Personality disorders

Almost nobody arrives using this phrase about themselves. It is a term people meet somewhere else — in a report, from a doctor, in a forum at two in the morning — and they come wanting to know what it means and whether it is being said about them.

What people describe in their own words is a pattern rather than an episode. Not one bad month, but the same thing happening again: relationships that begin intensely and end badly, jobs left the same way each time, a feeling of emptiness that returns regardless of what is going well. Some describe emotions that move further and faster than other people's seem to — fine at four o'clock, unable to bear it at five, and by morning no clear memory of how it got there.

Others describe the opposite: a distance from everyone, including people they love. The people around them describe walking on eggshells, or the same argument in a new costume.

The word frightens people, so it is worth saying plainly what it is: a clinical term for long-standing patterns in how a person relates to themselves and to others. Not a verdict on character. Online it is used loosely, and often as an insult.

Recognising yourself in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess you, and there is nothing here for you to score yourself against.

You do not need a label, a referral or anyone's permission to ask.

What a clinician pays attention to is duration, breadth and cost. Patterns recognisable since adolescence or early adulthood rather than since a particular event. Patterns that show up in more than one part of a life — at home and at work, with family and with friends, not only with one person. And a real cost: relationships that keep ending the same way, work that keeps being lost, or distress that returns however much the circumstances change.

It is also worth speaking to someone if you have been given this term and nobody has explained it. Being handed a word without a conversation is its own kind of harm.

Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that the question is a reasonable one to bring, and that bringing it is not an admission of anything.

PHC is an assessment-first practice, and on this question that matters more than most. A long-standing pattern and a current episode of depression or anxiety can look identical from outside, and they are not worked with in the same way.

1. An initial sessionWe ask what has been going on, for how long, and what it is costing you. Nothing is administered before this conversation.
2. Personality assessmentWhere the initial session points that way, the next step is a structured personality assessment, using internationally validated instruments and interpreted by a qualified clinical psychologist. Its purpose is to describe patterns carefully rather than to attach a word to you, and to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need.
3. A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, your presenting needs and clinical fit — and on this kind of work, fit is most of what makes sessions usable.
4. Therapy, reviewed as it goesWhere the difficulty is about managing emotion and managing relationships, the modality most often indicated is DBT, which PHC uses for emotional regulation and interpersonal effectiveness. CBT may be used alongside it or instead of it, depending on what the assessment found. Sessions are 50 minutes, in clinic at our PECHS clinic or in DHA, or online.

Confidentiality, session length, fees and choosing your psychologist are answered in full in questions people ask before booking.

• Low self-esteem
• Anger difficulties
• Depression
• Personality assessment
• DBT at PHC