for mental health conditions are set out in the International Classification of Diseases (ICD-10) produced by the World Health Organisation (WHO), and the Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association. All personality disorders are listed in these pieces of literature and have been arranged into three clusters, A, B and C. The assessment process can be lengthy and problematic for the health professional (usually a psychiatrist) who is undergoing the task. Some difficulties include: overlapping symptoms of other mental health conditions which creates a hurdle when attempting to identify signs and symptoms specific to a personality disorder; the complexities of personality disorders often mean that individual presentations reveal multiple symptoms that do not fit into any one of the clusters or perhaps overlap between two or three of them; alcohol and drug use alongside presenting symptoms at assessment; reluctance of medical professionals due to potential associated post diagnostic stigma which may hinder a patient accessing the appropriate support.

There is no definitive reason for the cause of personality disorders. Overlapping factors including biological and environmental are seen to be contributing factors to the development of personality disorders in later life (NHS). However, there is often a history of trauma for many of those diagnosed with a personality disorder. Problematic upbringing including experiences of neglect, physical, sexual or emotional abuse have been reported in a high number of cases of personality disorders. Within the parameters of normal childhood development we are taught how to create bonds with other people and become emotionally mature by being nurtured. Those who are damaged through neglect or abuse have not experienced these steps towards appropriate development and may struggle to manage and express their feelings during adulthood[3].

Those with cluster B personality disorders experience great emotional instability and can be viewed by others as unpredictable. Examples of these are:

Antisocial Personality Disorder (ASPD) 

Antisocial personality disorder (ASPD) is thought by many to be an untreatable disorder. Antisocial personality disorder manifests itself as a set of core personality traits which allow one to disregard the rights of others in pursuit of impulsive, self-serving goals. Individuals with this disorder typically disregard the welfare of others, display superficial charm in social situations, display a lack of guilt or regret, break the law, behave irresponsibly, manipulate or lie to others, act impulsively, seek stimulation through reckless activity and maintain an inflated sense of self-importance.

Antisocial personality disorder can be a devastating condition thus having a considerable impact on individuals, families and society. ASPD has the same prevalence in men as schizophrenia, which receives the greatest attention from mental health services. Furthermore, ASPD is associated with significant costs, arising from emotional and physical damage to victims and property, use of police resources and involvement of the criminal justice and prison services. Related costs include increased use of healthcare facilities, lost employment opportunities, family disruption, gambling and problems related to alcohol and substance misuse[4].

In 2001 a study by Scott and colleagues revealed that the lifetime public services costs for a group of adults with a history of conduct disorder (of which 50% will go onto develop adult ASPD) were found to be 10 times those for a similar group without the disorder. ASPD is closely associated with criminal offending and any intervention that seeks to improve the outcome of ASPD is also likely to impact upon this offending[5].

Borderline Personality Disorder (BPD)

DSM -5 (American Psychiatric Association) classification defines Borderline Personality Disorder (BPD) as a “pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity”. Presentation of the disorder typically involves a history of chaotic interpersonal relationships, unstable mood and self-image disturbances, self-injurious behaviours and other maladaptive coping behaviours[6]. It has been said that the extent of disability associated with the disorder ‘involves a terrible way to experience life[7]’.

Symptoms of BPD include significant emotional distress and impaired interpersonal and occupational functioning.  Also, to be diagnosed, a person must have at least five of the identified symptoms which are grouped into three clusters according to the DSM –5 Classification[9].

There is some divergence between ICD-10 World Health Organisation WHO (1992) and DSM-5 (APA 2013) as to whether BPD can be diagnosed in an adolescent younger than eighteen years of age.  The ICD-10 sets out a criteria and classifies overall groups of disorders of adult personality and behaviour, whereas the DSM-5 (APA 2013) specifies that adolescents with BPD can be diagnosed if the features of the disorder have been present for at least one year[10]. 

