Personality Disorders

First, it is important to remember that personality traits and personality disorders are different. Only a mental health specialist can distinguish between them, so do not take on that role or judge those around you. Doing so can reinforce social stigma and discourage people who genuinely need psychological treatment from seeking it.

The spread of information about mental health has generally had a positive effect on public awareness. However, some people have used this information unwisely and incorrectly. Someone might tell his wife when she is angry with him, “Life between us is impossible. You have borderline personality disorder!” Or he might tell a friend who complains about mistreatment by his manager, “He is a narcissist. How can you stay in that job under his authority?” Around 10% of people in the community have personality disorders. This means that the vast majority do not have these disorders but instead have personality traits: familiar, stable patterns of feelings, thoughts and behaviors that distinguish one person from another. When these traits deviate from social and cultural expectations, cause distress and impaired relationships, and negatively affect different areas of life, they are considered a personality disorder.

A person’s personality consists of the stable, long-term ways of thinking, feeling and behaving that make that person different from others. Personality is influenced by experiences, the environment and inherited characteristics. When it deviates from cultural and social expectations, causes distress and impaired functioning and relationships, and is neither temporary nor the result of a stressful circumstance or passing illness, this is what we call a personality disorder.

Personality disorders are divided into ten types across three clusters: odd and suspicious disorders, including paranoid, schizoid and schizotypal personality disorders; dramatic and emotional disorders, including borderline, narcissistic, histrionic and antisocial personality disorders; and anxious and fearful disorders, including obsessive-compulsive, avoidant and dependent personality disorders. This classification is based on shared traits involving emotional responses, relationships with others, impulse control and behavior. Around 10% of people experience these disorders, and the rate rises steadily in clinics, hospitals and prisons.

Recognizing personality disorders is essential because of the challenges they present in treatment. Treating disorders such as depression and anxiety can be difficult in people with personality disorders because they may resist treatment and show limited commitment to the treatment plan. They are also more likely to use alcohol and drugs and engage in dangerous, impulsive behavior, such as reckless driving, rushing into relationships with violent or unsafe people, making repeated suicide attempts, and injuring or harming themselves.

These disorders are usually diagnosed by a skilled mental health specialist who examines long-term patterns of functioning, relationships and symptoms. Although signs of a personality disorder may appear at a young age, we avoid diagnosing people under 18 because their personalities are still developing. A person may also have more than one personality disorder at the same time.

Origins of personality disorders:

Like other disorders, personality disorders have multiple causes. The temperaments people are born with, their biological makeup, and being raised amid trauma and deprivation are believed to contribute to the disorder together. Genetics accounts for 70% of individual differences in human psychological traits.

The behavioral perspective:

According to behavioral theory, we develop the habits that shape personality by responding to incentives through operant learning and modeling ourselves on the people around us through observational learning. We often do what brings rewards and avoid punishment. Personality disorders may develop if a family does not provide reinforcement—rewards and limits—that suits the child’s temperament. Parents may be excessively permissive or overprotective, punish harshly, or offer love only conditionally. The result may be aggressive rebellion, withdrawal, a constant need to please, or a combination of these. A person punished for being assertive develops habits of clinging or avoidance, while someone never rewarded for showing affection or trust becomes suspicious. As adults, they may avoid healthy, socially adaptive behavior because they developed opposing expectations in childhood.

Psychoanalytic theory:

Psychoanalytic theory views personality development as the result of unconscious processes driven by impulses or instincts and complicated by conflicts between those instincts and the demands of reality. Outcomes depend greatly on family relationships during childhood. From this perspective, personality acts as a defensive shield or fortress built against internal impulses and external attacks. Defense mechanisms help us avoid consciously recognizing unacceptable impulses. They distort these impulses, prevent their expression, reduce their intensity, or allow them to be partly and indirectly satisfied. For example, we use projection, rationalization and sublimation to deal with socially forbidden love.

Defense mechanisms are necessary for survival and mental health, but severe internal disturbances or intense and persistent external pressure can disrupt them.

If personality is a collection of defenses, it can be viewed as a psychological immune system that protects us from conditions such as anxiety and depression. Symptoms appear, however, when that immune system is deficient or excessive.

Childhood trauma causes personality disorders:

Child abuse and the neglect of children’s basic needs cause personality disorders. Many children and adults who have experienced sexual and physical abuse show symptoms of personality disorders, and many people with a personality disorder also have post-traumatic stress disorder as a comorbid condition. Anyone persistently exposed to severe stress during childhood may overreact to events and circumstances that most adults overlook.

Finally, it is worth noting that few people with these disorders experience distress from them or voluntarily seek treatment, although they may occasionally attend treatment briefly because of some of their consequences. These disorders often cause those around the person to suffer to the point of “madness.” I will soon present clinical portraits of the ten types of personality disorders to help Arab readers recognize them and offer advice on how to deal with them.

Download the Tatmeen app for online psychological and family consultations from the Apple App Store or Google Play. You can also register on the Tatmeen mental health website for valuable information and practical tools to support your mental and family well-being.