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Post No.: 0809strategies


Furrywisepuppy says:


Post No.: 0796 explored some immediate things you could try to soothe and take care of yourself if you struggle momentarily or day-to-day for having a personality disorder.


But we don’t just want strategies that come into play only when an adverse action or reaction is imminent though. We need longer-term strategies too. These strategies can include reaching out and sharing with someone how you feel, or regularly meeting with peer support groups i.e. those with similar experiences to you.


Monitor your feelings in a mood diary in order to better understand your mood patterns and triggers, as well as to identify the good things you’ve done and have happened to you.


Plan for difficult times, like telling those close to you whom to contact, what treatments you’d like to have or avoid, and at what point you’d like people to consider taking you to a hospital if things get really bad.


Contact an advocate, who can help you have your voice heard if you feel that it’s not getting heard (such as when talking to doctors or accessing treatment).


Practise self-compassion, self-care and self-kindness. Practise mindfulness meditation or relaxation exercises routinely. Spend regular time outside amongst nature. And never forget the basics of good health like getting the right amount of quality sleep each night, eating regularly and eating a healthy and balanced diet, and partaking in enough physical activities every week. Avoid/limit alcohol and caffeine, and avoid other recreational drugs altogether. Our physical health connects with our mental health.


And if you need to – find specialist support for any social issues contributing to your distress (e.g. if you have been or are being abused, bullied, discriminated against, or have PTSD).


…Now we don’t quite yet understand why some people develop the traits associated with personality disorders while others don’t. These are complex disorders. But (as is mostly the case) it’s highly likely going to be a combination of genetic factors along with early life experiences, social and other environmental factors.


People are born with different temperaments (e.g. babies vary in how active they are, their attention spans, and how they adapt to change). Yet people are also shaped by their development and life experiences too (e.g. the quality of care they received when young, perhaps due to an unstable family, traumatic events, adverse experiences during their school life, poverty, discrimination, or the constant upheaval due to having to repeatedly move home to a totally new place or culture). Any of these experiences can lead to one feeling overwhelmed with unbearable feelings, and in turn can make it challenging to deal with the daily fuzzy challenges of adult life. A difficult childhood can result in developing certain beliefs about the way people think or behave and how relationships work. Based on these experiences, one might find it hard to trust others, or learn that one can get what one wants better (at least in the short-term) if one acts in a certain way. Coping strategies that worked for someone as a child, like perhaps avoiding others or conversely constantly seeking attention, may not work well for them as adults, but such strategies have stuck.


Indeed, those who’ve been given a personality disorder diagnosis are more likely than the population on average to, when growing up, have experienced neglect, emotional, physical or sexual abuse, a sudden bereavement like losing a parent and/or have been involved in a major incident or accident. It doesn’t mean that everyone who experiences these things will inevitably develop a personality disorder or mental health problem. This is because it will also depend on the balance of protective factors like how much love and support one received and when too, as well as one’s protective genes. Likewise, not everyone who develops a personality disorder will have experienced serious trauma, because of factors like one’s risk genetics.


Our understanding of personality disorders, and mental health in general, is still refining, and the categories, types, labels and the diagnostic criteria that mental health professionals use are often controversial. Individuals with the same diagnosis (e.g. borderline personality disorder, or avoidant personality disorder) may even appear to have very different personalities and individual experiences! What’s considered as ‘extreme’ behaviour can depend on the context, thus environmental factors, like a person’s social context, should be taken more into account, because many social factors will affect our capacity to cope, to relate to others, and to respond to stress.


Also, some consider the labels stigmatising – some see that their behaviour is a reasonable, natural, human reaction towards going through difficult life experiences, hence it’s unhelpful, and perhaps insulting, upsetting or stigmatising, to label how they behave as a ‘disorder’ regarding their personality. They see that the problem isn’t in them as an individual but in their environment, and thus professionals should focus on what within their life has contributed to their difficulties, and to solve these by helping them to discover new ways of living or strategies for coping; instead of figuring out what disorder category they fit into.


For some others though, they find that a diagnosis helps them to name and understand their experiences. This also helps them to explain their behaviour to other people, to understand they’re not alone, and to possibly access support and treatment for it too.


Misdiagnoses sometimes happen however because, depending on your present mood and the things that are happening in your life when you speak to a mental health professional, the professional might find it difficult to identify the diagnosis that best fits your experiences. If you feel that a diagnosis doesn’t reflect the way you feel then do discuss it with a mental health professional. It’s important that you receive the right support and treatment for you.


Whatever the case, a consensus is that the feelings and behaviours associated with personality disorders are very difficult to live with, and whatever terms one prefers to use, one deserves understanding and furry compassion.


In the picture of wider society, we once more all need to be better educated about mental health in order to have this understanding and to recognise that empathy is the appropriate response to those who are neurodiverse to us. We all need to be advocates for better mental health. We all need to be advocates for compassion.


We may assume that it’s impossible to change our personality but – although it takes time, persistent effort and the right support, strategies and treatment – it is possible.


Professional treatments available for personality disorders include talking therapies such as dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT) (which aims to improve your ability to recognise and better understand your and other people’s mental states), cognitive behavioural therapy (CBT), and cognitive analytic therapy (CAT) (which combines the practical methods of CBT with a focus on building a trusting relationship between you and your therapist so that together you can make sense of your situation and find healthier strategies to cope with your difficulties).


Other talking therapies include schema-focused cognitive therapy, psychodynamic therapy, interpersonal therapy, and arts therapies. Therapeutic communities are group programmes where members support each other to recovery, with the help of a facilitator. These programmes can last anywhere between a day or several months. Medications like antidepressants, antipsychotics, anxiolytics (for treating anxiety) or mood stabilisers may also be prescribed, although not necessarily for the personality disorder but for any comorbidities like depression or psychosis.


What mental health services and treatments are available to you will depend on where you live, unfortunately. Some services require your general practitioner to refer you to them, while others can be accessed via self-referral. You should always have a structured assessment with a mental health specialist before you’re given a diagnosis, if you will be given one. A good, trusting relationship with your social worker, psychiatric nurse, therapist and/or psychiatrist can be pivotal. You should be well-informed and have a say in your care plan and what treatments you’re offered. You have the right to refuse medications and ask for an alternative treatment, unless you lack the mental capacity to make an informed decision, are being treated under a court order for having committed a criminal offence, or in a couple of other circumstances. You may choose to see a private counsellor or psychotherapist if you can afford it.


Friends and family can help someone with a personality disorder by learning about what they’re experiencing and what’s affecting their thoughts, feelings and behaviours; and by challenging any stigma. Learn their triggers. Clarify the boundaries and expectations. But try to be patient – don’t get involved in an argument in the heat of the moment. Talk in a calm and compassionate manner despite their possibly upsetting behaviour. Don’t judge them but listen and acknowledge how they’re feeling. Plan ahead by asking how you could help if things get difficult. Help them to seek treatment and support, or to find an advocate. Let them know that you’re always there for them. Do look after yourself too because supporting a loved one who is struggling can be difficult.


And remind them of the other aspects of their personality. Despite their personality disorder diagnosis, they could still be likeable, funny, kind and intelligent, for instance. Those with personality disorders can fail to understand why they do what they do half the time, and it can just take someone with hope and compassion to see something behind their eyes that they cannot see themselves, to save them and tell them that they can be okay.




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