BPD is difficult to define and although a high percentage of people in mental health setting may have been diagnosed with such a disorder, professionals are still undecided in their approach. It is very important to understand the above symptoms and borderline personality itself as it can easily be misdiagnosed as another mental illness particularly a mood disorder[11].

BPD is more likely to develop in women than men. It should also be noted that drug and alcohol use often occurs with personality disorders and also appears more apparent in those suffering with borderline personality disorder. The cause of borderline personality disorder is still suggested as a grey area and complex. A strong thought is that the cause of BPD could arise from childhood abuse, neglect, separation from loved ones or caregivers. These are seen to be major contributing factors particularly if the abuse is severe and sustained[12]. However, another school of thought is that BPD could run in families or that it may be related to a chemical imbalance in the brain[13]. Leib et al agree that  genetic components and adverse childhood experiences may cause childhood dysregulation leading to dysfunctional behaviours and conflicts later on in life[14].

It is important to note that the United Kingdom is the only country in the world to have a health service in which personality disorders are considered to be of great importance. As a result, in 2003, it was decided to include the treatment of personality disorders as part of the National Health Service. However, the development of these services remains inconsistent and in some cases undeveloped[15].

The implementation of relevant legislation and guidelines has been set out in England and Wales to support all who meet the criteria of BPD. The National Institute for Health and Clinical Excellence draft consultation document has commissioned a clinical guideline for anyone that has developed this disorder. Aims set out by this document include the evaluation of specific psychosocial and pharmacological interventions regarding treatment, whilst providing choice, best practice and advice for the care and treatment of the individual[16].

The Welsh Assembly Government document Raising the Standard: The Revised Adult Mental Health National Service Framework and an Action Plan for Wales sets out guidelines relating to the diagnosis of BDP using the DSM- 5 (APA 2013) and criteria to combat over- diagnosis. These guidelines lay down paramount importance on the delivery of client centred care. If the usual treatment is not sufficient, the drug treatment must be tailor made to meet the individual’s needs with BPD and then combined with psychotherapy or behavioural strategies to be effective. All team members involved must be educated fully in the presentation of BPD and it is vital that the team approach is integrated to provide consistency[17].

Narcissistic Personality Disorder (NPD)

Narcissistic personality disorder (NPD) presents with behavioural traits which are in fact the polar opposite to an underlying condition blanketed from fragile vulnerability. Sufferers are predisposed to act upon an inherent over inflated ego and regularly display behaviours indicative to someone who possesses a superior sense of self importance. Those diagnosed with NPD harbour a deep rooted desire for regard and overwhelming appraisal. Unfortunately, they tend to experience difficulties throughout their lifelong relationships and fail to display empathy for others. Many of those diagnosed with NPD appear to be bursting with excessive confidence and self-esteem. However, this presentation is merely a mask which protects a damaged individual, wide open to the slightest criticism.

An individual diagnosed with NPD will encounter significant problems in several aspects of their life. These include: Interpersonal and family relationships; education; career; economics.  People with narcissistic personality disorder are likely to face great disappointment when they are overlooked for special favours they believe they are deserving of. They are likely to experience unfulfilling relationships without exceptional admiration and others may find their company unpleasant.

Histrionic Personality Disorder (HPD)

Individuals with this diagnosis strive to be the centre of attention in social situations and often present in an excessively dramatic, emotional and highly provocative (sometimes sexual) manner. Failure to be given such recognition or a perception of being ignored can result in extreme anxiety. People with HPD are often overly concerned about their physical appearance as this is viewed as a significant way in which to gain the attention of others. Personal opinions are often expressed with much gusto, however they lack substance. Emotional outbursts are common as they are fluid and rapidly changing but ultimately, shallow. HPD seriously affects the manner in which those diagnosed are able to relate to others as they can be easily influenced and often believe that bonds with companions are tighter than they actually are. Individuals may come to depend on approval from other people and often blame others for personal failures or disappointments. Criticism can be met with extreme sensitivity and an unwillingness to accept any changes in personal habits or mannerisms is most likely viewed in a threatening way.

