Today, I offer teachings about personality disorders. As a parent, I strongly believe that talking with our teens about mental health is important, and one such area is the topic of personality disorders (PDs). Also, you might be co-parenting with a person who has some degree of a personality disorder, which can be very challenging. 

This blog was born not only as a doctor who sees many patients with personality disorders but also from my own life. My mother has a severe form of personality disorder, and this has made me have to learn a lot about how to be in a relationship with her since I was little. She has Schizotypal personality disorder. Also, my father had the disease of schizophrenia. 

The other day, I was talking with a dad who was telling me about his ex-wife, and he said, “I think she was a narcissist, but I don’t like to label people.”

The conversation prompted me to write on this topic. I do not know his wife, nor do I know if she has a narcissistic personality disorder. Still, his blanket statement about not wanting to label people made me think about the confusion people have with mental health diagnoses and, in this case, the area of personality disorders. 

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“Labels” do indeed have a negative connotation. However, understanding a person’s mental health condition is important to help decrease hardships that come with conditions. Having a label in the form of a diagnosis can be very helpful. 

There are currently ten primary personality disorders in the Mental Health Central Diagnostic manual called the DSM5. 

I have long been very interested in the area of personality disorders and have spent time teaching my children, once they were teens, about what this means and does not mean for a person to have a personality disorder. 

I wanted my children to understand my mom’s/their grandma's many challenging traits and to help them have a better understanding of her condition and help them have healthy boundaries with her, two things I believed would help nurture caring feelings toward her. 

Indeed, my two children have told me that my conversations with them have helped decrease their frustrations with her and increase their compassion. To this day they turn to me with a new struggle around having boundaries. I am always there to help, and they know my mantra: “Maintaining boundaries, with love but with consistency, is one of the hardest things we do as humans.”

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Let me share three other teachings about personality disorders that I have shared with my children and many adults over the years. 

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1. People with Personality Disorders rarely have insight into their condition.

It is a central aspect of these disorders that makes it very difficult for anyone to be in a relationship with a person who has them, whether it’s narcissistic personality disorder, borderline personality disorder, schizotypal personality disorder, or others. My mom, for example, has no insight into her condition and has never wanted to try therapy or any other treatments. When I was 13, she experienced a full-blown psychosis and was hospitalized. Even now, she attributes that episode to nerves and doesn’t believe she has any relationship issues. Her inability to see things from other people’s perspectives, along with the other traits associated with her personality disorder, further complicates her relationships.

If you are in a relationship with someone who has a personality disorder, it is crucial to get strong support, whether from a counselor or a knowledgeable friend. People with personality disorders typically lack insight into their limitations and have little to no desire to change. As a result, they often have no interest in participating in couples therapy or similar interventions.

It's important to know that people with personality disorders can have many wonderful qualities. However, being in a relationship with someone who has a personality disorder can be challenging. It requires effort, especially in setting boundaries, to ensure that the difficulties associated with the disorder don’t overshadow the positives in the relationship.

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2. Personality disorders occur when typical human traits become so extreme, inflexible, or persistent that they disrupt a person’s ability to function well in life. 

For example:

Borderline Personality Disorder (BPD) is characterized by significant difficulty in maintaining healthy relationships. Individuals with BPD tend to see people in extremes, categorizing them as either all good or all bad. For example, they might idealize one doctor while intensely disliking another. They also struggle with emotional regulation, often reacting intensely to minor triggers. A small action they perceive negatively could lead to an outburst, which is why interacting with someone with BPD can sometimes feel like walking on eggshells.

While everyone faces challenges in relationships, individuals with Borderline Personality Disorder struggle significantly more. Many people with BPD find it difficult to form lasting, close friendships.

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3. Personality disorders are biological.

These disorders have a strong biological basis; a person is born with them. Now, this is not to say that the environment does not play a part in how traits manifest, for it does, but they do not stem from environmental occurrences like a trauma during childhood. 

It is tricky to say when the signs of a personality disorder show themselves. A child growing up shows all sorts of complicated emotions and actions, and it is rare to have a child or teen diagnosed as having a personality disorder, although that can happen. Often, there is more of looking back at a childhood and seeing the signs.

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Questions to get the conversation started with your family or group:

1. Have you ever heard of the term personality disorder before?
2. Let’s review the various types and see how they involve human traits that we all share but at heightened levels.
3. Making a diagnosis for mental health conditions is a tricky endeavor. We don’t have blood tests or imaging for 99% of them. We base diagnoses on behaviors and what people tell us. Therefore, people can get diagnosed differently at different times by different providers. Have you known a person who has gotten one diagnosis by one provider and then another by another provider? 

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