What Does It Actually Mean to Have a 'Personality Disorder'?
Our personalities are what define who we are as individuals. It’s our way of thinking, feeling emotions and behaviors that make each of us different. An individual’s personality is influenced by their life situations, surroundings as well as inherited characteristics. But what happens when you’re told your personality is a “disorder”?
What Do We Mean by ‘Personality’?
What we mean by personality depends on who you ask. In traditional psychology, the “Big Five” theorizes that people’s personalities can be described by variations across five basic dimensions; agreeableness, conscientiousness, extraversion, openness and neuroticism.
In theory, these five traits are found across a wide “range of population.” But is it fair to fit everyone into this “healthy” personality box? What about people who don’t seem to fit into one of these five dimensions? For example, this five-factor personality model doesn’t apply to a small indigenous society or Japan’s Hikikomori.
Personality theories have been written within a confined context by classic psychologists, most of whom were white, straight, male, wealthy, and from democratic and industrialized countries. Western ideas about personality may not be applicable to other cultures. There isn’t a one-fits-all approach to personality theories in cultural, socioeconomic, political, religious and historical contexts.
How Should We Define Personality?
According to the Theory of Cognitive Modes, we each have a particular dominant cognitive mode that affects how we respond to situations we encounter and how we interact with other people. The top and bottom parts and left and right halves of our brain have different functions. How they all interact differ from person to person based on how our brain developed its connections. One way of thinking and perceiving is not right or wrong in comparison to the next person.
Determining personality or a psychological issue may be more complex than a physiological health issue; medical professionals can diagnose a disease by measuring low red blood cells, for example, or through a CT scan and ultrasound, or by lab results based on diagnostic science, detection markers and clinical tests.
While some diagnoses of mental health conditions are classified based on brain biology, the diagnosis of a personality disorder is more subjective, based on who determines what’s “normal.” There is no single medical test to diagnose any personality disorder. Instead, a patient gets labeled on the sole clinical diagnosis of a mental health professional following a comprehensive psychiatric interview based on a flawed definition “normal.”
Why Do We Call Some Mental Illnesses Personality Disorders?
Between the late 19th and early 20th centuries, personality disorders were devised by a number of European psychologists.
“We have been using the term ‘personality disorder’ to describe folks with complex, long-term mental health struggles since around 1919, long before we had a modern understanding of trauma,” said Katie Lear, LCMHC.
In 1952, the first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published, a handbook used by health care professionals as the authoritative guide to the diagnosis of mental disorders. The manual is revised every decade or so — we’re currently on the fifth version of the DSM, which was published in 2013.
The DSM is a guideline, a diagnostic manual, and for some, may not be the most accurate psychiatric “bible” because of how it was written. It does not come without criticism; the British Psychological Society (BPS) criticized the whole concept of the DSM stating it’s a “top-down” approach to mental health, where patients are made to “fit” a diagnosis.
The DSM can also be a problem because of who wrote it. Like defining “normal” personality, the DSM and its many diagnoses have been drafted primarily by white, male psychiatrists and phycologists in Western countries. Perhaps one of the best examples of how these narrow definitions of personality and “disorder” can stigmatize people is borderline personality disorder.
What Is Borderline Personality Disorder?
People with borderline personality disorder (BPD) have difficulty regulating their emotions, which can lead to impulsive behaviors and difficulty in relationships. They may also experience intense bouts of anger, depression or anxiety; feelings of emptiness and fears of abandonment, and experience dissociation.
Certain events during childhood may play a role in causing BPD, including a chronically misattuned caregiver, loss, neglect, and emotional, physical and sexual abuse. Some people are more likely to develop BPD due to their biology or genetics, and harmful childhood experiences can further increase the risk.
To be diagnosed with BPD, a person must have at least five of the nine BPD symptoms listed in the DSM. Sometimes it can be difficult to diagnose BPD because it can co-occur with other conditions such as depression, substance use and eating disorders. Also, BPD symptoms differ from person to person, and symptoms can fluctuate over time.
