Personality Disorders: The Complete Guide Singapore (2022)

Updated: Jan 12


Do you know of someone with a personality disorder? Find out the causes, how to diagnose and treat personality disorders with this article.

In this article

  1. What are personality disorders?

  2. Personality disorders in the DSM-5

  3. Personality disorders versus personality traits

  4. What are the different types of personality disorders?

  5. Most common types of personality disorder

  6. What causes personality disorders?

  7. How can personality disorders affect my daily life?

  8. How are personality disorders usually diagnosed?

  9. Treatment of personality disorders

  10. Where can I get treatment for personality disorders in Singapore

  11. Can personality disorders be completely cured?

  12. Self-help for personality disorders

  13. How do I help someone with a personality disorder?


What are personality disorders?


Personality disorders (PD) are persistent negative behavioural patterns that affect many aspects of a person’s life, especially social interactions. These disorders typically manifest during adolescence. Due to the limited research on personality disorders, it is difficult to diagnose. Furthermore, links to a myriad of other more prominent and well-researched comorbidities such as depression, means that misdiagnosis is a frequent occurrence. [1]


Personality disorders in the DSM-5


The complexity of each of the personality disorders has made it difficult to diagnose. Many criticisms arose surrounding the defining symptoms of personality disorders due to their low clinical utility and the ambiguity of many of the diagnostic criteria.


As such, several personality disorders nearly lost their place in the DSM-5. However, research strongly supports the fact that maladaptive personalities are starkly different from normal traits. [2]


Personality disorders were published in the DSM-5 but it is largely agreed that more research is needed.


Personality disorders versus personality traits


Personality disorders can be difficult concepts to understand. We’ve all got personalities, and most times, those personalities are a combination of both positive and negative traits. What, then, is the threshold between negative personality traits and its pathology?


According to the MSD Manuals, personality traits are defined as a culmination of reactions, thoughts and perceptions that are considerably unchanged over time. Personality disorders form when negative personality traits become a constant and starts to damage and impact a person’s social relations. [3]


What are the different types of personality disorders?


There are ten different personality disorders, split into three different categories – clusters A, B and C. In addition, there is also Personality Disorder Not Otherwise Specified (PD-NOS), a diagnosis commonly used when diagnosing personality disorders.


Clusters were formed to categorize the personality disorders in accordance with the similarities in their symptoms and causes. [4]


Cluster A personality disorders

Cluster A personality disorders are known as odd or eccentric personality disorders. The three personality disorders falling within this category are:

  • Paranoid personality disorder (PPD)

Individuals suffering from PPD have great mistrust for people and as its name suggest, are influenced by paranoia. They hold suspicion for people even when there are no reasons that warrant it. [5]

  • Schizoid personality disorder (SPD)

People sometimes mix up schizoid personality disorder with schizophrenia due to the similar name. While individuals with SPD do have the negative cognitive symptoms of schizophrenia, such as reclusiveness, detachment and limited motivation, they lack the hallucinations that are distinct in schizophrenic diagnoses.


Schizoid personality disorder patients are observed to have a limited emotional range, and lack of interest in the people around them. [6]

  • Schizotypal personality disorder

Schizotypal personality disorder is often mistaken for schizoid personality disorder. The differences between the two lie in the reasons for their social isolation. While schizoid personality disorder sufferers stay away from people due to the lack of interest, schizotypal people typically are detached from the world due to social anxiety and their own peculiar behaviours.


They also have paranoid personality traits – they have excessive suspicion for people around them, including family. [7]


Cluster B personality disorders

Cluster B personality disorders are typically described as dramatic, emotional and impulsive. Four different personality disorders belong to Cluster B:

  • Antisocial personality disorder (ASPD)

Antisocial personality disorder is commonly seen in the incarcerated population. [8] This is because people with the disorder tend to possess a disregard for others, and are impulsive. Other well know traits observed in antisocial personality types are manipulation, irritability and inability to feel remorse. [9]


People with antisocial personality disorder are prone to substance abuse, self-harm and violence against others. [10] While other personality disorders typically manifest during adolescence, antisocial personality disorder is one of the few that can present itself during childhood. [11]

  • Borderline personality disorder (BPD)

Borderline personality disorder is characterized by intense and impulsive responses to stressors. People suffering from this personality disorder are prone to low esteem and self-confidence and have difficulty regulating their emotions, especially anger. [12] [13]