During the month of February, Khiron will be looking in depth at the personality disorders discussed in cluster B. The remaining cluster C will be explored during the month of April. Please keep an eye out for our forthcoming articles on these topics and if you have a client, or know of someone who is struggling with a personality disorder, or recognise that they have symptoms discussed in this article – reach out to Khiron. We believe that we can stop the revolving door of treatment and misdiagnosis by providing effective residential and out-patient therapies for underlying psychological trauma. Allow us to help you find the path to effective, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

1. Coid, J. & Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain.The British Journal of Psychiatry. 188: 423-431

2. NHS Choices, personality disorders (http://www.nhs.uk/conditions/personality- disorder/Pages/Definition.aspx) accessed 26/12/2019

3. http://www.emergenceplus.org.uk/what- is-personality-disorder/93-causes.html accessed 26/12/2019

4. Myres MG (1998). Progression from Conduct Disorder to Antisocial Personality Disorder following Treatment for Adolescent Substance Abuse. American Journal of Psychiatry, April; 155 (4): 479-85.

5. Scott, S., Knapp, M., Henderson, J., & Maughan, B. (2001). Financial cost of social exclusion: Follow up study of antisocial children into adulthood. British Medical Journal, 323(7306), 191.

6. Otong.A (2003) Evidence-Based Care of the Patient with Borderline Personality Disorder. 2016 Jun; Vol. 51 (2), pp. 299-308.

7. Gunderson, J G & Kolb J E (2008) Discriminating features of borderline patients. American  Journal of  Psychiatry. 135 792-796 Lieb, K Zanarini, M C Schmahl, C

8. Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL. (1989). The Revised Diagnostic Interview for Borderlines: discriminating BPD from other axis II disorders. J Personal Disord.: 3:10–18.

9. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. (5^hedn.) DSM-V. Washington DC: APA.

10. National Institute of Clinical Excellence (2008) Borderline Personality Disorder: Treatment and Management. A draft Consultation.  http//www.nice.org.uk/guidance/index.jsp?action=folder&o=4039 Accessed 26/12/2019.

11. Arntz A (1999) Do personality disorders exist? On the validity of the concept and its cognitive-behavioural formulation and treatment. Behaviour Research and Therapy.37 97- 134.

12. Lieb, K Zanarini, M C Schmahl, C Linehan, M Bohus M (2004)  Borderline Personality Disorder. The Lancet: 364, 9432, RCN Edition: Pro-Quest Nursing and Allied Health Source. 453

13. Alper, G Peterson S J (2001) Dialectical Behavior Therapy for Patients with Borderline Personality Disorder. Journal of Psychosocial Nursing and Mental Health Services. 39 10.

14. Lieb, K Zanarini, M C Schmahl, C Linehan, M Bohus M (2004)  Borderline Personality Disorder. The Lancet: 364, 9432, RCN Edition: Pro-Quest Nursing and Allied Health Source. 453

15. National Institute of Clinical Excellence (2008) Borderline Personality Disorder: Treatment and Management. A draft Consultation. http//www.nice.org.uk/guidance/index.jsp?action=folder&o=4039 Accessed 26/12/2019

16. ibid.

17. Welsh Assembly Government (2005) Raising the Standard: The Revised Adult mental Health National Service Framework and Action Plan for Wales: Welsh Assembly Government.

.

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The majority of people with a personality disorder struggle to engage with mental health services. For those people who do, the event will commonly follow a crisis, an episode of self-harm, assessment for a different psychiatric complaint or a crime. Health professionals value the identification and diagnosis of a personality disorder, as any overlap can significantly affect the presenting signs and symptoms of already existing mental health conditions and future approaches to care.

Personality disorders can cause lifelong difficulties in areas such as health, education, employment and interpersonal relationships, therefore, it is necessary that they be addressed regardless of any other connections. Much controversy surrounds the question regarding where the responsibility lies, as healthcare professionals oversee the care of those with a personality disorder despite a percentage of those being involved in criminal activity.

