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PARALLELS CONSULTING

REDUCING THE STIGMA OF PERSONALITY DISORDERS.

Personality Disorders (PD) are often portrayed as being dangerous or scary in movies, on television, and on social media. The terms ‘psychotic’ and ‘narcissist’ get casually thrown around and attached to emotional outbursts and even moods.


 

The reality is that many people live with various personality disorders, whether diagnosed or not. For those who are aware of having one disorder or co-occurring disorders, the negative perception held at the societal level can exacerbate a feeling of shame or need to hide the truth about their mental health.


It is imperative to work toward reducing the stigma of personality disorders and recognize they are not something to fear.


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THE IMPORTANCE OF REDUCING STIGMA SURROUNDING PERSONALITY DISORDER

About 9.1% of the adult U.S. population meets the criteria for at least 1 of the 10 recognized types of personality disorder.


Because stigma and discrimination against people with mental illness are so prevalent, more than half of those who need help do not seek it out. They may worry about reactions from family and friends or that they may lose their jobs.


Discrimination is often a product of the stereotype of the “dangerous” psychopath depicted in movies and television, and even in the news media, In fact, most mentally ill people are more likely to be victims of violent crimes than perpetrators. Even when people do seek help for mental health issues, they often receive lower quality of care due to unconscious bias among providers.


WHAT IS PERSONALITY DISORDER?

According to the DSM 5, there are ten types of personality disorders categorized into 3 “clusters” based on the presentation of symptoms. Many people have several personality disorders at the same time or other comorbid psychiatric conditions. Often, people with PD do not realize their traits and behaviors are harmful and initially seek treatment for another condition such as substance abuse or anxiety.


Symptoms of PD involve a distorted sense of self or identity. People with PD often have difficulty forming healthy relationships because they lack empathy, are emotionally distant or are attention-seeking and in constant need of reassurance.


Scientists are not sure exactly what causes PD, but it is thought to be a combination of genetic and environmental factors.


Cluster A Personality Disorders involve appearing strange or out of sorts:

  • Paranoid (characterized by mistrust and suspicion)

  • Schizoid (characterized by a lack of interest in others)

  • Schizotypal (associated with odd or eccentric behavior)

Cluster B disorders involve appearing dramatic, irrational, or erratic:

  • Antisocial (characterized by social irresponsibility, disregard for others, deceitfulness, and manipulation of others for personal gain)

  • Borderline: (defined by inner emptiness, unstable relationships, and emotional dysregulation)

  • Histrionic: (illustrated by attention seeking and excessive emotionality)

  • Narcissistic: (delineated by self-grandiosity, need for admiration, and lack of empathy)

Disorders placed in the cluster C category are recognized by a fearful or anxious appearance:

  • Avoidant: (characterized by avoidance of interpersonal contact due to rejection sensitivity)

  • Dependent: (shown by submissiveness and a need to be taken care of)

  • Obsessive-compulsive: (defined by perfectionism, rigidity, and obstinacy)


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PUBLIC STIGMA

Public stigma refers to negative attitudes and behaviors displayed by the general public (as opposed to self-stigma). People may not be aware that they hold stigmatizing views, which are often produced by fear and misunderstanding. Furthermore, studies have shown that most people hold negative views of those with mental illness, even though they may recognize the legitimacy of the disorder itself and the need for treatment. Those diagnosed with a personality disorder also face disproportionate amounts of stigma from healthcare providers. Research has shown that caregivers sometimes perceive those with PD to be difficult, manipulative, or resistant to treatment.


PD is difficult to treat, and providers can be pessimistic about the ability of patients with PD to recover. Public stigma in society and in healthcare settings not only affects the patient but their friends, family, and support system as well.


SELF-STIGMA

Negative portrayals of people with PD in media and culture are often internalized by those who are diagnosed. This can lead to depression and low self-esteem, isolation, or a lack of motivation. Individuals may have lower adherence to treatment protocols if they don’t believe they are “worthy” of recovery.


Because of the cultural association between violence and PD (especially antisocial personality disorder), those who are diagnosed may fear being involuntarily committed if they seek treatment.


INSTITUTIONAL OR STRUCTURAL STIGMA

Stigma can be embedded in institutions, organizations, and systems. Beyond provider/patient interactions, healthcare systems often systematically discriminate against those with PD. PD is just as prevalent as other diagnoses, if not more so, but fewer resources are allocated to it by insurance companies and research and development teams in the academic, government, and nonprofit sectors.


HARMFUL EFFECTS OF STIGMA

Individuals living with PD may be afraid to be truthful with friends and colleagues for fear that they will be stereotyped based on inaccurate or exaggerated cultural portrayals of people with personality disorder. They are sometimes perceived to be dangerous or violent, which can negatively affect interpersonal relationships and sometimes result in loss of a job or housing. People with PD may avoid seeking treatment because of these stereotypes, and when they do seek treatment, they interact with providers who may also hold negative views of them, which affects their quality of care. Systemic stigma in healthcare also means that diagnostic and treatment tools may be underfunded. Self-stigma may cause low adherence to treatment plans once they are implemented.


WAYS STIGMA CAN APPEAR IN CULTURE

  • While Hollywood’s portrayals of mental illness have become a bit more nuanced in recent years, what people seem to remember most are extreme examples such as “Psycho,” and “Silence of the Lambs.”

  • 90’s pop star Britney Spears was recently released from a restrictive conservatorship that was initiated after the singer displayed erratic behavior that was exploited by paparazzi who labeled her as “crazy.”

  • Clinical terms such as narcissistic, OCD, manic, schizoid, and antisocial are used in a non-clinical manner to describe traits or behaviors, trivializing those conditions.


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THINGS YOU CAN DO TO REDUCE STIGMA

If you or someone you know is living with PD or other mental illness, there are some things you can do to help. Not everyone with PD is comfortable disclosing it for reasons already discussed, but if you feel comfortable sharing your experiences, it may really help someone else who is going through the same thing.

When we are exposed to people with mental illness, we are less likely to dehumanize or stereotype them and more likely to encourage them to seek help. Talk to your friends and family directly.

Treat people with mental illness the same way you would treat a person with a physical illness or disability. This helps to normalize mental health treatment. Be aware of how you use language surrounding mental health issues, and don’t use clinical terms in casual conversation.

HOW TO HAVE COMPASSION WHEN TALKING TO A PERSON WITH MENTAL HEALTH CONCERNS

  • Let them lead the conversation and speak at their own pace. Don’t try to force them to talk before they are ready. Instead of asking questions that may feel too personal, say things like “How do you feel today?” and “Is there anything I can do to help?”

  • Don’t make assumptions or try to give advice unless you are a trained counselor. Instead, demonstrate empathy by statements such as “I’m sorry to hear you are going through that, it sounds really hard,” or “I’m here for you when you need me.”

  • Don’t be dismissive or invalidate them by saying things like “we’ve all been there” or “just snap out of it.” The person will be discouraged from placing trust in you if you don’t take their concerns seriously. If you can’t think of anything to say, a simple “I love you” or “I care about you” goes a long way.

IN SUMMARY Stigma and discrimination are major barriers to accessing mental health care, particularly for those with personality disorder. Research shows that self-stigma reduces the likelihood of recovery from severe mental illnesses. Those who do seek treatment for mental health issues sometimes experience low-quality care due to a lack of training and unconscious bias among clinicians. The stereotype of the mentally ill as dangerous and criminal is possibly the most damaging, but this perception can be altered when people with mental illness share their experiences. Reducing stigma is possible on an individual basis, and it’s important to provide compassion and support for those that are close to you and confide in you about their illness and treatment.


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