Individuals with borderline personality disorder are most likely, out of all the other personality disorders, to self-harm or attempt suicide. The disorder is diagnosed more in women than men. [14]

  • Histrionic personality disorder (HPD)

Those with histrionic personality disorder are known for their excessive attention-seeking personality traits. These people are observed to call attention to themselves in various ways – they may react or emote expressively, dress in bright colours, or revealing outfits. [15]


People with histrionic personality disorder can also be manipulative, impulsive and have volatile moods. [16]

  • Narcissistic personality disorder (NPD)

Compared to other personality disorders, this is one we may have some familiarity with. People diagnosed narcissistic personality disorders can be one of two subtypes – the overt subtype and the covert subtype. [17]


The overt narcissist is what we usually associate with narcissism; they require constant attention and admiration. They have an inflated sense of self-importance and tend to exaggerate their achievements, and have a disregard for other’s feelings and lack empathy.


On the other hand, covert subtypes tend to shy away from the spotlight and do everything to direct attention away from themselves. Covert narcissists are very sensitive to the reactions of others are easily humiliated. Their narcissism shows in the form of manipulation, guilt-tripping people to get the reactions they want from them. [18]


Cluster C Personality disorders

The third cluster of personality disorders is known to be the anxious and fearful types. There are three disorders within this cluster:

  • Avoidant personality disorder (AVPD)

AVPD is very often confused with social phobia due to their many overlaps. A twin study in the American Journal of Psychiatry argues that avoidant personality disorder and social phobia are just different parts of the same spectrum. [19] Socially anxious people were found to still be able to function in social situations, whereas someone with AVPD was debilitated. [20]


In the DSM-V, AVPD is characterised as deep-seated feelings of low esteem, and extreme sensitivity to negative judgement. People with AVPD typically avoid social situations unless absolutely sure they are well-liked. Relationships are greatly affected due to the individual’s own perception of their worth and inferiority complex. [21]

  • Dependent Personality Disorder (DPD)

As its name suggests, those diagnosed with dependent personality disorder rely on others to make all kinds of decisions for them. They take on a submissive role in their own lives and are very agreeable to appease those that care for them. This also leads to intense fears of abandonment. [22]


Dependent personality disorder is often confused with co-dependency. The main difference between the two is that the prefix co- means that both parties are both reliant on each other, while DPD is almost a surrendering of one’s life to the hands of their caretaker. [23]


  • Obsessive-Compulsive Personality Disorder (OCPD)

According to an academic review, OCPD is one of the most common personality disorders. [24] OCPD and OCD are pretty similar. In both disorders, individuals have rigid habits and behaviours they need to adhere to. The difference lies in the individual’s awareness of their condition.


Individuals with OCD are aware of the strict rules that are self-imposed. Not only are people with OCPD oblivious to their condition, they have a tendency to hold other people to the same set of rules, and believe that the way they do things are the best way. [25]


Another diagnosis that healthcare professionals may give is Personality Disorder Not Otherwise Specified (PD-NOS).


PD-NOS is when there are maladaptive personality traits observed but do not fit specifically into the diagnostic criteria of one personality disorder. It is also known as mixed personality disorder as its symptoms can come from various different personality disorders. However, again, due to lacking research, misdiagnosis is very probable. [26]


Most common types of personality disorder


The most common type of personality disorder differs from country to country. USA reported Avoidant Personality disorder being the prevalent [27], while borderline personality disorder topped the list in the UK and Australia. [28] [29]


While Singapore does not have definitive reports, a review about suicide in Singapore also named both borderline personality disorder and avoidant personality disorder the most common. [30]


causes of personality disorders singapore include genetics and or trauma.

What causes personality disorders?


As per most other mental disorders, personality disorders result as a combination of factors. Please do note that this is a generalization and causes of each personality disorder may be attributed to one factor more than the other.


Genetics

Susceptibility to a mental illness is usually higher in people whose family have had that particular condition. However, most manifestations rely on other factors that trigger these mental disorders.


In a journal article titled The Nature (and Nurture) of Personality Disorders, it was found that genetics played a bigger role in the onset of obsessive-compulsive, histrionic and borderline personality disorders. [31]


Trauma

Trauma is a catalyst for many personality disorders. Studies show that children who were neglected in various aspects of life such as emotionally or physically faced an onset of PD during their adolescent years, especially cluster B personality disorders. [32]


How can personality disorders affect my daily life?


Humans are a social species and most of the time have an innate need to belong. For individuals with personality disorders, connecting with people in their daily life may be difficult. Due to the heightened insecurity, self-deprecation and in some instances the inability to control their emotions, relationships of someone with PD can be strained. [33]


This may lead to fear of abandonment, loneliness and may result in comorbidities. [34]


personality disorders diagnosis methods singapore

How are personality disorders usually diagnosed?


The identification of personality disorders themselves is half the battle when treating personality disorders, due to the difficulty to do so. Symptoms of personality disorders are intangible in that it is not observable at a glance. [35]


For example, someone with depression might lose weight due to appetite loss, someone with panic attacks has the physical symptoms to show for it. Personality disorders do not. Moreover, people with personality disorders may not know how to get help because they can still function as part of society for the most part.



Since personality disorders are more obvious to people around the individual, it is not uncommon for other people to prompt someone to get help for personality disorders.


Interview and questionnaire

Two interviews may take place. Healthcare professionals need to get a sense of how a person behaves and reacts to different situations in life to identify patterns that are maladaptive over a significant period of time. This means talking to the individual and maybe even people around them to understand and figure out if the behaviour is purely personality traits, or require a diagnosis and treatment plan.


After a physical exam, if physical causes of an individual’s symptoms are ruled out, there will likely be a second interview. The person’s behaviour will be scrutinized to see what personality disorder they align with. also be compared against the DSM-5 to makes sure that majority of the criteria match.


A psychiatry article highlighted a 4-step process to reach a verdict suggested by Thomas Widiger. A person’s personality would be described and then compared to the Five Factor Model of Personality. Thereafter, the problematic traits identified in the person will be compared against the DSM-5 to determine whether it is serious to warrant a diagnosis. The final step would be figuring out what personality disorder or disorders the individual has. [36]


Physical examination

Some symptoms of personality disorder are similar to those of a physical ailment and thus, may be misdiagnosed. For example, thyroid diseases may affect mood, and result in someone being irritable and easily angry.


A physical exam will help to determine whether or not the symptoms are attributed to a physical or psychological abnormality.


treatment of personality disorders in singapore include CBT, DBT and pharmacotherapy.

Treatment of personality disorders


There is limited research for the treatment of personality disorders, and most studies are based on borderline personality disorder.


Psychotherapy

The most common form of therapy, talk therapy, helps the health professional and the patient work together to figure out the maladaptive behaviours and thoughts. In itself, psychotherapy would pivot around someone’s ability to reflect on their own behaviours and try to understand situations from other perspectives.


There are also two types of talk therapy that are used to treat personality disorders. [37]

  • Cognitive behavioural therapy (CBT)

CBT is one of the major psychotherapy methods. It focuses on correcting behaviour and dysfunctional thinking.


Kate Davidson wrote in Cognitive-behavioural Therapy for Personality Disorders that the CBT strategy designed for personality disorders, known as the biosocial model, helps the patient to strengthen behavioural strategies that are underdeveloped and find healthier ways of coping with fears. [38]


An example highlighted was in the context of avoidant personality disorder. The individual might avoid social interactions but with the help of therapy, learn to value themselves and work on developing relationships with people that want that connection. [39]


  • Dialectical behavioural therapy (DBT)

DBT is a subset of cognitive behavioural therapy with mindfulness as its core strategy of helping people. Developed by Dr Marsha Linehan, it was originally created to combat suicidal ideation and self-harming behaviour in women with BPD.


Four of the most notable strategies that DBT uses are core mindfulness, interpersonal effectiveness, distress tolerance and emotional regulation. These techniques target areas that people with personality disorders struggle with by helping patients to improve their interpersonal skills and rectify thoughts that result in dysfunctional behaviour.


Both CBT and DBT have had similar efficacy rates in treating personality disorders. [40]


Pharmacotherapy

Disordered personalities don’t have medication specifically to treat the conditions. However, medication can be used to treat the symptoms that one might face as a result of a personality disorder.


High comorbidity rates across all personality disorders mean that medication will help to treat those comorbidities like depression and anxiety. Cluster B disorders may get mood-stabilizing medication due to their impulsivity, irritability and difficulty in regulating their emotions, while cluster C conditions typically are prescribed anti-anxiety drugs like Selective Serotonin Reuptake Inhibitors (SSRIs) to combat their anxiety. [41]


Patients may receive treatment plans that combine both pharmacotherapy and psychotherapy. Combined treatment methods have shown to have higher efficacy rates. [42] [43]


Other therapy

Art therapy has also been shown to be an effective method of treating personality disorders, especially clusters B and C.


