Can a Personality Really be a Disorder?
Updated: Dec 10, 2019
Have you or someone you love been diagnosed with a personality disorder? Or maybe you've heard the term being thrown around and are curious about what they mean? There are many ways to understand human development, identity and behavior and one very common way that trained mental health professionals use is the DSM-V--filled with all kinds of "disorders" and their symptoms. The most common "personality disorders" are Borderline Personality Disorder and Narcissistic Personality Disorder. I imagine there are many professionals who find these labels helpful, although in my experience, I find that they have significant stigma attached to them and often taint the relationship between the therapist and the client. There are also people who have been diagnosed with "personality disorders", and find the diagnosis helpful. For those folks, I respect that, and would also like to offer another--more compassionate and I think, more accurate perspective.
The DSM aims to provide a simplistic, categorized understanding of mental health. It does so by identifying disorders, and drafting measurable symptoms and behavioral patterns through which clinicians can make an accurate diagnosis.
For personality disorders, criteria include the following:
Impairments in Identity
Flipping the Script: Character Solutions
One way of working is looking at these "symptoms" and "treating" them, that is "helping" people identify these symptoms and patterns and teaching them alternative, more pro-social strategies. I do not take this approach.
Instead, I think it's important to understand them more deeply. First, I recognize that each and every one of us exhibit some of these behaviors/patterns some of the time. After all, who feels completely secure in relationships all of the time? But, it's also true that some people suffer with these feelings more than others. And in these situations, I have found it helpful to understand them as symptoms of an underlying problem--often unmet, early childhood needs--not of some medical or biological or personality "disorder". In my years of experience, I have never met someone who was diagnosed with a "personality disorder" who did not have childhood trauma. And rather than think of these symptoms as a reflection of what is "wrong" with the person, what needs to be "fixed", I get curious about them, and help people get curious about them too.
Because often, these kinds of patterns are actually a solution that a young child creatively came up with to protect themselves--their emotional and psychological selves, to be specific. They're attention-seeking because they didn't get the attention they needed-we all need--as children, or they're compensating for a deep sense of shame they feel about themselves due to abuse or neglect. They might have Separation Insecurity because they've experienced loss or abandonment of loved ones before and can't bare to feel that again. Similarly, they act with hostility to keep people away so they can't be hurt again. These are all just theoreticals, but I write them to show exactly how such kinds of behaviors--precisely not symptoms--are actually solutions to a very big problem--the overwhelming suffering felt in relation to our most important developmental relationships and as a result, challenges in the way we see and relate to ourselves.
Why It Matters
Someone might be diagnosed with a personality disorder and receive treatment, teaching, counseling for their symptoms, and it could be very helpful for them. But I think the most important difference in working with someone who understands that there are no personality disorders, only character solutions, lies in dignity. When you work with someone who seeks to understand rather than pathologize and teach, you feel a sense of dignity--both in yourself and in relationship with someone else. And when you've experienced early childhood trauma, that might be something new. Something that you've needed that hasn't yet been met. That may have led to some of the protective solutions listed above. The idea of feeling dignity in yourself or in relationship with someone else might sound unimaginable. But its an experience you deserve. And when you work with someone who will relate to you as a person, honoring your strengths and needs (met and unmet), you will start to believe that too.