The term ‘personality’ is used to describe the pattern of thoughts, behaviours and feelings that makes each of us the unique individuals that we are. Depending on the environment and situation we are in and the company we are with at the time, we do not always adopt the same patterns of thought, or feel and behave in the same way ritualistically. Having a personality disorder may mean that we regularly experience problems regarding our attitudes and opinions towards ourselves and others. These thought patterns may be fixed and unhelpful.

There must be 3 constant signs and symptoms that occur at any one time in order for a diagnosis of a personality disorder to be considered. They are:

1. The way we feel, think and behave causes us and/or  those around you significant difficulties on a regular basis. e.g. We may experience feelings of mistrust or abandonment towards others which results in unhappiness for both parties.
2. Our thinking patterns, feelings and the way we act causes a great many problems across the spectrum of our life. e.g. It may be challenging to meet new people or maintain friendships and relationships as we struggle to control your feelings and behaviour.
3. These problems are ongoing and may have begun in childhood continuing through into adulthood.

A diagnosis of a personality disorder is often viewed in a positive light as it can make way for someone to access the correct services for them to get the help they need and to learn more about their condition. However, for some, a diagnosis could result in difficulties in coming to terms with having a personality disorder and lead to a feeling of being “labelled” or “stigmatised”.

Belonging to Cluster A and reported as rare compared with other personality disorders is Schizoid personality disorder which has a prevalence estimated at less than 1% of the general population[1]. This condition usually begins by early adulthood, however, significant features may have been present during childhood. Over time during normal childhood development we learn to precisely interpret social cues and respond accordingly. The exact cause of schizoid personality disorder is unknown, however, research leans towards a series of environmental and genetic factors, most likely in early childhood contributing towards the development of the disorder. Michelle L. Esterberg and colleagues report that there is evidence to suggest cluster A personality disorders share both environmental and genetic risk factors, and there exists an increased risk factor to the pervasiveness of schizoid personality disorder in those related to people with schizophrenia[2].

In 2012, Theodore Millon and colleagues suggested that the link between being underweight and schizoid personality disorder may also indicate involvement of biological factors[3]. Premature birth, low birth weight and prenatal caloric malnutrition are risk factors for future diagnoses of mental health disorder which in turn may contribute to the development of schizoid personality disorder[4].  In 2014, Brigham Young University reported that, ‘those who have experienced traumatic brain injury may be also at risk of developing features reflective of schizoid personality disorder.[5]’ Other historical researchers such as Jenkins (1946) have hypothesised that excessively perfectionist, unloving or neglectful parenting may play a role in the development of this personality disorder[6].

Characteristics of Schizoid Personality Disorder typically include: disinterest in building new relationships with others (including family members); a belief that relationships cause problems and interference with one’s own freedom; emotional coldness and indifferent towards others; choosing to live without interaction with others; preferring to be alone with one’s own thoughts; gaining little pleasure from life; having very little interest in intimacy or sexual contact with others; may appear lacking in a sense of humour or motivation towards goals; failure to react to criticism or praise from others.

In 1990, Aaron Beck and Arthur Freeman stated that those with schizoid personality disorder consider themselves observers as opposed to participants in their surroundings and that their aloof lifestyle offers comfort. However, it is noted that, this group of people refer to themselves as socially defective in comparison to their peers, e.g when watching films or reading books that address the subject of interpersonal relationships. Even though individuals diagnosed with schizoid personality disorder may not desire closeness, they are observed to have become weary of being “on the outside, looking in”. In turn, such feelings have the potential to later develop depersonalisation or depression. In such cases, those affected report “going through life in a dream” or “feeling like a robot”.

