Is psychiatry difficult difficult or easy
Personality disorders are characterized by difficulties in interaction, in the interpersonal area. When we call people with personality disorders difficult, we are avoiding half the truth: Not only are they difficult, but we also have difficulty dealing with them.
Personality disorders are always a problem of interaction and are never the sole problem for those affected. People with personality disorders have often had the same problems over and over for a very long time, sometimes for decades. They always come into conflict with others in the same way, are disappointed, break off relationships or fail at their jobs, always for similar reasons.
It is often very easy for outsiders to understand what the person would have to change in order to no longer have these difficulties. But those affected themselves cannot recognize this and continue to maintain the behavior that gives them so many difficulties.
There are two reasons for this: First, personality disorders are, in a sense, survival strategies. (...) You have developed the behavior as a solution to a difficult situation, it has proven itself and now it is retained, even if it no longer makes sense. (...) On the other hand, personality disorders are experienced as ego-synton. Psychiatrists use the I-synton to describe things that people perceive as "belonging to themselves". This means that those affected do not have the impression that something is wrong with them, that they could be sick. (...)
There are many different personality disorders and it is often difficult to tell them apart. It is not uncommon for people to meet the criteria for several personality disorders (...):
- Dissocial Personality Disorder (...)
- Histrionic personality (...)
- Dependent personality (...)
- Narcissistic Personality Disorder (...)
- Compulsive Personality Disorder (...)
- Paranoid and passive-aggressive personality disorder (...)
- Schizoid Personality Disorder (...)
There is no clear, unambiguous cause for personality disorders. It is enough to realize how different the individual personality disorders are to understand that they cannot all have the same cause. Personality disorders are also believed to be caused by multiple factors.
First and foremost are the psychosocial factors: unfavorable attachment styles of the parents, psychological problems of the parents, unfavorable parenting styles, an anxious or easily excitable temperament in the child, lack of social support and critical, traumatic events are important triggers of increased vulnerability. Genetic and somatic causes, on the other hand, can only be found for individual personality disorders, especially for antisocial personality disorder.
Overall, it can be said that the interaction of unfavorable environmental conditions and a certain instability of the person favors the development of a personality disorder. Exactly which factors these are and why they lead to a personality disorder and not to another mental illness in individual cases has not been conclusively clarified. (...)
Diagnostics and frequency
Personality disorders are complex disorders. The disturbances do not occur infrequently. However, it is not known exactly how many people will develop a personality disorder in the course of their life, but around 10 percent of the population in Germany is affected by it every year. Men and women get sick about equally often. (...)
Personality disorder is often not the only mental illness and occurs with other mental illnesses. (...) For example, people with a psychosis from the schizophrenic group also have a personality disorder in 50% of the cases and about half of the people with a diagnosis from the schizophrenic group also have a personality disorder. Depression, anxiety disorders, addictions and eating disorders also often occur together with a personality disorder. (...)
Not infrequently it can be observed that conspicuous personality traits and behaviors are weakened with increasing age and life experience and the clients largely get along. This means that a diagnosis of personality disorder is not an irrevocable judgment. (...) The problems and abnormalities of people with personality disorders usually begin in childhood and adolescence. However, the diagnosis can only be confirmed after entering adulthood. The transitions between an accentuated personal style and a personality disorder are fluid.
A personality disorder is only spoken of when:
- the behavior patterns and experiences of the person concerned differ significantly from culturally expected and accepted guidelines and norms; these deviations manifest themselves in the way we think, feel and in the way we shape interpersonal relationships;
- the deviation is so pronounced that the resulting behavior is inappropriate, inappropriate and inflexible in many everyday situations;
- This behavior creates considerable suffering on the part of the person concerned and / or in their social environment;
- the deviant behavior pattern is stable, long-lasting and started in late childhood or adolescence;
- Another serious mental or organic illness is not the cause of the abnormal behavior.
What helps in everyday life?
Therapy with psychotropic drugs usually plays a subordinate role in personality disorders. The self-help movement is also not very pronounced in personality disorders - apart from borderline personality disorder. This has to do with the fact that people with personality disorders usually do not experience themselves as sick and cannot recognize what part they have played in the making of all their difficulties. Accordingly, they tend to look for the cause of their problems in their surroundings, in other people.
