Personality Disorders

How is a personality disorder different from a normal personality?

Firstly, there is no such thing as a “normal” personality. Everyone has a cluster of traits that make you, you. When we manifest these traits in an extreme or inflexible way (i.e., we have difficulty adapting our response to what is called for in a given situation), it creates a pattern of behaviour (e.g., how we are in relationships) and inner experience (e.g., the range, intensity, and appropriateness of our emotional responses; how we interpret ourselves and events around us) that interferes with our ability to function effectively in our daily life.

All of us respond to situations in inflexible and unhelpful ways sometimes. Just because this happens to you does not mean you have a personality disorder. Personality disorders are not episodic like other mental health diagnoses. (e.g., When you are experiencing a depressive episode, you exhibit particular symptoms, but when the depressive episode resolves, the symptoms go away.) Traits are longstanding (i.e., since at least adolescence), persistent (i.e., are always present regardless of the circumstances), and pervasive (i.e., across all life domains). When these ways of responding differ significantly from what is typical of an individual’s culture and cause impairment, we might consider whether this pattern is evidence of a personality disorder. Sometimes certain personality-disordered traits ‘hang together’, and when this happens, we might make a diagnosis of a specific personality disorder.

There are three clusters of personality disorders, and although each personality disorder has its own unique set of traits, the clusters are characterized by some overarching features:

I am not going to describe all ten personality disorders in detail here. Because personality-disordered traits represent extremes of traits observed in everyone, you will almost certainly identify with at least some descriptions, and I don’t want you to start self-diagnosing. Making a personality disorder diagnosis is a complex process and requires specialized training and experience. Personality-disordered traits can often be overlooked when someone is coming in for an assessment for another issue, such as depression or drug use. Additionally, symptoms of personality disorders can be confused with other mental illnesses. For instance, sometimes people receive a diagnosis of Bipolar Disorder because their mood fluctuates, but their mood is actually better explained by Borderline Personality traits. A diagnosis of personality disorder takes time to make. It is not always apparent during a brief, structured clinical interview, which is often what people experience in mental health settings. This is one of the reasons my assessment interviews are a bit longer than what is “typical” at times.

There is a lot of stigma surrounding personality disorders.

Yes, there is. Unfortunately, there is a lot of misinformation out there about personality disorders, which leads to an inaccurate understanding of why people do what they do and a lack of appreciation for the person’s internal experiences. An individual might be judged as “manipulative” or the diagnostic label may be used in a pejorative manner (e.g., “they are so borderline”). This is hurtful and often exacerbates the problem. Unfortunately, these types of judgements can be made by well-meaning family and friends who are simply misinformed about how to best support their loved one.

Borderline Personality Disorder receives the most attention in research, but unfortunately, it does not appear to have had much of an impact on the stigma associated with the diagnosis. The short film below, created by the Self-Regulation Project in partnership with the Wright Institute Los Angeles, attempts to offer an alternative perspective on the sometimes challenging behaviours individuals with Borderline traits can engage in.

***Trigger Warning: this video talks about suicidality and self-harm and may evoke strong emotions. ***

Who treats personality disorders?

The latest research suggests that many personality-disordered traits are likely dimensional (i.e., they exist on a continuum). This means that people often have traits from more than one specific personality disorder, which requires flexibility in treatment. Sometimes clinicians focus on treating one type of personality disorder because they specialize in providing a particular type of intervention (e.g., a considerable amount of research supports the use of Dialectical Behaviour Therapy for the treatment of Borderline Personality Disorder; Oud et al., 2018). I have experience assessing and treating a wide range of personality disorders because personality disorders are more prevalent in forensic psychiatric settings (prevalence rate of 18%) than in non-forensic psychiatric settings (prevalence rate of 2-4%). In fact, identifying whether someone has a personality disorder is one of the most common referral questions I receive in my forensic work.