Mental health has long been overlooked in Nigeria’s healthcare discussions, with conditions like personality disorders often going unnoticed and unaddressed. Despite their prevalence, a lack of awareness leaves many struggling in silence, unaware of what they are experiencing or how to seek help. Unfortunately, those suffering from personality disorders in Nigeria are often tagged as the ‘black sheep of the house’ or accused of being bewitched by the ‘village people,’ further deepening the stigma and preventing access to proper care. To shed light on this critical issue, Africa Health Report’s Gom Mirian sits down for an exclusive interview with Dr. Diepriye Tariah, a highly respected consultant psychiatrist with decades of experience spanning Nigeria, the United Kingdom, and now Canada, where he practices at Cape Breton Regional Hospital.
With deep expertise in diagnosing and treating mental health conditions, Dr. Tariah unpacks the realities of personality disorders in Nigeria—why they are often misinterpreted, how they manifest, and what can be done to bridge the awareness gap. In this conversation, he offers professional insights into a topic many hesitate to discuss, but one that urgently needs attention.
What are personality disorders, and how do they differ from other mental health conditions?
Personality disorders are a group of mental health conditions characterised by enduring patterns of presentation in terms of behaviour, cognition, and inner experiences that deviate significantly from cultural expectations. It is worth noting that these patterns are pervasive and persist over a long period. The term ‘personality’ itself implies a fundamental aspect of an individual’s constitution, meaning these traits are expected to remain throughout a person’s lifetime.
Unlike other mental health conditions, individuals with personality disorders are generally insightful, even when they appear not to be. One thing remains clear—they are not psychotic. However, their behaviours, thoughts, and interactions with society are markedly different from the norm.
The key distinction is that most individuals with personality disorders retain insight and are not as disorganised as someone whom society would label as ‘mad’ in the psychotic sense.
What are the main types of personality disorders, and how are they classified?
There exist various categories of personality disorders. Since these are personality disorders, they inherently relate to an individual’s personality. Broadly, they are categorised into three groups, referred to as clusters.
The first, Cluster A, encompasses conditions such as paranoid, schizophrenia-related disorder, and schizotypal personality disorder and then there is another one, Cluster B which includes antisocial, borderline, histrionic, and narcissistic personality disorder and then we have Cluster C consists of avoidant, dependent, and obsessive-compulsive personality disorder. These classifications highlight the different forms that personality disorders can take.
What are the common signs or symptoms that may indicate someone has a personality disorder?
Because they are many and varied, and we classify them under clusters, it will be difficult to give a generic kind of signs and symptoms. So, each one is different in unique ways and that is why as psychiatrists, we look at these symptoms and try to place them in clusters and make a sense of them, because they are very important in the way we approach, diagnose and treat them. But having said that, there are major symptoms that cut across the clusters I’ve just mentioned.
One of them would have difficulty in maintaining relationships, so they find it difficult to maintain interpersonal relationships because of their symptoms. Okay? They have intense, unstable emotions and their emotions fluctuate rapidly, some of them have disordered self-image, and they may be lacking in identity.
Another symptom will be impulsivity, where they can do things on impulse, most times with self-destructive consequences, and also chronic feelings of emptiness or loneliness, lack. Some of them could be suspicious and very distrustful of other people, these are in the clusters of paranoia, and some of them may be extremely sensitive to criticisms and hate rejection.
You also have those groups that are perfectionists and rigid in their outlook towards whatever thing that they are doing. So, as you can see, these are all symptoms across different clusters. So, depending on which particular type you’re dealing with within the clusters, any of these symptoms may come up, and these are the things that make them navigate relationships successfully.
How are personality disorders diagnosed, and what tools do mental health professionals use?
Right from medical school, the first thing they teach you is how to take a history and do an examination, and then go on to do other things, like the tests to help you to coalited things. But in psychiatry, clinical judgment is paramount but of course, you still have to take the history, you still have to do your examinations, but it’s essentially clinical when you have excluded all the other things that may be attributable to a physical cause.
