Personality Disorders

What they are, and how we can help provide needed treatment for positive mental health outcomes.

Sean Alexander, LCSW

Some people learn they, or their loved one has been diagnosed with a Personality Disorder. This can be confusing and scary. It is not entirely clear to most what is meant by “Personality Disorder”. Many might think there is a “disorder” in the fundamental unique person you are, and therefore no hope of improving what seems to be going wrong. That can be a hopeless and lonely place to be. Fortunately there are treatments to help you acquire behavioral skills that can greatly improve your quality of life, and quality of relationships! It is important that we learn more to clearly understand what Personality, and Personality Disorders are. Let the education begin!

Let’s first start by learning exactly how a personality is defined. Then we can learn the clinical definition of a Personality Disorder. Finally we can explore how such conditions are treated in therapy.

Personality Defined:

In clinical terms, a personality is a set of traits in behavior that can be recognized across social realms, that create patterns in how a person interacts with the world (and people) around them. These patterned traits become recognizable in social contexts , and we can identify familiar traits in others and ourselves as predictable over a given time. When we say we "know" someone, we are actually saying we are familiar with the patterns and traits in that person’s behavior, and we can confidently predict what they may do in a variety of circumstances. In other words, we have gotten to know that person’s “personality”.

Personality develops from the time you are a child and goes through changes, evolving through adolescence. In our early 20’s if all development has been largely successful, our personality stabilizes and we settle in to relatively predictable behavior as a fully matured adult.

So what happens when things go wrong? What causes these issues?

Personality Disorder Defined:

As previously mentioned, a "personality' is a set of traits that are patterned in relation to the way a person interacts with other people and their external world. So when a personality is “disordered”, that means their behaviors, in relation to their external world are chronically problematic, and maladaptive. This means, that person's adaptations of behavior wind up harming their health, and/or the health of the relationships that are close to them. The onset of personality disorders only happen in late adolescence, to early adulthood. There is no occurrence of “late-onset” Personality Disorder in established adulthood.

According to the DSM-V, there are three categories of personality disorders. There are 10 personality disorders divided into 3 "cluster" groups of A, B, and C. I will list them briefly here, to demonstrate an overview of the characteristics of each group. The specifics of each particular personality disorder can be looked up readily for traits and diagnostic criteria.

Cluster A Personality Disorders are considered the odd or eccentric group. These personality disorders are identified as:

-Paranoid Personality Disorder

-Schizoid Personality Disorder

-Schizotypal Personality Disorder

Cluster A Example: If a person were to demonstrate an unusual characteristic of magical thinking, pervasively bizarre ideas, odd behaviors, and profound superstition; to the point of it infiltrating every decision they make, and how they attribute the outcomes they observe in their environment; they might be demonstrating traits of Schizotypal Personality Disorder in the cluster A category.

Cluster B Personality Disorders are considered the hyper-dramatic, emotionally dysregulated group. These Personality Disorders are Identified as:

-Narcissistic Personality disorder

-Borderline Personality disorder

-Histrionic Personality disorder

-Antisocial Personality disorder

Cluster B Example: If a person has unstable changing extreme moods, a preoccupation with abandonment, impulse control problems (substance, sex, dangerous risk taking), chaotic relationships, chronic self-harm, and or suicidal ideation; they may be demonstrating traits of Borderline Personality Disorder in the cluster B category.

Cluster C Personality Disorders are considered the anxious and fearful group. These personality disorders are identified as:

-Dependent Personality Disorder

-Avoidant Personality Disorder

-Obsessive Compulsive Personality Disorder

Cluster C Example: If an individual behaves profoundly dependent on the approval of other people around them, demonstrating little to no ability to make decisions autonomously without the reassurance of others, or not being able to tolerate being alone to care for themselves; these might be traits of Dependent Personality Disorder in the cluster C category.

You may notice a common theme amongst all these personality disorder groups, in the way a person conceives of themselves, and the way they interact with the external world, as fundamentally “maladaptive”. As a reminder, maladaptive means that the adaptation of behavior is unhealthy, unrealistic, and damaging to oneself, and to relationships with other people.

What causes Personality Disorders:

The cause of a personality disorder is a complex topic. One could easily fill a library with the literature and research establishing statistics in clinical significance of personality disorder outcomes in people. Research has established that adverse childhood trauma experiences can causally contribute to maladaptive alterations in the personality. If you recall, we’ve established that personality develops through our childhood, and solidifies in adulthood. If adverse conditions during childhood are extreme enough, a person might develop a way of "behaving" to survive those extreme conditions. Examples of extreme conditions can be chronic abuse, neglect, or when the fundamental necessities of life in resources and emotional nurturance are not readily available. When this occurs, established maladaptive defense mechanisms can cause unhealthy personality outcomes in adulthood.

At this point we have defined what personality is, what happens when there is a disorder in the personality, the categories of personality disorders as defined by the DSM-V, and brief examples of each. Now let’s turn our attention to treatment options, and how problems of this nature or addressed in therapy.

Therapy Treatments:

One of the most effective psychotherapy treatments for personality disorders, especially borderline personality disorder in the cluster B category, is Dialectical Behavioral Therapy.

Dialectical Behavioral Therapy (DBT) is an offshoot of Cognitive Behavioral Therapy. DBT is divided into four major categories of “instruction”. These categories are:


-Emotional Regulation

-Distress Tolerance

-Interpersonal Skill

Mindfulness skills are used to help stabilize a person when intense emotions overcome them, helping to deescalate intensity. Next, Emotional Regulation is the "cognitive" aspect of this treatment. It helps a person recognize unhealthy thinking patterns, and how to rationally redirect them. Distress tolerance helps a person confront negative emotions, instead of avoiding or repressing them. When we practice confronting negative emotions, we become more adaptive and less preoccupied by them.

Finally, Interpersonal skill is the section of treatment that refers to "strengthening the ability to sustain relationships". This lesson teaches people how to set boundaries, or communicate assertively. Dialectical Behavioral Therapy is an evidenced based treatment, and has been shown in clinical control trials to have effective treatment outcomes.

Behavioral Activation Therapy can also be used to support personality disorder treatment. This kind of therapy teaches a person how to create positive reward incentives for desirable behavioral redirection. This helps a person build a better association when confronting circumstances that may be uncomfortable, or even triggering.

Psychodynamic Therapy is also a modality of treatment used in treating personality disorders. Psychodynamic therapy is one of the older psychotherapy treatments that focuses on theories of personality and relationships. This kind of therapy helps a person become aware of some of the behaviors and actions that they do unconsciously that influence their outcomes. It also aims to make the person aware of how circumstances in their childhood might be linked to some of their behavior in their adulthood. Once a person can become more aware of these dynamics, they are empowered to make different choices that yield better outcomes.

Personality disorders can be confusing, and a significant challenge to live with. There is treatment, and there is hope. Contact me today, and let’s formulate a treatment plan that works for you.

Sean Alexander, LCSW

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