What is a personality disorder?
It seems I am asked this question at an increasing rate. People come in to discuss problems with family members whom they deem difficult, and they ask me if I think the difficult individual has a personality disorder. Since when did this term become common usage?
A personality disorder is a problem with emotions, coping skills, relationships, and behavior. Personality disorders take many forms. Individuals with personality disorders may have trouble keeping jobs, friends, or stable lives because of their tendency toward unhealthy coping. Like the range of personality itself, there is a continuum from healthy to unhealthy disposition. So, when do the moods, coping skills, relationship problems, and behaviors rise to level of “disordered?”
Some might say disordered is in the eye of the beholder. In the midst of a failing marriage, most people say their partner is cruel and selfish, cannot get along with others, or lacks the ability to communicate. Likewise, during a tumultuous period of development, parents ask if a teen or young adult exhibits signs of a disorder. Family members say, “This behavior is abnormal – out of control. There must be a name for this madness!”
A truly disordered individual has difficulty across most contexts (at work, at home, in both social and intimate relationships) and has the problems throughout adult life.
But in my experience, most of the people who ask me the question: “Does my loved on have a personality disorder?” are not, in fact, dealing with a person who has a true disorder. Most loved-ones can only accurately gauge their firsthand experience with a difficult person. We all have trouble with behavior and coping from time to time. Experts have shown that the most extreme failures of interpersonal communication happen in the closest relationships—we express ourselves poorly with the people we love most. When we are attached to someone, getting upset impacts our behavior and coping most severely.
Rather than search for diagnostic labels, family members get closer to a resolution when they search for methods – methods to resolve conflict, methods to communicate or cope with a difficult period in a relationship. Essentially, improvement comes when people work to address their own reactions to stressful encounters instead of naming the loved-one’s problem.
Personality disorders are serious mental health problems, requiring intensive, long-term psychotherapy. If working on one’s own reactions to difficult encounters is unproductive and if the unhealthy disposition crosses into most contexts, certainly seeking compassionate long-term care for a loved one is in order. But labeling with a mental disorder as a kind of blame for tough relationships is not helpful.
Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.