Everyone (hopefully) has a personality. We all have our individual peccadilloes, quirks, traits and characteristics that make us unique to those who know and love us. Some of us are flexible and adaptive, by and large, in the way we relate to people. Some of us, however, have characteristic, long-held, but extraordinarily rigid and unwavering ways of thinking, feeling, behaving, and relating to others that, when they become so pervasive and inflexible as to cause persistent problems in living and interpersonal relationships constitute a “personality disorder.” Such individuals experience transient but intense, almost intolerable mood fluctuations typically in times of stress, and mostly as a reaction to what others say and do, based on their perception of how and why other people treat them the way they do. This perception can be a mix of subjective truth, painful reality and extremely distorted thinking. Many so-called “normal” and highly functioning individuals may also regress to this level of functioning during times of extreme upheaval in their lives. Their mood symptoms may include anger, irritability, depression, emotional turmoil, hostility and aggression.
Many personality disordered individuals actually come for treatment at the urging of others—friends, relatives or authorities who are alarmed by their behavior, behavior that the person either discounts or is able to ignore but nonetheless repeats to their detriment. Others come on their own seeking therapy not for their personality but more specific distress: anxiety, depression, addictions, violence, and relationship problems among others.
These individuals often get misdiagnosed with major psychiatric illnesses as prescribers try in vain to find medications that work. Unfortunately, the individual’s environment and their relationships are often not addressed. Medications alone cannot change lifelong relational patterns that are laid down in neural circuits. Nor can medications change the very real stressors people find themselves under with regards to family and or work. These people need a psychodynamically informed psychopharmacology for their specific symptoms so that they will not be overmedicated. They benefit from psychotherapy to stabilize their sense of personal wellbeing, to have their internal experience validated and understood, to differentiate distortion from reasonable cognition, so that they may better regulate their impulsive behaviors and mood swings and directly address what is going on in their interpersonal relationships. Occasionally, significant others may need to be involved in treatment.
Psychotherapy also fosters their ability to think about themselves as agents of their actions, to feel in control, in fact to know what they feel and understand better its significance. This will help them understand others better too and create more satisfying and empathic social relationships. Once people are able to reflect upon, accept, understand and reframe their inner emotional states of mind, then their symptoms, fears, fantasies and anxieties may no longer seem intolerable, but as part of the experience of being human. This way they may develop the ability to be mindful of and change, however incrementally, the way they behave, or react to their loved ones under stress. Vice versa, their family may reciprocate and also embrace constructive change. If that happens it may be the beginning of a path to a caring and more meaningful connectedness, and more fulfilling, or at the very least, less distressing and chaotic lives both for themselves and their significant others.