Theodore Millon identified four subtypes of schizoid personality disorder[7]:

1. Languid Schizoid (including depressive features). This is characterised by the experience of profound angst without the ability to adequately express it, the inability to seek simple pleasures or act spontaneously, lethargy, exhaustion, inertia, weariness, apathy, listlessness and incapacity.
2. Remote Schizoid (including avoidant schizotypal features). Those diagnosed are often identified as; inaccessible, removed and distant, disconnected, secluded, peripherally occupied, solitary, aimlessly drifting. This subtype is often identified amongst the homeless community.
3. Depersonalised Schizoid (including schizotypal features). This group of schizoid types are often witnessed ‘staring into space’ or occupying themselves with a specific task when in fact they are not applying themselves to anything. They are distant and disengaged from themselves and their peers.
4. Affectless Schizoid (including compulsive features). Typically unresponsive, cold, lackluster, lacking in passion, unaffectionate, emotionless, spiritless, in-excitable and uncaring. Exhibits a preference for rigid schedule (obsessive-compulsive feature) with the coldness of the schizoid.

If you have a client, or know of someone who is struggling with a diagnosis of Schizoid Personality Disorder, or is experiencing symptoms described in this article – reach out to Khiron. We believe that we can stop the revolving door of treatment and misdiagnosis by providing effective residential and out-patient therapies for underlying psychological trauma. Allow us to help you find the path to effective, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources: 

1. Esterberg, M.L., Goulding, S.M. & Walker, E.F. J Psychopathol Behav Assess (2010) 32: 515. https://doi.org/10.1007/s10862-010-9183-8
2. ibid.

3. Millon T.  Carrie M.; Meagher, Sarah E. (2012). “The Schizoid Personality (Chapter 11)”. Personality Disorders in Modern Life. Seth D. Grossman, Rowena Ramnath (2nd ed.). John Wiley & Sons. pp. 371–374. ISBN 0-471-23734-5.

4. Abel Kathryn M (2010). “Birth weight, schizophrenia, and adult mental disorder: is risk confined to the smallest babies?”. Archives of General Psychiatry. 67 (9): 923–930. doi:10.1001/archgenpsychiatry.2010.100. PMID 20819986.

5. Brigham Young University (2014): Head injuries can make children loners. For original study, see Levan, Ashley; Baxter, Leslie; Kirwan, C. Brock; Black, Garrett; Gale, Shawn D (2015). “Right Frontal Pole Cortical Thickness and Social Competence in Children With Chronic Traumatic Brain Injury”. Journal of Head Trauma Rehabilitation. 30 (2): E24–E31. doi:10.1097/HTR.0000000000000040. PMID 24714213.

6. Jenkins R; S. Glickman (April 1946). “The Schizoid Child”. American Journal of Orthopsychiatry. 16 (2): 255–61. doi:10.1111/j.1939-0025.1946.tb05379.x.

7. Millon, Carrie M.; Meagher, Sarah E. (2012). “The Schizoid Personality (Chapter 11)”. Personality Disorders in Modern Life. Seth D. Grossman, Rowena Ramnath (2nd ed.). John Wiley & Sons. pp. 371–374. ISBN 0-471-23734-5.

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Within each individual person there lies a spectrum of traits. E.g. It is not unusual to experience jealousy, seek favour or feel emotional throughout our lifetime. However, being diagnosed with a personality disorder involves these traits causing problems, risk or damage. Research has revealed that personality disorders occur regularly. ‘Around one in 20 people live with some form of personality disorder.[1]’

Living with a personality disorder can affect an individuals coping mechanisms, emotions and interpersonal relationships. Often, those with a personality disorder find that their strategies for daily living and set of beliefs differ from peers and remain fixed.

The manner in which emotions are experienced may be intense, difficult to control, tiring and often confusing. The individual alongside friends and family members may find this distressing. Quite often, high levels of this type of discomfort may lead to the development or exacerbation of other mental health issues such as anxiety or depression. Amongst many other signs and symptoms associated with having a personality disorder is the prevalence of self-harm. There are various reasons to why people exhibit these behaviours. Some report self-harm to ease the way in which feelings triggered by negative or overwhelming emotions are managed. It can also be used as a means of coping with distress alongside communicating the levels and significance of stress being experienced at that time.

