19.8 Personality Disorders
(i) Personality refers to those persisting characteristics of a person that are demonstrated by the ways in which the person behaves or reacts in a wide variety of circumstances. These characteristics or traits can be used to describe, in broad terms, the type of personality. For example, a person who is basically friendly, outgoing and likes mixing with other people is said to have a "social trait" to the personality. Some persons are by nature very cautious and careful ("obsessional trait") or very easily provoked to aggression ("aggressive trait"), or falling in very easily with the wishes of others ("dependent trait"). People's personalities are a mix of these various traits but one is usually more evident than the others.
ii) In a few people the main (dominant) personality trait is so overbearing and predominant that it causes major difficulties to the person and for other people. Such a person is then said to have a personality disorder.
(i) Personality disorders can cause considerable problems to the persons who have them, to the persons' families and to people with whom they come in contact.
(ii) The behaviour of people with personality disorders will depend on the particular type of dominant personality trait, and can vary from being unable to take any responsibility for themselves to being thoroughly impulsive and irresponsible in their actions. Very rarely there are severe personality disorders which are difficult to differentiate from psychiatric illness.
(iii) People with a predominantly dependent personality disorder are weakwilled, passive and readily compliant with the wishes of others. They may avoid responsibilities and lack self reliance, drive and enthusiasm. Some react by persuading other people continually to help and assist them because of what they describe as their own helplessness. If married or in long-term relationships, such people may have the support of more self-reliant spouses or partners who may care for their every need. Sometimes this support is provided by several members of the family or by a son or daughter who may have committed their life to supporting and caring for the perceived helplessness and demands of the highly dependent and demanding parent.
(iv) Another type of personality disorder which may make demands on other people for support and care is the antisocial (dissocial) personality disorder. This type of personality disorder is sometimes referred to as psychopathic. However this term is no longer in routine use because it has certain connotations which are pejorative, deprecatory or are coloured by the loose use of the term in the media and drama to describe criminal or murderous individuals. At one extreme the person with an antisocial personality disorder can show lack of guilt, highly impulsive behaviour and failure to learn from life experiences. When these are accompanied by low tolerance of other people's needs and violence or aggression they may, indeed, lead to repeated offences against the law.
(v) Alcohol abuse or drug dependency may be a feature of some people with serious personality disorders. In such cases reference should be made to Chapter 22.
(i) People with a personality disorder (or a member of their family) may claim that there are care needs because of the effects of the personality disorder. In those with a dependent personality disorder attention to bodily functions may be claimed. However the person with such a personality disorder will usually be capable of attending to their bodily functions in the absence of any other co-existing disabilities. However, people with dependent personality disorder may experience greater difficulties in coping with the needs which may arise from co-existing disabilities.
(ii) Impulsive or irresponsible behaviour by some people with antisocial personality disorders may be advanced as a reason for supervision or watching-over. It would be rare for someone with such an antisocial personality disorder which produces behaviour that poses danger to the person or others to be permitted to remain in the community.
(iii) Therapeutic community methods are sometimes used, in which people with the more severe forms of personality disorder reside in, or attend, a therapeutic community for several months where they can talk about their problems in relationships and try to help other members of the group to identify and resolve their own problems. This form of therapy as well as group or individual counselling may be of benefit. However, treatment in such a therapeutic community does not imply the presence of any significant care needs.
19.8.4 Mobility Considerations
(i) Supervision when walking out of doors is most unlikely to be required by someone living in the community who has a personality disorder. [See also paragraph 19.7.8 above].
(i) The borderline between the limits of a normal personality and personality disorder is hard to define. Moreover, the effects of personality disorders themselves are highly variable. It is very likely that someone with a personality disorder whose effects are so disruptive or disordered that they are claimed to give rise to care needs, will have been assessed by a consultant psychiatrist and will be known to the local psychiatric and social community services. (ii) Confirmation of the diagnosis and an assessment of its principal features is essential. Information should thus be sought from a hospital doctor (usually, consultant psychiatrist) who has been involved in the case. It may also be helpful to seek information from the general practitioner or mental health care worker.