Those affected are more likely to seek therapeutic help because of critical situations in their lives or if another mental illness has set in in addition to the personality disorder, such as depression. (...)
For a long time, people with personality disorders were considered untreatable. It was assumed that they were not motivated because they had no understanding of their problem. They were seen as resistant, inconsiderate clients who often broke off therapy. In fact, one has to deal with and work differently with personality disordered people than with other mentally ill people.
An indispensable prerequisite is an understanding approach, one who is open to the point of view of the person concerned and tries to classify and value today's highly problematic behavior against the background of the biography as an originally sensible survival strategy. If it is possible to meet those affected on an equal footing in this sense, they will benefit greatly from therapeutic support and advice from specialists. You will then be able to defuse interpersonal conflict situations and solve problems. Insight into one's own shares is never a prerequisite for a therapeutic alliance, but one of its goals. (...)
On the other hand, people with personality disorders usually have a lot of difficulties with other people, for example with colleagues or in relationships, in coping with changes in the workplace, after moving or in taking on social roles. Because of all these difficulties, they definitely seek help and support from specialists. They just don't come with the desire to work on themselves, they want others to change. Specialists should take up these wishes and first support those affected in their view of the problem in order to get access to them in the first place. (...)
Building on this, the next step should be a positiveization: It must be possible to empathize with the client's motives and to appreciate them as meaningful. If this succeeds, that is the crucial step in gaining access. For those affected, too, it is often immensely relieving when someone tries - perhaps for the first time in years - to see a positive meaning in their behavior. But of course this is not easy with people, some of whom have shown behavior for a long time (...). As a rule, such behaviors cannot be viewed as positive or meaningful. What is crucial, however, is to understand the underlying motive and to appreciate it. (...)
Understanding the motives of those affected does not mean approving their methods and strategies. They can certainly be discussed critically. What is important, however, is an understanding approach at the level of motives, which is usually successful because those affected do not pursue any other motives than other people. The aim is to leave the motives as they are, but to consider together how he can satisfy them in a different, more socially acceptable way. (...)
When working with people with personality disorders, it is very important to present yourself as a reliable, emotionally tangible interaction partner. (...) Another promising approach in working with people who suffer from personality disorders is not wanting to change them themselves so that they fit better into their environment, but rather to change the environment so that they fit in well. (...)
Last but not least, we should bear in mind what it means that many people with personality disorders have been practiced for years in certain one-sided behaviors that they consider to be tried and tested. It means, on the one hand, that they have mastered these behaviors well, in some cases see them as a survival strategy, and will not be ready to give up such behavior until a better one is available. On the other hand, it also means that they no longer have any practice in other, alternative behaviors and are often no longer able to behave any differently.
Anyone who just adapts will at some point no longer be able to defend themselves at all. Anyone who always wants to stand out no longer knows how to be cautious. And those who constantly distrust others have forgotten how to approach others in a friendly manner. It is therefore important to train alternative behaviors with those affected. Groups for training social skills are well suited. Another very good method is model learning. It should not be underestimated how much those affected learn from the specialists, simply through observation, imitation and inquiries. Through targeted suggestions and reinforcing feedback, they can try to expand the repertoire of action of those affected.
Studies show that people with personality disorders are more willing to give up problematic behavior once they have learned alternative behaviors. In addition to these generally helpful ways of dealing with personality disordered people, there are also specific strategies that can be helpful, depending on the personality disorder.
- Download the S2 guidelines for personality disorders (short version) as a PDF file.
- Fiedler, P .; Herpertz, S. (2016): Personality Disorders. Beltz Publishing House.
- Herpertz, S .; Saß, H. (2003): Personality Disorders. Thieme publishing house.
- Lelord, F .; Andre, C .; Pannowitsch, R. (2009): The normal madness. How to deal with difficult people. Structure of the publishing house.
- Sachse, R. (2017): Self-love, but correct. Paradoxical advice for living with narcissists. Verlag Klett-Cotta, 9th edition.
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