You wake up, half-dazed, not quite awake as your alarm beeps with the knowledge of the Zoom class taking place in 5 minutes. With drunken tiredness, you reluctantly sit up and open your laptop to listen to your lecture. You haven’t put your contacts in; you haven’t even brushed your teeth. And as you sit there, listening to the professor mumble about cameras and participation, you find your eyes closing again, until you wake up to the sound of static and a ticking clock. The impact COVID-19 has had on our lives almost seems to be immeasurable. About two years of seclusion, social distancing, and quarantining has shifted our lives in ways we don’t fully understand. Understandably, the toll it has taken on our mental health is very real and has even affected people without prevailing mental health challenges. But, I want to shed some light on a group particularly at risk from COVID-19: the personality disorder (PD) community. Personality disorders are a category of mental illness that do not receive the same spotlight that mood disorders and anxiety disorders have in recent years. Of course, this is not to fault anyone. It’s great that we have begun to normalize the experiences of those with depression, bipolar, or anxiety. But we should not overlook and disregard personality disorders. They are very real and can be very debilitating.
There are many variables to consider when thinking about the effects of COVID-19 on our community’s wellbeing. A particular focus on personality disorders is worth a discussion. There are 3 types of personality disorders that affect people greatly when put into dire situations, each with their own notable characteristics. We can categorize these people into Clusters A, B and C. Those who suffer with Cluster A personality disorders are highly introverted, emotionally detached, and hypersensitive to interpersonal threats. Cluster B personality disorders are characterized by unstable interpersonal relationships, emotional reactivity in the form of impulsive, dramatic, erratic and manipulative behavior. And Cluster C is characterized by anxious, fearful thinking and behavioral issues.
With Cluster A, understandably, introversion and paranoia play a role in producing harmful consequences with respect to mitigation behaviors and compliance. On one hand, where paranoid PD patients may partake in high mitigation measures, arguably to a detrimental level as a result of their introversion and suspiciousness and mistrust of others, schizoid PD patients may have an entirely different reaction. For example, this increase in paranoid tendencies and general cognitive distortions as a result of fantastical thinking has contributed to some of the conspiracy theorist sentiment that arose over the course of the pandemic, such as mistrust in government and vaccination. Understandably, the treatments for this cluster deserve more research.
Similar to Cluster A, the wellbeing of those with Cluster B personality disorders during the pandemic is rocky, but in a different way due to the variations in their symptoms. Therefore, the way in which we treat and consider those in Cluster B PDs should be different. For example, borderline personality disorder is characterized by the aforementioned traits, but a notable one is the fear of abandonment, be it perceived or imaginary. Quarantine and social distance may have had an adverse reaction on people with B PD, as this perceived threat of abandonment impacts them further. Studies have shown that, as a consequence of these symptoms, B PD patients were more likely to engage in substance misuse as self-medication (North et al., 2011). In general, substance abuse has increased as a result of the pandemic. It is worth understanding how it has affected the behaviors of those with Cluster B PDs. Even further, mitigation behaviors and safety compliance has been impacted by these personality disorders.
Trait impulse may seriously impact the ability of B PD patients to maintain social distancing, perhaps even Histrionic Personality Disorder patients as well (a personality disorder characterized by attention-seeking behavior).
Lastly, Cluster C personality suffers from the type of disorders that induce fear and anxiousness. Avoidant PD, characterized by detachment and emotionally avoidant based behavior and already have seen a reduction in emotional well-being, depression, anxiety, and stress as a result of the pandemic (Mazza C., Ricci E., Biondi S., 2020). Dependent PD patients are characterized by their intolerance of being alone and their reliance on the approval of others. Understandably, this creates its own variety of emotional disturbance and reduced well-being, as well as its own impact on mitigation behaviors and compliance. OCD is also shown to take a particular toll on well-being, potentially increasing levels of anxiety and depression as they stress over their own daily routines and the new habits that they have to take on.
Considering the following, it is a responsibility of society to pay more attention to personality disorders, especially in light of COVID-19. Although we have progressed tremendously in society with the normalization of mental illness, we have seldom focused on personality disorders. Society has created an environment in which we don’t understand the implications of what we say and do, perhaps to the detriment of people with these disorders. For example, we shame those who break pandemic social conventions, such as social distancing, when cluster B and cluster C types may be particularly prone to breaking them. Although it is understandable, the delicate nature of the pandemic needs to be handled much more carefully. It is clear we have a ways to go in society in discussing and normalizing personality disorders.
Inarguably, we have a ways to go with conducting research on the novel impact of a social event such as the COVID-19 pandemic.
Preti, E., Di Pierro, R., Fanti, E. et al. Personality Disorders in Time of Pandemic. Curr Psychiatry Rep. 2020 November 10;22(80). doi: 10.1007/s11920-020-01204-w
Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, Roma P. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int J Environ Res Public Health. 2020 May 2;17(9):3165. doi: 10.3390/ijerph17093165.