Supporting a loved one with a personality disorder

Supporting a family member who is suffering from a personality disorder can be challenging and difficult. Common symptoms of personality disorders include distorted thinking, problematic emotional responses and regulation, over- and under-regulated impulse control, and significant interpersonal difficulties. It's also not uncommon for individuals struggling with a personality disorder to have a mental health diagnosis such as clinical depression, anxiety, or substance abuse. A concurrent diagnosis such as this can make a person's mental health issues more complicated to address and more challenging for loved ones.

Symptoms associated with personality disorders can vary widely. Personality disorders are grouped into categories, clinically known as clusters, based on the type of behavior the person demonstrates and reports. There are typically three types of clusters:

• Cluster A personality disorders involve eccentric thoughts and behaviors. These include paranoid, schizoid and schizotypal personality disorder
• Cluster B personality disorders refer to dramatic, emotional, and erratic thoughts and actions. Disorders in this group include borderline personality disorder and narcissistic personality disorder
• Cluster C personality disorders typically involve actions related to fear and anxiety. Dependent personality disorder and avoidance personality are in this cluster

Having a family member with a personality disorder can be especially challenging since the hallmark of these disorders include difficulty relating to others and developing healthy relationships. These issues are caused by the individual's issues with emotional regulation, lack of empathy, inconsistency, lack of self-awareness, and poor follow-through. Understandably, such behaviors are difficult for their loved ones to understand, tolerate and, sometimes, even to accept. It's not uncommon for people with personality disorders to have a very small or nonexistent support system separate from their own family. This circumstance can place family members in the difficult position of feeling they must support and/or "hang in there" with someone whose mental illness causes them to be hurtful to others and destructive to themselves.

Below are five tips to help family members cope with a loved one who has a personality disorder.

1. Educate yourself about personality disorders, their symptoms and available treatments by participating in seminars, groups or other educational experiences offered in your community. Behaviors and emotional responses from people suffering with personality disorders can cause a great degree of confusion and feelings of powerlessness to the receiver of their actions. Having knowledge about your loved one's disorder greatly helps with gaining a sense of control when a loved one is out of control and what to do when it happens.
2. Set personal boundaries and limits with your loved one. Be realistic with your expectations. Recovering from a personality disorder takes time and patience and loved ones in treatment may regress. However, being clear and setting boundaries with love and kindness that respects you and your loved one is important for families members and a healthy thing to do.
3. Seek professional help. Talking to a professional about feelings regarding a loved one's personality disorder and its impact on one's life is important for helping loved ones maintain a healthy perspective, discuss options for interacting with your personality disordered family member and creates a space for emotional understanding and support.
4. Separate your loved one from their behavior. When communicating to your loved one make it clear that it's not the person you dislike but the behavior. Try to remember that your loved one does not purposefully want to react and behave in ways that are damaging to themselves or others.
5. Support other family members. Being able to talk to family members about your loved ones personality disorder, it's impact on the family as a whole and it's impact upon each family member individually helps with decreasing and managing negative feelings regarding the personality disordered family member. Knowing you have other family members supporting you while coping with your loved ones mental health challenges can go a long way in keeping everyone's emotions in check.

Dr. Paula Durlofsky is a psychologist in private practice in Bryn Mawr, whose practice focuses on psychological issues affecting individuals, couples, and families. She is affiliated with Bryn Mawr Hospital and Lankenau Medical Center.