Personality Disorder: A Care Staff Overview

"Personality disorder" is a phrase many care staff have heard, often attached to a label or a difficult handover note. Behind it sits a group of long-term patterns of thinking, feeling and relating to others that cause real distress to the person living with them, and sometimes to the people around them. Understanding the basics helps staff respond with consistency and compassion instead of judgement.

This overview explains what the NHS says about personality disorder, how diagnosis is changing, what treatment looks like and how care staff can support people well. It draws on the NHS page on personality disorder, last reviewed in January 2024. For the two best-known types, see our separate guides to borderline personality disorder and antisocial personality disorder.

What is a personality disorder?

The NHS describes several different types of personality disorder. The page names borderline personality disorder and antisocial personality traits as examples, and notes that a person may also have other conditions, such as depression or drug addiction. Symptoms vary by type, but the common thread is a lasting pattern that affects how someone copes with emotions, relationships and daily life.

According to the NHS, borderline personality disorder typically involves disturbed thinking, impulsive behaviour, difficulty controlling emotions, intense but unstable relationships and a fear of abandonment. Antisocial personality traits typically involve becoming easily frustrated, struggling with anger, blaming others and aggression.

How diagnosis is changing

The NHS points out that diagnosis is changing. Instead of always naming a specific type, clinicians may now describe a person as having a mild, moderate or severe personality disorder with particular traits. For care staff, this matters because the label on a care plan or referral letter may look different from older paperwork, and the same person may be described in different ways in different records. What matters in practice is the person's needs and traits, not just the name of the diagnosis.

What causes personality disorder?

The NHS says the exact cause is unclear. Personality disorders are thought to result from a mix of inherited genes and early environmental factors, such as abuse or neglect in childhood. Because early abuse or neglect is thought to play a part for some people, a trauma-informed approach is important. Our guide to trauma-informed care in practice sets out the principles.

Treatment

The NHS describes these main approaches:

• Talking therapies are the main treatment. They can last months or years, and the therapist helps the person understand their thoughts and behaviour and develop strategies to change them.
• Therapeutic communities offer intensive group therapy over several weeks or months for some people.
• Medicine may be used to treat associated problems such as depression, anxiety or psychotic symptoms. For example, moderate to severe depression may be treated with an SSRI.

The NHS adds that many people recover over time, and that treatment should be tailored to the individual. That message of recovery is worth holding on to, particularly when progress feels slow.

Supporting people with a personality disorder

The NHS page does not give detailed guidance for care staff, so the points below are general good practice rather than NHS recommendations. They should fit the person's care plan and your organisation's policies.

• Be consistent. Predictable routines, clear boundaries and following through on what you say help build trust, especially when relationships have been unstable.
• Use respectful language. Avoid describing people as "attention-seeking" or "manipulative". Describe what you see and what the person may be trying to communicate.
• Stay calm during distress. Take strong emotions seriously, keep your own tone steady and give the person time and space.
• Take risk seriously. Talk of self-harm or suicide should always be reported and followed up under your risk procedures, whatever the diagnosis.
• Share a consistent approach. Agree as a team how to respond so the person does not receive mixed messages.
• Look after yourself. Working with intense emotions can be draining. Use supervision and team support.

Supporting families and carers

The NHS recognises that a personality disorder can affect family and friends as well as the person. It points to Mind's guidance on helping someone diagnosed with a personality disorder, and to Rethink Mental Illness and the Royal College of Psychiatrists for information and support. It also suggests asking a GP about local support groups or contacting NHS mental health services, and, for those who are pregnant or parenting, speaking to a GP, midwife or health visitor.

Training and CPD

Understanding personality disorder is an ongoing process. Record what you learn in your CPD log, discuss real situations in supervision, and browse the options on our CPD pages.

Key points to remember

• Personality disorders are lasting patterns that affect emotions, behaviour and relationships; there are several types.
• Diagnosis is moving towards mild, moderate or severe descriptions with particular traits.
• Causes are unclear but are thought to involve genes and early experiences such as abuse or neglect.
• Talking therapies are the main treatment, and many people recover over time.
• Consistency, respect and a team approach help staff support people well.

Frequently asked questions

Is personality disorder the same as a mental illness?

The NHS places personality disorder within mental health conditions, and notes that people may have other conditions as well, such as depression or drug addiction.

Can people with a personality disorder get better?

Yes. The NHS says many people recover over time, with treatment tailored to the individual.

Is medicine the main treatment?

No. The NHS describes talking therapies as the main treatment. Medicine may be used for associated problems such as depression, anxiety or psychotic symptoms.

This guide is for general information and is not a substitute for clinical advice or your organisation's policies.