Is it “just” anxiety or is there something else? Signs it could be a personality disorder

Anxiety is one of the most common mental health conditions. However, when anxiety symptoms are accompanied by rigid and inflexible patterns of behavior and thinking, we may be dealing with a personality disorder. In this article, we’ll explore the key differences between anxiety and personality disorders, present Ana’s case as an illustrative example, and discuss how Transference-Focused Therapy (TFT) can be an effective treatment option.

Anxiety vs. Personality Disorder: What's the Difference?

Generalized Anxiety:
Generalized anxiety is characterized by:
– Excessive worry about future events.
– Constant feelings of tension or stress.
– Sleep problems (insomnia, nighttime awakenings).
– Fear of certain social situations or events.
According to the World Health Organization (WHO), in 2019, 301 million people suffered from an anxiety disorder, including 58 million children and adolescents.
Anxiety in Personality Disorders:
In personality disorders, anxiety does not occur in isolation, but as part of a deeper pattern of thinking and behavior. Some characteristics include:
– Intense fear of abandonment or rejection: This is not just social anxiety, but a persistent fear that important people will leave you.
– Extreme emotional swings in a short period of time: Going from calm to distress in minutes for no apparent reason.
– Difficulty maintaining stable relationships: Intense but conflictive relationships, with constant ups and downs.
– Constant feeling of emptiness: An existential anxiety that doesn’t disappear with common relaxation techniques.
A study published in the Journal of Psychiatry and Mental Health indicates that the lifetime prevalence of dysthymia (a type of chronic depression) is around 3%, being higher in women (4%) than in men (2.2%). Furthermore, comorbidity between dysthymia and other personality disorders is very high, reaching between 65% and 100%.

Clinical Case: Ana

Patient Profile:

Name: Ana
Age: 28
Occupation: Graphic Designer

Presenting Symptoms:

Constant, generalized anxiety.
Bouts of intense anger with no apparent cause.
Unstable interpersonal relationships.
Deep fear of abandonment.
Persistent feeling of emptiness.

Clinical History

Ana came to the clinic complaining of uncontrollable anxiety, accompanied by abrupt mood swings and difficulty maintaining stable relationships. She often felt that her friends and family were going to abandon her, which led her to engage in impulsive behaviors to avoid them. She also described a constant feeling of emptiness and lack of purpose.

Evaluation and Diagnosis:

After a detailed evaluation, it was identified that, in addition to anxiety symptoms, Ana exhibited patterns of thinking and behavior characteristic of Borderline Personality Disorder (BPD). These included an intense fear of abandonment, unstable interpersonal relationships, an unstable self-image, and impulsive behaviors.

Treatment Implemented:

A treatment plan based on Transference-Focused Therapy (TFT) was proposed. TFT is a form of psychoanalytic psychotherapy that focuses on the transference relationship between patient and therapist, exploring and clarifying aspects of internalized early relational experiences that manifest in the current therapeutic relationship. This approach seeks to integrate self-perception and relationships, promoting a maturation of personality structure and overcoming BPD pathology.

Progression:

After six months of TFP, Ana showed significant improvement in managing her anxiety and emotions. Her interpersonal relationships became more stable, and she developed greater awareness of her thought patterns, allowing her to manage them more effectively.

Personality Disorders in which Anxiety is a Frequent Symptom

If you identify with the above, you may be dealing with one of the following disorders:

Borderline Personality Disorder (BPD): Extreme emotional intensity, impulsivity, and fear of abandonment. It is estimated that around 80% of people with BPD have comorbidities with other disorders, including anxiety.
Avoidant Personality Disorder: Excessive fear of rejection, leading to avoidance of social situations. There is a high comorbidity with mood and anxiety disorders.
Obsessive-Compulsive Personality Disorder (OCPD): Extreme anxiety about control and perfection. This disorder often coexists with anxiety disorders.

Relevant Statistical Data

Prevalence of Personality Disorders: Approximately 9% of the population suffers from a personality disorder. These disorders tend to affect men and women equally, although some types are more common in one sex than the other. For example, antisocial personality disorder is three times more common among men.
Comorbidity with Anxiety Disorders: One study found that the comorbidity rate between anxiety disorders and personality disorders ranges from 35% to 50% in hospitalized patients and from 50% to 85% in outpatients.

When to Seek Professional Help?

If your anxiety is affecting your daily life, your relationships, or your emotional well-being, it’s important to seek help. Transference-Focused Therapy (TFT) can help you understand the root of these symptoms.

Don’t hesitate to book an appointment with us to get to the root of your symptoms and help you heal.