Friday, January 7, 2011

Personality Disorders: To End or Not To End the Reign of Terror? That is the Question. . .

Let me hear from you.

Do you have something to say on any or all of these?  Or maybe something more to share.
  • Who out there has been effected by someone. . .or many someones in their life who have personality disorders or personality disorder traits, or do you have a personality disorder yourself?
  • What is the craziest thing that ever happened to you because of personality disorder craziness?  
  • If you have been able to maintain something resembling a sense of humor, is there something funny that you recall? 
  • What questions do you have about things?  
  • And, most importantly, what have you done to survive?

I believe that of all the mental health disorders and diagnoses out there the most insidious and the most nasty are personality disorders.  Countless numbers of people out there have never been formally diagnosed, but there are legions of us who are still effected by these people with "traits."  You know the people, the ones who keep the pot stirred and leave a nasty taste in your mouth.  The people you dread being around and who you attempt to avoid entirely whenever possible.  The people who seem to suck the very life out of a room and color the world black with their negative energy.  These are people who create conflict and chaos and then are in crisis because they have been 'victimized'.  Or at least that is their story, and they are sticking to it.  And if you know what is good for you then you had better stick to it too because anyone who has had to deal with one of these people knows that World War III is not far behind any confrontation of this person's craziness.  And so, unfortunately, many people end up enabling and perpetuating the very nasty thought patterns and behaviors that need to be extinguished.

Why?  Why, you ask, would someone do ANYTHING that would allow these people to continue on with their crazy-making?  The answers are varied, but while it may be easier to just avoid the craziness of acquaintances and distant relatives and appreciate the built-in respite from co-workers when you leave the office each day, when the crazy person or people are your spouses/significant others, parents, children, or other family members with whom you are forced to frequently and more intensively interact then the situation becomes more complicated.  And overwhelming.  Some people allow these toxic persons to continue their reign of terror because they are immobilized by fear, exhausted, confused, panicked, or lazy, or they may have developed a self-protective sort of apathy.  Some people are either unable or unwilling to establish boundaries and set limits with these persons who poison everything in their paths.  Perhaps, similarly to the cycle of abuse and violence where the abuser acts out, expresses remorse, then promises change, and since no one is always 'evil' or always 'good', during those times that small windows of relief open up we are so busy catching our breaths that we can't mobilize into action.  Whatever the reason, at some point we all feel as though we cannot go on one more minute, but on we go.

Perhaps that is when we become sad, or perhaps that is when we get angry.  Sad as we grieve the loss of healthy relationships as they could have been or 'should' have been, and angry at this villain who would have us remain prisoner of our guilt for being mad at someone with a mental health disorder.  It is not seen as politically correct to 'blame the victim', and on some level most of us can rationally wrap our heads around the idea that the person with the disorder is a victim, but as the people with these personality disorders go crashing through our lives we are the ones standing. . .or sitting. . .or laying in the devastation while they dance off to create more chaos.  Sometimes with no insight but oftentimes knowing perfectly well what they are doing  they shout their innocence and demand retribution for their own victimization.  And what is too often lost in the effort to empathize with these 'victims' is the sight of the countless other victims left in their wake.

For myself, I know that while it has always seemed uncomfortable to me I have very different feelings and interactions when it comes to people in my personal life who have personality disorders versus my clients who have personality disorders.  While I can empathize with my clients with personality disorders, and I have even liked some of them quite a lot, I have almost no tolerance for people in my personal life who infect my space with their personality disorder traits.  Cognitively, I remind myself of all the things I 'know', but emotionally, I can't stand the distorted thinking and the crappy behaviors.  I don't feel especially therapeutic, and I want to scream, "Go get a therapist!"

When I was in graduate school a guest speaker in one of my classes was a private practice psychotherapist who specialized in working with people who had personality disorder traits and/or diagnoses.  Little did I know at that time that just a few years later I would find myself in a situation where I was receiving numerous referrals and requests from colleagues and other professionals to transfer clients to me because I had gotten as reputation for doing good work with clients with these specific challenges.  At the time I was listening to this speaker I found her to have some head-shaking interesting stories, but the relevance was lost on me since my focus was a tract in children and families and school social work.  I had no idea that in less than a year I would be beginning an 18 year career as a psychotherapist.

Of all the things she must have said that day I remember only one thing.  It stayed with me into my first job when I had one of those "A ha!" moments that quickly become an "Oh no!"  The adage that the ones who are hardest to love need it the most  was embodied for me on one particular day as I paced back and forth between my office and the front desk every few minutes wondering if she was going to show up late again and quietly hoping the phone would ring in the next minute with her leaving a message canceling until next week.  She was a young woman in her early 20s with a lot of issues she wanted to address (i.e. Me to 'fix'.).  To say that her appointments were draining was an understatement.  If she arrived at all she would typically show up for her appointments 30 to 45 minutes late.  Then she would make herself comfortable on the couch in my office and look as though she was settling in for a long winter's nap.  Okay, not a nap because a nap would have meant that I could relax a bit and be a little less vigilant about what she was going to say next.  And to be more clear, with people with personality disorder traits it is oftentimes not what they say but how they say it.  The actual crisis or events occurring in their day to day lives may indeed be distressing to even the most ordinary individual, but the subjective experience of people with personality disorders takes things to a different level.

