Attitudes toward treating personality disturbances are changing, and I think the time is coming when few will think it either overly judgmental or insensitive to focus therapeutic attention on someone’s character.
During my early years of graduate training, instructors were still placing a lot emphasis on understanding personality: what it is, what shapes it, and how a person’s preferred “style” of relating to others and the world around them impacts the kinds of problems they might experience in life. By the time I first entered clinical practice, it was becoming increasingly unpopular among professionals to make character assessments of clients. That’s largely because the “medical model” of viewing the human condition had gradually come to dominate the mental health field, spurred in large measure by the emergence of managed health care plans. Subscribers to the medical model argued that it was both unproductive and insensitive to think that the kinds of problems a person might have were in any way an outgrowth of or a reflection on their character. Rather, they considered it more accurate, humane, and far less “judgmental” to view most people’s problems as the result of their situational stressors and certain biochemical “imbalances” in their system that caused them to cope with those stressors in less than optimal ways. Besides, even if character were a legitimate consideration, it would take a lot of time and money to help effect very little change in someone’s basic personality style. So, it was considered both more cost effective and therapeutically efficacious to focus on a person’s biochemistry and their coping ability as opposed to their personality. But in recent years, the trend that once discounted the role of personality in mental health problems has been reversing, and more and more professionals have come to realize the importance of taking personality factors into account when assessing a client’s difficulties and planning for their treatment.
Everyone has a distinctive personality. Over the years, we’ve tended to conceptualize the construct we call personality in some strikingly different ways. The classical notion of personality was that it was a mask or facade that the individual wears that conceals their true nature and feelings. The term actually comes from the Latin word persona, meaning “mask.” The various more commonly recognized personality types were thought to be defined primarily by the kinds of “defenses” a person learned and came to prefer in dealing with perceived threats from their environment. In more recent years, however, personality has come to be conceptualized as a dynamic interaction between one’s innate constitutional — genetic, temperamental, and biochemical — predispositions, what one has learned about and come to view the world, and the strategies one has found to work best in coping with life’s challenges. This dynamic interaction leads to the development of a unique “style” of perceiving and relating to people, places and things in one’s outer environment — a style that’s considered relatively consistent across a wide variety of situations and relatively unchanging over a person’s lifetime.
Many years of experience have taught me that there is an inextricable relationship between an individual’s preferred style of coping and the kinds of problems they might bring into a therapist’s or doctor’s office. For example, a person who tends to be relatively passive and also emotionally dependent but who has just suffered a major loss of support (e.g., a relationship breakup, family moving away,) might experience a period of significant despondency or possibly even a depression. By their nature, such a person remains vulnerable to similar episodes, even when properly medically treated, whenever they again face the issue of a loss of support. So, a professional working within a broader or “holistic” model will likely see the wisdom in helping a dependent personality acquire the coping skills and confidence levels necessary to function in a more emotionally independent manner, thereby reducing their risk of succumbing to a debilitating depression when faced again with a loss of external support.
Sometimes, an individual’s personality is not just an integral part of their problems but rather a prime source of their problems. When a person’s preferred way of perceiving and relating deviates so radically or intensely from generally accepted norms, or is so inflexible that it prevents them from functioning adaptively in the social or occupational arenas and causes significant distress to self or others, it’s possible they have a personality disturbance or even a personality disorder. And when the nature of one’s personality disturbance includes a paucity of social conscientiousness or ethics, we often speak of it as one of character. There was a time not too long ago when many clinicians ignored personality disturbances or disorders, questioned their very existence, or simply considered them untreatable and therefore not worthy of much attention. But as I assert in my first book, that has changed in recent years as more often than not problems coming to the attention of mental health professionals involve matters of character. For more on character disturbances, see:
- my book Character Disturbance [Amazon-US | Amazon-UK](?)
- my article “What is a Character Disorder?”
- my article “What is a Character Disorder? Part 2: Questions and Comments”
By nature, personality and character disturbances are difficult to treat. And they’re virtually impossible to treat effectively with methods originally designed to treat other psychological conditions, such as “neurosis.” In recent years some remarkable strides have been made in personality disorder treatment, especially within the cognitive-behavioral therapy (CBT) paradigm. Such treatments address beliefs, attitudes, and thinking patterns that predispose a person to various problematic ways of coping and relating. Most of the time, it’s necessary to employ a multifaceted approach to dealing with personality disturbances. For example, a person with borderline personality traits or who has a Borderline Personality Disorder might well need a carefully crafted medication regimen to help stabilize and regulate mood and control impulses as well as specialized therapy (e.g., Dialectical Behavioral Therapy, long-term psychoanalysis) to forge a stronger, more stable sense of self. For more on these topics, see:
- article series on the distinction between neurosis and character disturbance
- my book In Sheep’s Clothing [Amazon-US | Amazon-UK](?)
- my article “Getting the Right Kind of Help With Character Disturbance”
- my article “Borderline Personality Disorder: A Primer”
Personality and character disturbances have always been with us. For a time they were largely ignored, but that’s been changing as awareness about the interrelationship between personality and various other psychological conditions and problems continues to grow. As research has emerged suggesting personality might not be as stable and unmodifiable as previously thought and newer treatments have shown promise, attitudes toward treating personality disturbances are changing as well. I think the time is coming when few will think it either overly judgmental or insensitive to focus therapeutic attention on someone’s character. And I expect the move toward a more holistic approach to understanding the human condition will lead to great advances in our ability to ameliorate psychological dysfunction.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by Dr Greg Mulhauser, Managing Editor on .on and was last reviewed or updated by