Quite often, a diagnosis of personality disorder can be further complicated by the use of substances and/or heavy alcohol consumption as a means of coping. It is frequently recognised that drug use and personality disorders are regularly associated with each other[2]. In 1990, Edgar P Nace et al presented the view that, ‘the pharmacological effects of alcohol and drugs induce personality regression with a weakening of ego function.[3]’ This conclusion is fundamental when considering the key aspects of personality disorders such as; necessity for instant gratification, poor interpersonal skills, impaired ability to recognise and process painful emotions and regulating behaviour, difficulties maintaining personal relationships and poor stress responses.

The two most widely used set of guidelines applied by medical professionals to diagnose mental health problems are: International Classification of Diseases (ICD-10) originating from the World Health Organisation (WHO), and Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association (APA). Personality disorders diagnoses are grouped into three ‘clusters’, A, B, and C. In certain cases, Doctors encounter difficulties working towards the diagnosis of a personality disorder. These include; Complexity and symptoms not settling into any specific one of the 3 clusters, reluctance of Doctors to give a diagnosis due to fears it may cause future difficulties in accessing help, symptom overlap whereby there exist difficulties in pinpointing unique characteristics, drug/alcohol use. Those finally diagnosed with a personality disorder may feel that doctors making the decision are unclear regarding their diagnosis. Some may experience being stigmatised by a diagnosis whilst others have the opportunity to use the diagnosis to their advantage by accessing the correct support and treatment. 

Cluster A personality disorders present with those experiencing difficulties relating to others. Behaviour patterns may appear eccentric or out of the ordinary. Schizotypal Personality Disorder is a significantly debilitating personality disorder belonging to Cluster A which makes forming relationships and bonds with others extremely difficult. Some people may experience odd, intrusive thoughts and feel paranoid and/or experience auditory or visual hallucinations. This can also be identified as those diagnosed as appearing eccentric and lacking emotion. Other characteristics of this condition include; those diagnosed thinking alternatively and exhibiting odd behaviours. Upon times, some may become tense or anxious when people fail to share their beliefs. It has been noted that some people often use strange words or phrases. Those diagnosed with schizotypal personality disorder sometimes refer to themselves as having special abilities, e.g. sixth sense or telepathy and can feel very uncomfortable in social settings. There are no specifically recommended medications for the treatment of schizotypal personality disorder. However, Doctors may prescribe antidepressants, antipsychotics, benzodiazepines or mood stabilisers to help alleviate symptoms such as low mood and anxiety.

Schizotypal personality disorder exhibits many symptoms of psychosis. Each individual’s experience of psychosis is totally unique. Schizotypal personality disorder occurs in approximately 3% of the population and is more common in males. Many of these people do not come into contact with mental health services because they do not find their experiences distressing. Some people, however, are so distressed and have experienced significant life changing problems that they seek professional help, or others seek help on their behalf.

Many individuals who suffer from psychosis have survived traumatic or abusive experiences, therefore, it may be beneficial for therapy to focus not only on the present but also on the psychological effects of trauma. At Khiron, our psychologists are skilled in working therapeutically with trauma survivors, including working with flashbacks and dissociation (mentally distancing yourself from what is happening, a common way that people cope with trauma).  We use adapted trauma-focused approaches to therapy as a method to help those who experience psychosis.

If you have a client, or know of someone who is struggling with a diagnosis of Schizotypal Personality Disorder, or is experiencing symptoms described in this article – reach out to Khiron. We believe that we can stop the revolving door of treatment and misdiagnosis by providing effective residential and out-patient therapies for underlying psychological trauma. Allow us to help you find the path to effective, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

1. https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/personality-disorder/ accessed 9/11/2019

2. Daley D.C. Moss H.B and Campbell M.S.N (1993) Dual Disorders: Counselling Clients with Chemical Dependency and Mental Illness. Hazelden. Minn