To say she irritated me or to admit out loud that I just didn't like her seemed like a betrayal to all clients I had ever seen, would ever see, and most importantly to myself.  That just wasn't who I am.  I felt that if I didn't like her I was a complete failure as a therapist because what warm, caring, "good" therapist would not like another human being???  Isn't that somewhere in our professional code of ethics?  It certainly felt as thought it should be.  I felt guilty for even having the thought that I didn't like her and hoping on a weekly basis that she would either call to cancel her appointment or just not show up at all.  I knew that 'no-shows' were a "very bad thing" for community mental health centers who depended on keeping their sessions filled, so I heaped another helping onto what was slowly becoming a small hill of guilt.  But I couldn't deny the relief that would wash over me when I realized that I was free from our appointment together for one glorious week.  I mean how many times could one moderately sane counselor explain to a client that it was really a bit difficult to do any work in a 15 minute session?  And how many more times would I find myself pushing back the rest of my appointments for the day because as she slowly put her hand upon the doorknob to leave she glanced back over her shoulder and dropped some dangerous bomb out of her mouth.

I don't remember how long it took me to come to my "Ah ha!. . .OH NO!" moment, but it couldn't have been much longer than a few weeks because of the way our diagnosing system worked in that mental health center.  A few veeeerrrrrry long weeks.  And then it came.  I realized that I had the piece to this puzzle in my memory all along!  Yes!  This was exactly how she described it!  I recalled that guest speaker from my class somehow managing to look serious but yet slightly amused and telling us that a significant diagnostic indicator (not in any books, mind you. . .) for a person with a personality disorder was when you found yourself hoping the hell he or she would not show up for your appointment, and if that didn't happen then counting the seconds until your session was over.  Something else about that client exhausting you until you felt as though you wanted to crawl into a cave and hibernate until the next spring.  Or maybe the one after.  Check, check. . .and after a quick confirmation from the trusty diagnostic manual, yep.  There we have it.

I would say that this young lady was my baptism by fire into the realm of interacting with people with personality disorders.  And during our time together I developed a fondness for her, and she was able to make some amazing positive changes.  Within the next couple of years more and more clients with personality disorders kept being directed my way labeled as "difficult to treat" or "unsuccessful" with other counselors.  These clients seemed to be able establish relationships with me that helped them make improvements, and my personality seemed to lend itself to a good skill set and good practice that helped reign in the craziness of characterological, or what most people call personality, disorders.  Some of them you may have heard before:  Paranoid Personality Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, and Dependent Personality Disorder.  Then there are the less familiar Schizoid Personality Disorder, Schizotypal Disorder, Avoidant Personality Disorder, Obsessive-Compulsive Personality Disorder (not to be confused with Obsessive-Compulsive Disorder), and the most nasty diagnosis of them all, Personality Disorder Not Otherwise Specified, which includes both situations where someone may have mixed traits of several different personality disorders without meeting the criteria for one specific diagnosis AND/OR situations where someone meets the criteria for a personality disorder but the diagnosis is not included in the current diagnostic classifications - such as Passive-Aggressive Personality Disorder or Depressive Personality Disorder.

I will be talking in more detail about some of the specific disorders later, but now I am looking forward to what you have to say.  Please feel free to leave your comments here, email me at


  1. A very insightful and honest blog post. My guess is that your tardy client had BPD and ones you found charming had NPD.

    I write books on BPD (Stop Walking on Eggshells and the Essential Family Guide to Borderline Personality Disorder) and I certainly see the chaos that PD's cause.

    What we need is an awareness campaign, especially on BPD and NPD. The American Psychiatric Association needs to keep NPD in the DSM-5; right now it plans to merge it into antisocial/psychopaths and anyone who knows anything knows these two are very different.

    Thanks for the great post.

    Randi Kreger

  2. Randi,
    Thank you so much for sharing your time by reading and commenting on my discussion of personality disorders. Of course I know you and your work! I highly recommend your books to anyone who isn't familiar with them but has a personal experience with BPD or to those who may be on the fringe of these experiences.

    Good call on the tardy client, and sign me up for that awareness campaign. I agree wholeheartedly.

    Thank you again for your complimentary and thoughtful comments.


  3. Hey Kristie - I've been reading some of your posts. The personality disorder topics are of special interest to me as it is something I have been thinking alot about as of lately. My question(s) is this - Can personality disorder traits be learned behaviour?

  4. Hi,
    The simple answer to your question is, "Yes." That is to say that personality disorder traits can be learned behaviors. The qualifier is that the question about whether or not personality disorders are environmentally influenced or behaviorally learned and/or have a genetic link has been a hot topic among professionals for quite some time.

    While many professionals have their own paradigm for practice, and in the past it was not uncommon for their to be clear sides with contingencies of professional asserting that personality disorders were solely a product of 'learned behaviors' or that personality disorders were solely a result of genetic inheritance, researchers have continued to slog away at trying to determine whether or not a genetic or psychobiologic factor is at play in personality disorders. What some research has been seeming to find is that specific traits within disorders such as impulsivity and aggression may, indeed, have a genetic link. Additionally, some of the personality disorders such as Antisocial Personality Disorder look to have a psychobiolic predisposition while others such as Dependent Personality Disorder may not.

    As with any behaviors and many health and mental health issues, a unique combination of genetic predisposition and environmental factors seem to be the most likely to generally effect personality disorders. Genetics don't work in a vacuum. Certainly, some people who have a genetic predisposition never develop any pathological symptoms, and some people who have a supportive and positive environment may exhibit significant personality disorder traits.

    Finally, in discussing "learned behaviour", the pervasive maladaptive coping skills or traits that persons with personality disorders exhibit can be learned through modeling or direct observation (such as the case in having a parent or other significant person in their lives with personality disorder traits) and/or through intentional or unintentional reinforcement.

    Thank you for your question and your time to read my post. I would love to hear if you have any other thoughts or questions.