personality features. In addition to personality
disorders being conceptualised on a continuum of
severity, there will be five ‘domain traits’, which
further describe the core features of the person’s
personality difficulties. The five proposed
domain traits in the new classification system are
negative affective (emotional) features, dissocial
(antisocial) features, disinhibition, anankastic
(obsessive) features and detachment.
The negative affectivity trait domain is
characterised by the person’s tendency to
experience a wide range of distressing emotions
that are usually brought on by even seemingly
small and, at times, imagined stressful events. In
years gone by, people with these features would
have been called ‘neurotic’, but this term has
fallen out of favour. Their distressing emotions
include anxiety, anger, sadness, a sense of
vulnerability, and other negative emotional states.
The main aspects of the dissocial trait domain
include a callous disregard for the rights and
feelings of others, a failure to meet expected
social obligations, and a lack of empathy, which
often results in aggressive and hostile behaviour.
People with these features can also be entitled,
ruthless, and hold themselves in high regard.
They also tend to manipulate and exploit others.
People with features of disinhibition will tend
to act impulsively, that is, before they give much
thought about whether or not they should do
something – they’ve already done it. They can be
reckless, easily distracted, and have little regard
for the risks or consequences involved. Longer-term
consequences are not considered by people
with these features.
The main features of the anankastic trait domain
is the need to control one’s behaviour and also the
behaviour of others, ‘It’s my way or the highway’.
People with these features exhibit perfectionism
and orderliness, and they rigidly prefer things
to be ‘just the right way’. They also like to focus
closely on the task at hand, although this leaves
them at risk of losing sight of the bigger picture.
People with these features can also experience a
level of enjoyment from ‘sticking to the rules’.
At the core of the fifth and final trait domain
is detachment. Within this trait domain are the
features of both interpersonal and emotional
distance, meaning that a person with these
features does not need to be close to, or even
socialise with, others. These people could
meet Johnny Depp and not have the slightest
bit of interest, other than being aware that he
was in ‘those pirate movies’. When it comes to
other people, they simply don’t care – they’re
indifferent. Certain professions or hobbies
may attract individuals who have features of
detachment, for example, Scandinavian fur
trappers, online gamers, potters, and taxidermists.
Research to date indicates that medication is
not very effective in the treatment of personality
disorder, unless a person with personality
disorder develops a co-occurring mental health
condition, for example, a recurrent depressive
disorder or generalised anxiety disorder. In this
case, using antidepressants or other anti-anxiety
medication may well be appropriate.
The good news is that since the 1990s there
has been a growing number of safe and effective
non-medication treatments available for people
living with personality disorder. Contemporary
treatment mainly focuses on borderline personality
disorder (DSM-5), as this is the patient group most
often seeking treatment. Treatment options include
Cognitive Behavioural Therapy, Interpersonal
Psychotherapy, Dialectical Behaviour Therapy,
Cognitive Analytical Therapy, and Mentalisation
Based Therapy. The latest evidence shows that
they are all as effective as each other, meaning
that often the choice of treatment is determined
by what would best suit the individual person and
their circumstances. A person engaged in one of
these evidence-based therapies can be expected
to experience a reduction in symptoms and the
associated negative behaviours, together with
improvements in their relationship and wider
social functioning.
It is important to acknowledge that personality
is for life, but personality disorder doesn’t have
to be. The presence and severity of personality
difficulties during one’s life will depend on
their current stressors, social circumstances and
environment. Once the person has an accurate
diagnosis and is engaged in appropriate treatment,
they can expect to experience improved levels of
functioning in important areas of their life, such as
their relationships, occupation or education.
34 | Pindara Magazine ISSUE 13 | 2018