So, clinical interviews are what we use. We just talk to the person and assess the person’s behaviour, how the person thinks, and what emotions the person exhibits. So, these are the main things. Then, we also do psychological assessments and there are some standardised tests and questionnaires. For instance, we use it in some cases. In terms of diagnosis, we have standardized diagnostic criteria such as the DSM-5 and ICD-10 to confirm the diagnosis.
What factors contribute to the development of personality disorders?
Essentially, in broad terms, personality disorders arise from a combination of genetic, environmental, psychological, and social factors.
under the genetic factors, we look at family history of personality disorder or other mental health conditions because there’s some degree of inheritance in this. And in terms of the environment, you must have heard it. We’re all exposed to nature and nurture. So yeah, we are all subject to it; those with personality disorders are not exempt, so you can have things like childhood trauma, childhood neglect, abuse, and an unstable family environment.
These are all factors that may exacerbate some of the symptoms, and there are psychological factors, like people having maladaptive coping mechanisms, for instance, to cope with some of life’s difficulties, they either use unusual strategies like drinking or taking drugs on the line.
The last one as mentioned, was social, as we all know, cultural and social influences impact people’s behaviour, so if you live within a society that follows particular norms as a member of that society, inevitably, you have to conform to, so these are some of the factors that contribute to the development of personality disorder.
Are certain age groups or demographics more prone to personality disorders?
Personality disorder has to do with the personality of the person. So, it is ingrained, it is what defines you as a person. So, then other factors propagate it. I talked about environmental factors, genetics and the rest of them when we started the discussion. So, it could happen to anybody. It could happen at no particular age, but the symptoms begin to manifest when the person is in the active years of life, for instance, early teenage, early adulthood and the rest of them, that is when the impact begins to show.
How do personality disorders affect relationships, work, and social functioning?
Yes, in many ways. So because of the symptoms that I highlighted at the beginning of this discussion, one of the things I mentioned was the difficulty in maintaining a stable, healthy relationship so they may have trust issues. For instance, if somebody has a paranoid personality disorder, the person will have trust issues with people, and those with unstable personality disorder and emotional instability, or narcissistic personality disorders are into themselves. So they have the ‘me first’, and ‘everything is about me’ attitude.
So when you’re growing up in an environment where people like to support, share things, and do things together, it becomes difficult to thrive, that person will have some kind of manipulative behaviour in such a way that they will always have others focusing on him rather than sharing, for instance.
This can also be found in workplaces. Some of them do not like authority. They don’t like teamwork. It’s difficult for them to meet the expectations of other people due to their rigid or impulsive behaviours.
When you have social functioning, for instance, you have difficulties with people anxious avoidant, so they always like to isolate themselves and they have conflicts with other people and difficulty adapting to social norms. Those who are impulsive, bordering breakers just can’t conform to societal norms. So, these are some of the ways in which personality disorders affect a person’s relationships.
If I could take one specific one, for instance, if you have somebody that has say, for instance, borderline personality disorder. These are groups that are emotionally, always dysfunctional, their emotions can change from one moment when they are happy to the next moment when they are sad, and this dysregulation of their mood can affect the relationship. People don’t understand why they are happy one moment and sad the other moment, they are also impulsive. So, they indulge in impulsive things like stealing, taking drugs, and drinking alcohol. These are all ways in which they are trying to map attacks to the fluctuations in their mood. But, of course, once they’re doing that, they are also causing a lot of challenges to other people around them.
What challenges do individuals with personality disorders face when seeking help or a diagnosis?
We tend to sort of always Stigmatize them, which is one of the things that makes things worse for them. So, we do like to judge or discriminate against them, and many individuals may not recognize their behaviour as problematic.
Sometimes, I’ve mentioned a few symptoms that may overlap with one another, and this sometimes may cause even for professionals in misdiagnosis. For instance, borderline personality disorder can be misdiagnosed at times as bipolar disorder, which is another psychiatric illness that affects the mood, because of all these restrictions, access to care may be difficult for them, especially in low-resource settings. They need a lot of care, and they need a lot of support.
But because of the stigma, because of the misdiagnosis or even lack of access to care, these combine to sort of isolate them even further from society and even treatment.
What treatment options and therapies are available for managing personality disorders?
These are personality-based. I can’t over-emphasize that, but the symptoms that they exhibit can be helped medically.
