Personality disorders

People with personality disorders tend to have longstanding difficulties in managing relationships with others and their emotions. These difficulties originate from early experiences. 

For example, it is common for people with personality disorders to have experienced some form of abuse or neglect in their childhoods. These early experiences affect the way in which the person comes to view the world and others around them, their expectations of how others will respond and treat them. This in turn affects how a person interacts with and approaches others and their ways of coping.

Features can include;

  • frequently becoming overwhelmed by difficult feelings
  • having difficulty managing emotions without self-harming, using drugs or alcohol or other risky behaviours
  • difficulty maintaining stable and close relationships
  • feeling emotionally disconnected and avoiding people

The term personality disorder is used to describe the way in which such difficulties are pervasive and enduring so that we can think of them as part of the person’s personality, rather than as a separate collection of symptoms. They arise out of the person’s emotional development being impacted in a way that has longstanding consequences. This tends to be extremely difficult for the person and they may require long term help in order to understand these aspects of themself and their ways of relating to others.

There are many kinds of personality disorder; these tend to be diagnosed once a person reaches adulthood, by a psychiatrist. Prior to adulthood the personality is still in a state of development and flux and so it is not generally helpful to consider diagnosis earlier in life.  However, during adolescence and young adulthood, the term ‘emerging personality disorder’ might be used to describe particular patterns and difficulties in relating to others that may be developing. Here at the Tavistock our approach is to try to understand each person as an individual, to help them think about themselves and reach a better understanding of their particular difficulties.

How the Tavistock and Portman can help

We work with children, families, adolescents and young adults to help understand issues in emotional development as they arise. We believe that this can enable young people to enter adulthood with greater emotional resources, helping to prevent more entrenched difficulties arising in later life.

We offer a range of therapies to adolescents and young adults presenting with emotional and interpersonal difficulties. Such difficulties do not necessarily mean that a person will go on to develop long standing problems. But in some cases these difficulties might be becoming more established. Psychodynamic psychotherapy can be useful in exploring and helping to understand a person’s feelings and ways of relating to others, so that they are left with a greater awareness and choice over how to act. Because such work is holistic, rather than addressing individual symptoms, it can take a long time. It is not unusual for such therapies to last for 18 months, sometimes longer. We also offer family therapy, CBT and IPT. Different approaches work for different people and a range of options will be explored when a person is referred to us, through conducting an in-depth assessment.

The Fitzjohn’s unit is a specialist service offering treatment to adults with severe and enduring mental health problems more often regarded as arising from difficulties that take their origin from early in life and which are better understood as personality related rather than as ’illnesses’ . These include:

  • affective disorders
  • manic-depressive disorders
  • psychotic episodes
  • eating disorders
  • certain psychosomatic illnesses

The people we treat tend not to fit into a single diagnostic group (and they do not need to meet criteria for any specific diagnostic category), but they  are likely to feel severely troubled in their mental functioning. They might be suicidal or self-harming, suffer from severe depression or anxiety, or have impulsive behaviours. Many will have experienced major breakdowns in their relationships, work or education. Often the patients who come to us are regarded as being ‘hard to help’. They may have difficult or anxiety-provoking relationships with other services and community mental health teams.

Our aim is to understand the whole person.  Our approach is psychoanalytic and fundamental to it is an understanding that our patients need a significant length of treatment to provide adequate containment for a developmental process to take place.  With this in mind we offer  longer term psychotherapy, usually once or twice weekly individual psychotherapy (for 2 years)  followed by the possibility of group therapy ( 3 or more years) .