3. Edgar P. Nace MD (1990) Substance Abuse and Personality Disorder, Journal of Chemical Dependency Treatment, 3:2, 183-198, DOI: 10.1300/J034v03n02_08

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The main characteristics of Paranoid Personality Disorder (PPD) are pervasive distrust and suspicion of other people. When someone is suffering from PPD they often believe that people want to hurt them, use and abuse them or humiliate them somehow. They spend their time trying to protect themselves from these phantom attacks. They will also often preempt an assumed attack on themselves by mistakenly attacking others as a defence mechanism. People with PPD struggle to let go of old grievances and consequently are very resentful and hold grudges for a long time. They also tend to be excessively jealous and obsessive. It is obvious to see how their thinking is distorted as they regular read malicious intent into genuinely harmless situations or behaviour.

Often people with this condition will not develop close personal relationships as they do not trust anyone. This may make it harder to spot and subsequently treat.

The predominant symptoms of this disorder are:

• Believing that others have hidden malicious motives or are out to harm them.
• Doubting others intentions and loyalty.
• Unable to take criticism .
• Unable to work with others.
• Easily angered and often hostile.
• Detached and isolated.
• Unwilling to confide in others die to lack of trust
• Feels often attacked by others.
• Resentful.
• Unjustified suspicion and resulting jealousy of partners.

According to the DSM5, PPD often first becomes apparent in childhood or early teen years. Although direct causes are unknown, research has shown links to both biological factors – such as a history of schizophrenia in the family, and environmental factors, such as adverse childhood experiences like neglect, abuse or a generally unstable home environment. More likely than not, a combination of these factors will be what leads to the development of the disorder. Triggers that may bring on symptoms of this disorder can be harmless actions from others that are misinterpreted by the sufferer as malevolent. When a sufferer starts to become suspicious and paranoid, the decline can be rapid. Often the more suspicious and paranoid they become, the more they will isolate which in turn allows their distorted thinking to go unchallenged and take a stronger hold.

Treatment for those suffering from PPD is often difficult due to the severe trust issues and suspicion sufferers will often feel towards mental health professionals. This usually results in them being unwilling to seek treatment or take on board any advice from a professional. For any psychiatric treatment to be successful the professional must build a good relationship with the client that is based on trust and will put the patient at ease. This must be done before the patient is likely to confide in them.

For this reason it’s vital that the individual suffering from PPD is connected to a dedicated professional. Long term residential programmes are ideal for people looking to find support and recovery from PPD because in such a setting they will have the time to develop the needed rapport and trust needed to maintain recovery. At Khiron Clinics, our staff understand that clients suffering from this personality disorder will need time to ease into the process of treatment in order to achieve the most positive outcomes.

We know that in order for recovery from PPD to begin, the client needs to believe they are in an environment with a treatment team who really cares and where they will be heard and taken seriously. Time is needed to establish the necessary groundwork to develop the critical sense of trust in order for progress in treatment to be made.

This disorder is more difficult to treat in an out-patient setting or with short term treatment, because patients suffering with Paranoid Personality disorder are often unable to stick with the treatment process due to their paranoid feelings mistrust and unease. If a person refuses treatment then it is likely the condition will get gradually worse, almost feeding itself with each paranoid thought. This will inevitably lead to a breakdown in personal relationships and hugely impact the person sufferings ability to lead a functional life.

In cases where the individual accepts treatment it can often be very successful. Depending on the case a combination of psychotherapy and medication is often used. At Khiron our main aims with individuals suffering from PPD would be to help them understand more about their disorder, learn how to communicate with others about how they are feeling and to aim to reduce the feelings of paranoia through mind and body work such as meditation, yoga, and somatic experiencing.

If you have a client, or know of someone who is struggling with a diagnosis of Paranoid Personality Disorder, or is experiencing symptoms described in this article – reach out to Khiron. We believe that we can stop the revolving door of treatment and misdiagnosis by providing effective residential and out-patient therapies for underlying psychological trauma. Allow us to help you find the path to effective, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

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