Rethinking Personality Disorders

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It’s hard to consider someone’s style of relating a “disorder” if plenty of people behave in a similar fashion and if, on top of that, the style “works” for them in many ways.

Those familiar with my work know that I count myself among the mental health professionals who believe that personality and character disturbances are a much greater problem today than are problems related to debilitating neurosis. Largely gone are the days when people’s overactive and oppressive consciences and their excessive anxieties and inhibitions made them truly sick from worry and fret. Learning not to be so hard on themselves and to tend to their feelings and emotional conflicts could help those with neuroses to get better. While problems stemming from neurosis still exist to a degree, ours is a time when far too many folks neither worry enough nor put sufficient pressure on themselves to do the right thing. Many people experience psychological problems of a very different variety: much of the time, it’s their ways of seeing things and doing things that are at the root of their difficulties. It’s their “style” of relating to others and the world at large — their personality — that’s caused so many of their intimate relationship problems, their conflicts at work, and their difficulties coping. But accurately pegging a person’s personality disturbances can sometimes be just as difficult as intervening in a way that effectively mitigates them. Part of the reason for this has to do with how personality disturbances and disorders have been traditionally defined and categorized.

In recent years, some personality disorders that have enjoyed a very long and distinguished tradition have been removed from official diagnostic classification schemes. Largely, this has been due to inconsistencies among clinicians about how to properly define and classify the various disorders, as well as uncertainty about whether certain disorders actually even exist. So for some time now it appears we have needed to rethink our perspectives on personality and character disturbances and disorders.

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Mental health professionals have conceptualized personality in many ways over the years. Some have viewed personality as an individual’s set of largely innate traits or behavior predispositions. Still others — mainly those steeped in the psychodynamic tradition — have seen personality as an unconsciously constructed facade concealing and protecting the “true self,” defined in type and in large measure by a person’s “preferred” ego defenses. But in recent years, many have taken a more multidimensional approach to conceptualizing personality. Within such a framework, biological factors — such as genetics, temperament, and constitution — and environment both influence in a dynamic way the “style” a person eventually develops of perceiving and relating to, and coping with the world. Sometimes, it’s the very way a person relates — their preferred way of seeing and doing things and interacting with others — that becomes a problem in itself because of the other problems it inevitably engenders. Traditionally, therefore, a personality disorder has been defined as a style of relating that is so extreme, inflexible, or deviant from accepted cultural norms that it causes significant impairment in functioning and significant distress to a person or to others.

It’s this very definition that probably needs some rethinking in our times, especially because these days some personality “styles,” once commonly regarded as “deviant” from the norm and socially dysfunctional, are not only much more commonplace but also often accepted, “enabled,” and promoted — even rewarded. It’s hard to consider someone’s style of relating a “disorder” if plenty of people behave in a similar fashion and if, on top of that, the style “works” for them in many ways.

One of the reasons the American Psychiatric Association strongly considered removing Narcissistic Personality Disorder as an official diagnostic category in the latest edition of its Diagnostic and Statistical Manual (the official guide many professionals use to diagnose mental disorders) is because narcissism as a personality trait is actually present in several personality disturbances. Moreover, we’re increasingly coming to realize that many conditions we traditionally believed could be distinctly categorized actually exist along a continuum. We’ve recognized this most evidently with the Autistic Spectrum Disorders. And many clinicians, myself included, report that while there might be little doubt in their mind that someone’s problems are actually rooted in their habitual ways of seeing and doing things — i.e., their personality — they often find a smattering of different traits and predispositions contributing to their dysfunction, making it difficult to specifically and neatly categorize their personality disturbance. There may be little doubt in a clinician’s mind that a client has a personality disturbance, and that the disturbance lies at the root of their problems, but it might nonetheless be difficult and even inaccurate to confer a single specific label on their personality dysfunction.

Personality and character factors commonly do and likely always will play a large role in the problems people have in their lives. And for the helping professional, correctly understanding and dealing with those factors is often critical to a successful treatment outcome. But our traditional labels, diagnostic categories, and conceptualizations don’t seem to be serving us all that well anymore, especially in our age of more prevalent personality and character dysfunction. It appears it’s time for some serious rethinking of what it means to have a personality or character disorder.

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 on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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