Filmmakers know personality disorders make for compelling viewing. Think of attention-seeking Scarlett O’Hara in Gone with the Wind (1939). Or the manipulation and callous disregard for others in Silence of the Lambs (1991), The Talented Mr. Ripley (1999) and Chopper (2000). Then there are the fears of abandonment and emotional instability in Fatal Attraction (1987) and Girl, Interrupted (1999).
Cinema is less adept, however, at showing the ordinary joys, heartache and sometimes suicidal despair of the friends, workers or relatives we might know with personality disorders.
What makes a personality ‘disordered’?
Personality describes individual characteristic patterns of thinking, feeling and behaving. A personality disorder is a class of mental disorders that are diagnosed when these patterns are repeatedly and seriously inflexible and dysfunctional, over an extended period of time.
Personality disturbances have long been recognised through history. Narcissism takes its name from the Greek myth of 50BC. Beautiful Narcissus was transfixed by his reflection in a pool of water. The longer he stared, the more he was driven by both passion and heartache. Over time he died in this state of self-absorbed despair.
People with personality disorders behave and perceive themselves, and others, in a markedly different way to most in their culture. These ideas and behaviours tend to develop in adolescence or early adulthood and are enduring. This can cause significant distress and impairment in all facets of life.
How common are they?
Personality disorders represent one of the most prevalent and severe mental health conditions. Around 6.5% of Australian adults will have a personality disorder over their lifetime. Data samples of more than 21,000 people worldwide, including Europe, the Americas, Africa and Asia, show a similar prevalence of 6.1%.
About 40% to 60% of psychiatric patients have a personality disorder, with similar rates in drug and alcohol units and prisons.
Personality disorders account for about one in four mental health emergency visits and inpatient hospitalisations.
How are they diagnosed?
Personality disorder is a diagnosed mental illness included in both the World Health Organization’s International Classification of Diseases (ICD-10, 1994) and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013).
Although there is considerable individual variation, four broad areas of difficulty are common:
- regulating emotions, such as sudden surges of anger or despair
- disturbed relationships, such as being aloof or overly familiar
- confused thinking: difficulty understanding the self and misperceiving others' intentions
- associated problem behaviours, such as impulsiveness with drug use, promiscuous sexual behaviour, or self-harm.
What are the causes?
Personality disorders appear to have both genetic and environmental causes. Individual genetic differences in temperament and attachment patterns early in life seem to play a role, as some people appear pre-wired to be more hypersensitive or ambivalent about bonding with others.
Imaging studies of brain functioning report reductions in amygdala and hippocampal regions, perhaps reflecting the difficulties in regulating emotions and integrating autobiographical memories.
Compounding these difficulties is environmental trauma, including experiences of neglect or abuse during childhood or young adulthood, often found in the histories of those with severe personality dysfunction.
What are the sub-types?
There is little consensus among experts about personality disorder subtypes. DSM-5 lists ten, clustered into three groups: