Trouble in the Making: Personality Disorders Mixed with Depression
By: Christine Hammond LMHC
Depression has its own signs and symptoms but when mixed with a personality disorder (PD) it can be more elusive. Each PD has a different manifestation of depression with varying levels of intensity. While not all depression becomes homicidal or suicidal, the risks for this possibility are presented as a word of caution. The following are the PDs most likely to raise a red flag.
· Anti-Social PD (Sociopath and Psychopath): This is the hardest of the PDs to diagnose as depressed unless they want a person to know about it. So accustomed to masking true feelings or emotions, they are even able to deceive themselves. At first, to counteract the sadness, they will escalate in two main ways: criminal and sexual behavior. Both behaviors have given them pleasure in the past however the acceleration and intensification of their actions will be noticeable. Just like a drug addict with high tolerance, they need much more than before to satisfy. When that fails to achieve relief, they will isolate. This may settle things down or it could be a warning sign that harmful behavior towards others is on the horizon. This PD is capable of homicidal behavior to satisfy their needs. They might even commit suicide after performing destructive acts in an effort to control their destination.
· Narcissistic PD: Depression for this PD can sometimes be casually tossed around whenever their needs of attention, affirmation, affection or adoration are not met. However, when it is prolonged, the depression might be real. The hard part is that this PD can fake things quite well at work or a social gatherings but it is at home that it most prevalent. This is why it is easy to miss the severity of the depression and the warning signs that things are worsening. Sadly, this is the one PD that given the right set of circumstances such as a loss of reputation, valued career or precious image is capable of suicidal behavior and in some cases homicidal behavior as well. They usually don’t threaten it however they just do it with almost no indication prior.
· Borderline PD: This PD is very accustomed to feeling depressed as some of them experience it almost daily. The problem is that those around this PD often become dismissive of this PD’s emotional expression because of the regularity. This in turn creates anxiety in the PD and in an effort to express the intensity of their feelings and they might threaten and/or carry out self-harming behavior. It can come in the form of risky sexual behavior, cutting, binge eating, combining alcohol and drugs, spending or gambling spree. They might even escalate to suicidal behavior when abandonment seems to become a reality. All suicide threats or attempts should be taken seriously regardless of the frequency of their occurrence.
· Obsessive-Compulsive PD: This PD likes to be precise about the details, perfect in appearance and right in their reactions, thoughts and behavior. Depression does not fit neatly into this mode. As a result, when they feel depressed the initial response is to “tighten up the ship,” double down at work, cling tighter to stuff, and overanalyze finances. When these things fail, they will reach out for help quietly because they don’t want anyone to know what they are really feeling. The problem is that by the time the do seek help, the depression has worsened and usually is quite severe. Even still, they have a very hard time admitting that to even a professional and would rather lie than acknowledge they might be suicidal.
· Paranoid PD: This PD lives in a constant state of depression for what has happened, anxiety over what is happening, and fear for what might happen. This trio of emotions feels more like a protective blanket then something to be avoided. They are constantly attempting to incite the same emotional reaction in others as a way of finding comfort or relief from the intensity. So when the conspiracy theories begin to impede work performance or daily living, things have escalated. While they are not likely to be intentionally harmful to others, they are capable of talking themselves into believing that homicidal/suicidal behavior is a form of protection either for self or others.
· Histrionic PD: For this PD, depression is one of many emotions they might use to gain attention from others. In their flair for the overly dramatic in behavior and dress, they might even adopt a Morticia (from the Addam’s Family) type of appearance. When this fails to get the reaction they desire, they usually escalate in the same fashion as Borderline PDs. However, their natural tendency is to act out more sexually than any of the other self-harming behaviors. Threats and attempts of suicide are likely to occur when the depression worsens. Again, all suicidal tendencies should be taken seriously.
· Avoidant PD: This PD lives with low levels of depression which they use as justification for refusing to engage socially. Because they naturally isolate, escalation of the depression is not normally noticeable. However, this PD is very in-tuned to their levels so they become almost instantly aware of worsening depression. While they might express their feelings to only one person, they are also good about reaching out for help. The problem is that because there is a constant low lying depression, others might not see the situation as grave as it really is. This further isolation is likely to lead this PD into suicidal behavior.
· Dependent PD: This PD’s constant need of reassurance from others wears people out. As a result, the resistance from others manifests in the PD as feelings of abandonment, rejection, or depression. When the risk of their fears becomes real, the escalation into a deep depression is rapid. This is the one PD that usually can point to a visible deteriorating relationship as the reason for their severity. The more hopeless the relationship outlook, the further they decline and can present with suicidality. Interestingly enough, the sooner they are able to attach to another relationship, they quicker they will recover.
While not all PDs are presented here, these are the ones most prevalent with homicidal or suicidal tendencies. Assessing the level of depression a PD should be done by a professional only and is experiencing is essential to obtaining adequate help.
To schedule an appointment with Christine Hammond, please call our office at 407-647-7005.