Broadly speaking, we approach them based on what we call the bio-psycho-social model. This includes Medication to manage specific symptoms like mood instability or anxiety. Psychotherapy: Cognitive-behavioural therapy (CBT) and dialectical behaviour therapy (DBT) can help with some of these issues. And then the third aspect is to formulate some kind of support group where they can meet with people with similar problems, they can compare notes, support each other, and build coping mechanisms.
Can individuals with personality disorders lead successful lives with proper treatment?
Absolutely, and this is what we advocate. We society need to understand mental health more so that the stigma and isolation will stop, if not, reduce considerably, because mental health is just like any other illness that may affect any human being. So even though, as I said, there is no cure for personality disorder because it’s ingrained in the person when the person presents with symptoms in crisis, is important that we support them so that they can lead successful lives, so it is important for them to see a mental health practitioner that’s the first thing, and the earlier, the better. Once they make themselves available, it’s likely that they will be directed to the right professionals, so they need to see a psychiatrist who can then diagnose the specific disorder and calibrate its severity.
Of course, if there are symptoms, the symptoms could be treated and depending on the type of presentation, a psychiatrist can work in collaboration with a psychologist to sort of give specific psychological treatment to those sufferers. And then, of course, basically what I can’t over-emphasize is some support from family friends, and also access to quality care, which is very important. And then, of course, I’ve also mentioned peer support groups and all the other facilities that they need to thrive with. So, if they’re getting all this, chances are that they will do well, and the long-term prognosis could be good. Yes.
How do cultural beliefs and societal norms influence the perception and diagnosis of personality disorders in Nigeria?
We need to look at the cultural norms that pervade our society in Nigeria, for instance, because I think even up to now, we depend on the esoteric, the spiritual and the like, which for me is a major impediment. Mental health issues are often attributed to spiritual causes, leading many to seek help from religious or traditional healers rather than medical professionals. This cultural belief system delays proper diagnosis and treatment. Addressing these misconceptions is key to improving mental health outcomes.
So, lack of awareness that mental health is real, it’s a problem. So, then people will need to understand that, and if they do, the stigma associated with mental health will reduce drastically. Because I know in Nigeria, if somebody, for instance, has a mental health problem, the first port of call is usually not a psychiatric hospital, and that way of life has to be addressed.
Also, our cultural beliefs have to be addressed as well. So, if we’re able to do that, then we will see a redirection of people with mental health disorders going to designated mental health hospitals to get the proper help that they need on time.
Second of all, the government also has to pay attention to mental health. Mental health appears to be the Cinderella of medicine. If it is not cancer, if it’s not major surgery, people do not give support to other aspects of medical problems, especially mental health. So, these are the two key elements that we should look for, and once we do that and remove these societal norms and influence on mental health, then we’ll begin to do better. We’ve done well over the years, but still, a lot needs to be done.
What steps can be taken to raise awareness and improve mental health care in countries with limited resources?
Public education is vital. Awareness campaigns, community-based mental health programs, and training for healthcare workers can make a significant impact. Governments must prioritize mental health funding and collaborate with international organizations to expand access to care.
I think worldwide, one in four persons will have a mental health problem. One thing I want to bring to the fore is to people. And the other thing, of course, is that if there is no mental health, there’s no physical health, and people lose their personality the moment they have serious mental health problems. So, I think the government and society in general should see it like that, mental health is also worldwide, and in any society, the distribution is fairly even, so you will have 1% of the population of any country having serious mental health problems.
But in general, one in four people will also have mental health problems. Within that 25% concept, you can see that some may have serious mental health problems, those with moderate and those with mild mental health problems. So, education and training are really important. Public awareness campaigns, just as you’re doing now, are also important. You can also start with community-based programs and programs with low-cost mental health services. One cannot overemphasize that because, in every community, you have people you can reach out to.
We also need to collaborate with international organisations and partners, the World Health Organisation, for instance, also some of the private individuals who are supporting the cause, so we need to fish them out and collaborate with them. So, any little help that we can get to boost our mental health system is quite welcome. So, it requires a lot of training, a lot of campaigns, a lot of awareness, as in many things, a lot of funds.