Personality Disorders and Trauma
Rather than being a sign of a “defective” personality, what psychologists and psychiatrists used to think of as a personality disorder is usually the result of developing in a traumatic or difficult environment. BPD is a perfect example: A child may not have the opportunity to learn how to regulate their emotions or self-soothe, due to no fault of their own.
“What distinguishes personality disorders from other mental disorders is that personality disorders are usually caused by a difficult upbringing and trauma in childhood whereas other mental illnesses have an organic or genetic cause (i.e. schizophrenia),” said Julian Lagoy, M.D., a psychiatrist with Community Psychiatry.
Personality traits are hereditary and frequently linked to trauma or neglect from a primary caregiver. Attachment is the deep connection established between a child and their primary caregiver that affects a child’s development and their ability to express emotions and build meaningful relationships later in life. The lack of attachment early in life may be linked to BPD.
“Individuals with personality disorders may have endured trauma early in their life or had insecure relationships with their primary caretakers; consequently, they perceive love and care differently,” said Leela R. Magavi, M.D. a Hopkins-trained psychiatrist.
BPD and many of its symptoms can fall within the range of complex trauma. Complex trauma stems from exposure to multiple traumatic events, usually in childhood, and its wide-ranging, long-term effects. These events can include child abuse, neglect, domestic and family violence, civil unrest, war trauma or genocide, cultural dislocation, sexual exploitation and trafficking.
“Complex trauma can affect a person’s entire worldview: their sense of hope for the future, the way they relate to other people, and their sense of trust and safety in the world,” said Lear. “The symptoms we see in people with these disorders aren’t some failing of their personality: It’s the result of trauma that has permeated many aspects of their lives.”
The Label ‘Personality Disorder’ Is Stigmatizing
Mental illness is stigmatized, and personality disorders are even more stigmatized — even among mental health professionals. There is a lot of misinformation about personality disorder and BPD out there, a lot of which isn’t accurate or even fair.
“In general people tend to think that since there is no genetic or organic cause for personality disorders, they are completely the patient’s fault,” said Dr. Lagoy, adding:
Obviously this is not true, because it is not someone’s fault if they are abused and traumatized as a child and develop a personality disorder. Likewise it is very detrimental to be told your personality is ‘wrong’ because it puts the blame all on you and is very damaging to a person and their self-esteem.
Even the terms “personality disorder,” “borderline” and “narcissist” are incredibly shaming, according to Lear. Research has suggested that the term “borderline” emerged as a label to group patients perceived as difficult.
“They have a bad reputation in popular culture and they’re often used dismissively or as insults. Our personality is almost synonymous with our sense of self — being told your personality is wrong can feel like you are being told that you, as a person, are wrong,” said Lear.
Some personality disorders are also misrepresented in media, leading to a stigma that can’t be easily erased.
“At the extreme it can be damaging and dangerous, but most people with borderline aren’t even close to being as violent and self-destructive as they look in the movies,” said Aimee Daramus, Psy.D. and licensed clinical psychologist. “People with the true borderline disorder are in an intense amount of pain.”
Borderline Personality Disorder Is Treatable
Contrary to what many people, including some medical professionals, believe, BPD is one of the most treatable mental illnesses. People with BPD can be treated with a combination of psychotherapy, peer and family support, and medications.
Dialectical behavior therapy (DBT) is considered the gold standard for BPD treatment. It was created by Marsha Linehan, who developed DBT particularly for people with BPD because she understood that with the right tools, it can be treated effectively. In DBT, people are taught tangible skills to help manage their emotions, interpersonal relationships, and learn more helpful ways to manage their world.
With proper treatment (and a mental health professional who doesn’t write them off as having a “defective” personality) it’s completely possible people with BPD can reach their life worth living.
To find a DBT therapist and learn more about borderline personality disorder, check out the following resources:
Header image via Drew Coffman/Unsplash