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.
