I had the second part of a psychology session which I said I’d tell you more about in Who’s Harbouring the Wasabi?! The appointments were the last in a few which made up my Psychology assessment on behalf of the Community Mental Health Team. It just so happens that Dr S is also a member of the Anorexia Nervosa Intensive Service as well so I’ll be seeing him for my first Family Therapy session next week.
In this session we were looking into the possibility that I have Personality Disorder. It is something that my psychiatrist had suggested a couple of months ago, so as usual, I did a bit of research to understand it a bit more. I was, understandably, a little upset that the professionals were saying that my personality was disordered.
Everyone has a set of feelings, thoughts and behaviours that are individual to themselves and these make up their personality. On a day-to-day basis someone’s personality will alter slightly depending on a given situation and it will also develop through their lives according to life experience.
Someone with a personality disorder, however, will find that their personality doesn’t develop as easily and they might find that they are less willing to be flexible in their thinking. The range of thoughts, feelings and behaviours might be more limited which makes coping with everyday situations more difficult. Although parts of their personality make life difficult, they can’t alter them.
It also makes it harder to relate to others and for them to relate to you. For this reason people might be more likely to avoid someone with a personality disorder without knowing why, causing that person to feel very isolated and insecure.
I had to do a questionnaire in the first appointment to ascertain which, if any, categories of disorder I came under. Initially it looked like there were four:
- Avoidant
- Dependant
- Obsessive Compulsive
- Depressive
All except ‘Depressive’ make up the ‘Anxious’ category of Personality Disorders. Here’s the definition from the Royal College of Psychiatrists website:
“Cluster C: ‘Anxious and Fearful’
Obsessive-Compulsive (aka Anankastic)
- worry and doubt a lot
- perfectionist – always check things
- rigid in what you do, stick to routines
- cautious, preoccupied with detail
- worry about doing the wrong thing
- find it hard to adapt to new situations
- often have high moral standards
- judgemental
- sensitive to criticism
- can have obsessional thoughts and images (although these are not as bad as those in obsessive-compulsive disorder)
Avoidant (aka Anxious/Avoidant)
- very anxious and tense
- worry a lot
- feel insecure and inferior
- have to be liked and accepted
- extremely sensitive to criticism
Dependent
- passive
- rely on others to make decisions for you
- do what other people want you to do
- find it hard to cope with daily chores
- feel hopeless and incompetent
- easily feel abandoned by others
Once Dr S had finished explaining all of this to me, the first session was over and I came away feeling very disappointed. I thought I was coming on so well with my recovery and felt much better in myself. The EFT was helping me get rid of negative cycles of thinking and I hoped that they would just evaporate slowly with time. However some of these descriptions were of traits I’ve had for as long as I could remember and the use of the word ‘disorder’ to describe them was pretty upsetting. It’s odd to have your thought processes translated directly to paper by some stranger, decades ago. I assumed it was perfectly normal to find some aspects of life difficult and that everyone had a set of individual issues.
Thankfully I saw my psychiatrist the very next day and she put my mind at rest. She said that the term ‘Personality Disorder’ was very outdated. She also pointed out that anyone that took the test would be able to identify with one or more of the traits. The difference comes when those traits start to cause problems and limitations in someone’s life. When they cause disorder in your life, if you like.
In the second session Dr S disregarded two of the traits, much to my relief. I had to complete the test according to how I’ve felt over the ‘last few years’, so my recent better mood didn’t come into account when filling in questions about depression. Then it turned out he had miscalculated the ‘dependant’ one. So we were left with ‘Avoidant’ and ‘Obsessive Compulsive’.
The different categories only count as part of your personality if they’ve been there for as long as you can remember. Some traits can be triggered by significant trauma or illness in someone’s life but these don’t count as Personality Disorders. I think that the depression was a side effect of the eating disorder and hopefully it will subside as I get better. Ideally it will disappear completely.
Although I initially found this diagnosis difficult to comprehend, when I think about it I can see that some of these traits have made my life more difficult. I would ordinarily beat myself up about it and tell myself that people avoid me because they don’t like me very much, that I’m boring and not fun or spontaneous enough. I would often wonder how I could be more popular and look on in envy at people who seemed not to have a care in the world.
I think my Mum recognised these traits in me from early on and has tried to get me to think differently by telling me I’m too sensitive and that I expect too much of people. The trouble is, as described above, when someone has a personality disorder they find it very difficult to change those traits that are causing distress or unhappiness.
What’s interesting about this diagnosis is how many of the traits overlap with those of people with Anorexia. The most notable of which are low self esteem and perfectionism. My drive to be as good, if not better, than other people has caused me great distress over the years. I am never satisfied with myself or any of my achievements and I think this is what has led to my Anorexia. I lost control of things in my life and was so disappointed in myself for letting things get so bad that the only way of regaining control was through food.
The Anorexia served its purpose because I was able to throw myself into my work during and after the divorce proceedings and actually received an award. I was ‘Highly Commended’ for my work by the industry magazine. Not that I really acknowledged it at the time. You see ‘Highly Commended’ was the label they used for the person that came second. So if people asked about it I would say ‘oh, I didn’t really win, but it was a really good night.’
The Anorexia also helped me achieve something new. Through my obsession with exercise I became very good at long distance running. I actually came 29th out of 4000 women in the Dubai 10km. Of course 2 weeks later I collapsed, but I was proud of this achievement nonetheless. Anorexia was not only helping me gain control through restricting food, it was actually getting my life back on track.
Recently I have been able to have more insight and understanding of the the various roads that led me to where I am today. Through guidance from my many health care professionals and my own research I am starting to see links between my personality traits, significant events in my life and the coping strategies I’ve developed.
It seems that I have quite a toxic mix with my Personality Disorders. On the one hand the Obsessive Compulsive trait makes me competitive and strive to be as good, or better than others (it also means my flat is very clean). On the other hand is the Avoidant trait which makes me insecure, anxious, unwilling to try new things and just generally feel inferior to others. So between the two of them I will never be good enough for my own high standards.
I’m hoping that now I recognise these thoughts and feelings as contributing factors of my illness I will be better placed to deal with them in the future. I’m told that over time they will fade and I look forward to a time when I can say with complete certainty that I …
‘Fully and completely love and accept myself.’