Home InsightsPersonality Disorders: Understanding Them and Our Unique Approach

Personality Disorders: Understanding Them and Our Unique Approach

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Edited & medically reviewed by THE BALANCE Team

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Personality Disorders are complex mental health conditions that affect an individual’s thoughts, emotions, and behaviours – often leading to serious impact in a person’s personal and social life. These disorders develop as a means of coping with early life, often linked to trauma or neglect. It shows up in interactions with friends, family, colleagues, and partners.

A personality disorder can be the root cause of a lot of symptoms. It usually co-occurs with other diagnoses. While this diagnosis reflects a stable part of a person’s personality, with the help of a professional, an individual can slowly work towards a more flexible mental state. To understand personality disorders more, we sat down with Dr. Med Sarah Boss to discuss why they develop, the different kinds, and how we treat them at The Balance.

Personality disorders are characterised by inflexible and maladaptive patterns of thinking, feeling, and behaving that deviates from cultural expectations. These patterns are deeply ingrained and tend to cause significant distress or impair functioning. It’s termed personality disorder because the condition is a stable part of a person’s personality. It shows up in how an individual interacts with friends, family, or romantic partners. It is a consistent set of patterns in a person’s life that is more or less active depending on how it is treated.

A personality disorder manifest earlier than other conditions. They come from “experiences with our early caregivers, in our early years of life. This can be neglect, abandonment, not enough care or love in childhood, but it can also be too much in the case of narcissistic personality disorder,” states Dr. Sarah Boss. A personality disorder develops out of a need for survival. They are strategies to cope. A personality disorder may develop later in life, but it is extremely rare.

Personality Disorders can be underlying cause of other temporary mental health conditions. “For example, if someone has a lot of trouble in relationships, they may end up feeling depressed because they are unable to be in a stable partnership. That may lead to anxiety, depression, or isolation. But the underlying personality disorder is what needs to be treated,” says Dr. Sarah Boss.

There are ten different types of personality disorders that fall under three different categories according to the DSM-5. The two most common diagnoses are borderline personality disorder and narcissistic personality disorder.

Cluster A (Odd or Eccentric Disorders):
- Paranoid Personality Disorder: Characterised by pervasive distrust and suspicion of others.
- Schizoid Personality Disorder: Marked by detachment from social relationships and a restricted range of emotional expression.
- Schizotypal Personality Disorder: Involves acute discomfort in close relationships, cognitive or perceptual distortions, and eccentric behaviour.
Cluster B (Dramatic, Emotional, or Erratic Disorders):
- Antisocial Personality Disorder: Disregard for and violation of the rights of others.
- Borderline Personality Disorder: Instability in relationships, self-image, and emotions, along with impulsive behaviour.
- Histrionic Personality Disorder: Excessive emotionality and attention-seeking behaviour.
- Narcissistic Personality Disorder: Grandiosity, need for admiration, and lack of empathy.
Cluster C (Anxious or Fearful Disorders):
- Avoidant Personality Disorder: Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
- Dependent Personality Disorder: Excessive need to be taken care of, leading to submissive and clinging behaviour.
- Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness, perfectionism, and control.

A personality disorder often develops out of a need for survival. It’s a strategy to cope with something that happened in the early years of a person’s life. As adults, we come back to these dysfunctional strategies and ask: are they still necessary? From there we can work on it. We can make the mind more flexible, and less rigid.

We work with a wide range of techniques with psychotherapy as our base. We use attachment theories to understand the meaning or purpose of having developed the personality disorder. We work with skills training like CBT or DBT to cope with the intense emotions and moments of dysregulation. We develop new options of behaviour. Often times, personality disorders are co-occurring with other conditions. We work to lesson the symptoms a patient experiences due to the personality disorder. This can make the diagnosis much more manageable when we are able to work through the anxiety or depression that might be coming from the personality disorder.

Once a patient is more stable, we do more trauma work and somatic experiencing to work with the nervous system and teach them to self-regulate. With severe symptoms, it can also be helpful to work with medication in the beginning to tackle some of the high intensity emotions. Something to improve the mood, anxiety, or to regulate the sleep. There is always a combination of techniques used. We give people a toolbox to change their life, and begin to build healthier relationships.

Personality Disorders are a stable part of a person’s personality that shows itself in how an individual interacts with other people. A person with a personality disorder often does not know they have one because they are so used to it being a part of them. It is important to remember that these disorders develop out of a need for survival linked back to events in early life and their upbringing. There are ten different types, with borderline personality disorder and narcissistic personality disorder being the most common causes. There are various treatment options available to those suffering. Over time, a person can develop new patterns of behaviour, create more mental flexibility, and have healthy relationships.

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Personality Disorders: Understanding Them and Our Unique Approach

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