Imagine this. You lived in an invalidating family all of your life. Your first conscious memory is of someone criticizing you and it hasn’t gotten any better since then. As a seven year old, you experienced more trauma in a month than the average person experiences in a lifetime. You have trouble regulating your emotions and you know that you need help. So you gather together all of the courage that you can muster, dial the office number, and make your first appointment. A week later you are nervous, yet hopeful as you walk in to meet your new therapist. Then comes the emotional avalanche as you walk out with a new diagnosis. According to your therapist, you have a Personality Disorder. In other words, your personality, your sense of being, the very essence of yourself – is broken.
Over the past few decades, the topic of diagnosing personality disorders has become quite controversial within the mental health community. The reason for this controversy is that some mental health professionals believe that personality disorders do not really exist and that a client’s symptoms are really the manifestation of other issues. These professionals believe that such diagnoses actually stigmatize patients by suggesting that a person’s personality is the cause of their mental health struggles. In fact, there can be such a strong sense of stigma attached to personality disorders diagnoses that even some mental health professionals groan when a client with one of those diagnoses comes in for treatment. Unfortunately, some patients with this disorder are viewed as manipulative or untreatable, which can reinforce negative ideas tied to self-worth and prevent positive treatment from taking place.
However, other mental health professionals believe that considering a personality disorder is a necessity in the diagnostic process. They say that symptoms of personality disorders are not periodic, like mood swings or panic attacks, but are often chronic and debilitating. Clients walk into therapy sessions looking well put together initially but after a short amount of time they become disorganized and impaired in their functioning. Mental health professionals recognize that these symptoms are consistent with certain groups of people and believe that they are in fact reflective of very specific disorders.
Whether you believe that personality disorders are real or you think that they are really just the reflection of a different psychological issue, it is important for the mental health community to focus on treatment of the symptoms. Consider the diagnosis of Borderline Personality Disorder. Individuals who have been given this diagnosis are often women who demonstrate many of the following symptoms: frantic efforts to avoid abandonment (real or imagined), struggles with relationships, experiences an unstable self-image, is known to be impulsive with intense mood reactivity, experiences chronic feelings of unhappiness, and sometimes engages in recurring suicidal behavior, gestures, or threats. However, individuals who have this diagnosis absolutely can receive very effective treatment. For instance Dialectical Behavioral Therapy (DBT) has been scientifically proven to be extremely effective in working with these individuals. The underlying premise behind this treatment is that people with Borderline Personality Disorder are biologically wired to be more emotionally vulnerable and they have learned to engage in certain behaviors to get their emotional needs met in an invalidating environment.
Treatment providers focus on helping clients learn better tools to manage their internal world while navigating their external environment.
Other personality disorders include Antisocial Personality Disorder and Paranoid Personality Disorder. Antisocial Personality is more commonly diagnosed in men and people with this diagnosis generally demonstrate the following symptoms: struggles with experiencing empathy for others, has an inflated self-esteem, often has a disregard for social rules and obligations, acts impulsively, and is often irritable. A Paranoid Personality Disorder diagnosis is given when individuals demonstrate many of the following symptoms: a pervasive distrust of the world, guarded and suspicious to the point that they are constantly on the lookout for situations that confirm their suspicions, has a strong sense of self-importance and personal rights, is extremely sensitive to setbacks, feels shame easily, and may persistently hold grudges. Because of their distrust of the world, they have a tendency to withdraw from other people, making it difficult for them to engage in close relationships. Although these symptoms can be severe, with the right therapist, both of these disorders can be effectively treated.
In addition to the three disorders mentioned in this article, there are also several other personality disorders. It is my professional opinion that there are true personality disorders– however the underlying cause is often much more complex than many practitioners acknowledge. The diagnostic process should be an aid in helping to determine the best line of treatment, not as a label that is inadvertently used to stigmatize patients. Whichever theoretical camp a provider is on, it is important that professionals in the field focus more on how to treat the presenting problems rather than inadvertently causing even greater wounds in people who are already struggling and seeking help.