Art therapy introduces a safe space where patients can deal with their strong emotions without fear or avoidance. This helps to build confidence in themselves so they distance themselves from maladaptive coping methods of confronting their self-presumed incompetence and worthlessness and their lack of control. [44]


Where do I get treatment for personality disorders in Singapore?

Clinic/Organization

Address

Contact

Costs

Costs (unsubsidised)

Institute of Mental Health


Buangkok Green Medical Park 10 Buangkok View

Singapore 539747


6389 2000 (24hr line) imh_appt@imh.com.sg

$42

$39 (subsequent visit)

$105-$155

$72 - $103 (subsequent visit)


National University Hospital

5 Lower Kent Ridge Road

Singapore 119074


+65 6779 5555


For appointments:

65 6772 2002

appointment@nuhs.edu.sg


$38-$58

$36 - $51 (subsequent visit)

$109.14-$145.52

$89.88 - $108.07 (subsequent visit)

Annabelle Psychology

Newton Branch

10 Winstedt #02-06 10 Winstedt Road Singapore 227977

Novena Branch

Royal Square Medical Centre

#17-12

101 Irrawaddy Road

Singapore 329565

Please contact clinic for costs and financial advisory

/

Allianz Care

20 Kramat Lane #04-11 United House Singapore 228773

$160 (1 hour individual therapy)

$240 (1.5hours individual therapy)

$130 (1 hour individual online therapy)


/

Psychology Blossom

308 Tanglin Road #02-15

Phoenix Park, Singapore 247974

Please contact clinic for costs and financial advisory

/

Promises

(for OCD, Borderline, Narcissistic disorder)


#09-22/23, Novena Medical Center, 10 Sinaran Drive, Singapore 307506

​Please contact clinic for costs and financial advisory

/


Can my personality disorder be completely cured?


Personality disorders typically do not last forever. In several studies, it is observed that people with personality problems that warrant a pathological diagnosis generally get better over time or will no longer possess the personality disorder they were originally diagnosed with. [45]


how o help yourself when you have personality disorders singapore

Self-help for personality disorders


Treatment for personality disorders focuses on correcting behaviour and dysfunctional cognition. There are several methods to help manage stressful situations or help regulate emotions. Most of the online resources are for borderline personality disorder but can be used in managing other personality disorders that share similar symptoms.


Reflection

Mood journals help to keep track of emotions, and the triggers that set off comparatively negative reactions. This can help to pick out fears and anxieties that an individual may need to face. Mood journals can also help to track mood boosters that work for an individual; noting any healthy activity that improves their mood can help build an arsenal of strategies to fall back on when they are feeling poorly.


Mindfulness

Mindfulness can be practised even without the help of a medical professional. There are many guides online that can offer pointers to jumpstart your own treatment if you are not able to seek proper help.


With mindfulness, the focus is awareness. Practising mindfulness brings attention to your emotions and behaviour.


how to help people with personality disorder singapore

How do I help someone with a personality disorder?


Being around someone with a personality disorder can be frustrating, confusing and at times even toxic and abusive. There are some ways you can help someone presenting signs of personality disorders.

  • Encourage getting help

Intervention earlier than later is always advised. Prompting someone to seek professional help can prevent the symptoms and the negative behaviours from getting worse.

  • Avoid judgement and be patient

People with personality disorders might not be aware of their condition and thus, do not think that their behaviours are maladaptive. Criticizing them for their behaviour may result in worsening their mental condition.


Be patient with them and let them know gently that the behaviour that they are presenting is not normal. This can create awareness of their own actions, and help in the correction of those behaviours.

  • Draw boundaries

People with personality disorders, depending on their personality disorder, can be abusive and toxic. Learn to create boundaries and express your intolerance of verbal and physical abuse. This again can help to bring the person’s attention to the way they are reacting and relating to people around them.


If need be, call a helpline or the police if someone is abusive or presents a danger to themselves.


Conclusion

Personality disorders are complex illnesses that still require a lot of research. If you or people around you are suffering from symptoms similar to any in this article, please seek help.

 

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About Our Writer

Rachel is an anxious INFJ with a slightly concerning obsession with coffee and true crime. She loves feeling smart and dislikes playing games she knows she will lose. Learning about mental health is her way of helping people around her. If the world was perfect, she wishes she could bring her friends flowers in a little red wagon.

 

This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.

 

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