The term “Personality Disorder” (PD) is, unfortunately, steeped with pejorative connotations. In fact, it sounds more like an insult than a therapeutic label. Nonetheless, the concept of a PD in its clinical terms is helpful in recognizing enduring counterproductive ways people interpret and react to their environment. Personality disorders are typically manifest in how people interact with others. For example, someone with obsessive personality disorder may be so hung up on their routines that they are completely inflexible. This might make it difficult to work with others, cause them to waste a tremendous amount of time, and prevent them from feeling a sense of peace or contentment because they are so focused on things being “just right.”

Another example is paranoid personality which is characterized by irrational suspicions and mistrust of others. Narcissistic personality is characterized by a pervasive pattern of feeling superior to others, the need for admiration, and a lack of empathy. These are just some examples of PDs. One of the important aspects of PDs is that they are often outside a person’s conscious awareness, so there can be resistance to accepting the idea. In some cases, it would be too hurtful to a person’s self-worth to accept that their view of themselves and people around them is inaccurate. In addition, they rationalize their behavior based on how others are behaving around them.

So, these chronic vulnerabilities cause a person to think they are responding rationally to their environment, but the behavior is actually self-defeating, ultimately causing emotional distress, not actually getting needs met in a way that makes the person happy in the long run, causing frustration, or interfering with relationships which causes distress for people in their lives. There are different theories of how people develop these entrenched ways of reacting. Theories range from PDs emerging from early childhood experiences, that they result from biological/brain chemistry predispositions, or that they stem from a combination of the two. It is probably best to think of PDs as personality vulnerabilities, which also avoids it sounding like an insult. Everyone has strengths and weaknesses. Sometimes very strong personality traits can lead to success in one area of life but cause damage in another. An example is with Narcissistic Personality Disorder which may be an asset on the professional side, for example in a sales position, but make it difficult to deeply connect with people on the personal side, like in a marital relationship. In fact, there has been a proposal to remove Narcissistic, as well as some other specific personality disorder diagnoses, in favor of this concept of Personaltiy Traits in the next edition of the official textbook of psychiatric diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (otherwise known as DSM-V).

This change is to reflect the concept that Personality vulnerabilites are not always so clear cut, that people can have a mixture of personality strengths and vulnerabilities, and that people can vary to the degree they are somewhat narcissistic, overly dramatic, or dependent. However, this proposed change is not without controversy, with many feeling that the new criteria are unweildy, impractical, and will result in a loss of clinically useful and valid diagnoses.

Best Regards, Neal G. Ranen, M.D.