Personality Disorders – Understanding the Hidden Struggle

A personality disorder often causes significant distress to those who experience it, although they tend to be unaware of the true source of their suffering. A great challenge is when others around them are hurt, sometimes unintentionally. One of the defining difficulties of a personality disorder is the conviction: “Nothing’s wrong with me.” The person feels that their life is falling apart in areas of relationships, achievements and emotions, but places the blame on others.

People with personality disorders (with the exception of antisocial personality disorder) don’t have malicious intent to hurt themselves or others. Their actions usually stem from defensiveness and deep-seated worldviews shaped by past experiences. While it’s harder to feel empathy for someone who causes harm and refuses help, when such a person sits in a therapy session and opens up about their emotional world, it becomes almost impossible not to feel compassion- even if their behaviors are misguided and damaging.

It is my sincere hope that someone reading this series of articles may recognize a pattern within themselves and seek help. A person is not at fault for having developed a personality disorder, but they are responsible for addressing and healing it.

Why Awareness Matters

Raising awareness is crucial for individuals, professionals, and for anyone building relationships. It’s important to know the signs in order to avoid unintentionally building a life with someone suffering from an untreated disorder, to protect your position or well-being in a work setting, or simply to recognize when a fellow employee, supervisor, or even client may be grappling with one. This is vital knowledge for therapists and counselors as well.

What Is a Personality Disorder?

Let’s begin with a familiar parable: A man is driving on the highway when his wife calls him, panicked: “Are you on Route 1? Be careful! The news just reported that someone’s driving the wrong way!”
To which he replies: “One person? Everyone here is going the wrong way!”

As a therapist, this story encapsulates the central challenge in treating personality disorders: the person believes they are the only sane one, and the entire world is off base. Helping someone in such a case brings immense satisfaction, but is no easy task.

The Clinical Definition

Every person has a unique personality. In some individuals, certain traits are so pronounced that they significantly impair their emotional, social, or occupational functioning. The DSM (Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association) defines a personality disorder as a consistent pattern of thoughts, feelings, and behaviors that show up in adolescence or early adulthood, that are inflexible, pervasive, and cause significant distress or impairment. This dysfunction must appear in at least two of the following four areas:

1. Ways of interpreting self and others

2. Emotional responses

3. Interpersonal functioning

4. Impulse control

The ICD-10 (International Classification of Diseases by the WHO) describes it as: “A severe disturbance in the characterological constitution and behavioral tendencies of the individual, usually involving several areas of personality and almost always associated with considerable personal and social disruption.”

In simpler terms, personality disorders involve a wide range of unhelpful thinking patterns, emotional responses, behaviors, and motivations that are persistent, rigid, and fall outside the “normal” range of human experience.

Types of Personality Disorders

The DSM identifies ten specific personality disorders, grouped into three clusters:

• Cluster A (odd/eccentric): Paranoid, Schizoid, Schizotypal

• Cluster B (dramatic/emotional): Antisocial, Borderline, Narcissistic, Histrionic

• Cluster C (anxious/fearful): Avoidant, Dependent, Obsessive-Compulsive

The DSM also includes categories for "Other Specified" and "Unspecified" personality disorders for presentations that don’t match any single type precisely but still meet general criteria.

The ICD-10 offers a slightly different classification, including additional terms including “emotionally unstable personality disorder” (borderline and impulsive types) and “anankastic personality disorder” (similar to OCPD).

Approaches to Understanding

Some frameworks treat personality disorders as categorical “illnesses,” while others see them as extreme forms of common personality traits on a spectrum. That is, we all have traits, but in some individuals, these traits become so intense that they become dysfunctional.

Several methods are used to assess personality disorders: clinical interviews (structured or unstructured), self-report questionnaires, and reports from others. The most accurate diagnoses often combine multiple methods.

In the upcoming articles, we’ll explore the major personality disorders one by one, discuss how to identify them, and offer tools for greater understanding and possible healing.

Hagai Tzadok specializes in psychotherapy and marriage counseling.