Compassion for People with Personality Disorders
Personality awareness should help us be more effective, not more judgmental.
Posted Sep 22, 2018
In this blog series and in my books, my goal is to inform people about five types of personalities that can be difficult and sometimes dangerous to deal with. My hope is that by providing personality awareness, people will learn to communicate more effectively, protect themselves when necessary and use new ways of managing difficult relationships. The feedback I receive is that most people appreciate this information.
But some people make highly critical comments about those with personality disorders because of being in difficult relationships and sometimes dangerous situations with them. Other people feel that they are being unfairly criticized or judged, and that it’s not fair to say that some people with personality disorders are dangerous because this could create a stigma for all of them. There is also a concern that some people are publicly labeling others or being labeled. In this blog I’d like to address these concerns.
It’s Not a Choice
No one chooses to have a personality disorder, so we need to have compassion for them. Personality development is well under way by age 5 or 6, when we have little awareness or control over who we are becoming. The three main factors in personality development are: 1) Our biology (our temperament at birth, our genetic tendencies); 2) Our early childhood experiences (insecure attachments, abuse); and 3) The culture we are raised in (war zone, peaceful community, poverty, narcissistic culture, etc.). By adulthood, about 15% of the population may have a personality disorder, according to research in the United States cited in the DSM-5.1
Personality disorders are distressing to the people who have them and to the people around them. The threshold issue is that the person experiences significant internal distress and/or social impairment. In addition, they are stuck in a rigid pattern of behavior that is pervasive across many settings. Lacking flexibility and openness to feedback, they tend to alienate the people around them but don’t understand why and don’t try to change.
Personality disorders are primarily interpersonal disorders, but people don’t know that they have one and get very defensive if you suggest that they do. They believe that the causes of their problems are always external to them, such as other people or bad luck. They see themselves as helpless victims in life, often going from one self-created crisis to another, because they truly are unable to see that changing their own behavior might make their lives better. But you can’t point this out to them or they become extremely defensive and may attack you and make your life miserable for months or years to come. So you have to use other ways of dealing with them (such as those suggested in my book 5 Types of People Who Can Ruin Your Life, see below).
They Are Doubly Frustrating
For the reasons above, they are often very frustrating to be around. It can be tempting to want to yell at them or criticize them or blame them for being purposefully difficult. Yet they are usually not rationally choosing their difficult behavior, but rather responding automatically based on their personality-based patterns of behavior. Of course, this doesn’t justify their behavior, so that you may need to set limits, provide consequences, change your expectations or dis-engage from the relationship.
Not only are these behaviors frustrating to be around, but the person also refuses to try to change their behaviors as well. Similar to treating an alcoholic or addict, yelling at them doesn’t help at all. They need a program of behavior change, to learn better self-management and relationship skills. But, just as with an alcoholic or addict in denial, they don’t think they have a problem and therefore don’t seek counseling or treatment programs.
Comparable to Substance Abuse Awareness
Society and some individuals are starting to become more aware of personality disorders and how to treat some of them. In many ways, we are currently addressing this problem the way we did forty or fifty years ago with treating alcoholism and other addictions. People used to be very judgmental on one hand, and afraid to talk about it on the other. Judges ordered alcoholics to stop driving drunk and gave them a lecture, but they still did and still killed people. Ministers tried to get them to use will power and faith to turn their lives around, but they still drank and got worse. Family members didn’t talk about the “elephant in the room” or they yelled at them endlessly and families split up.
Now, most people realize that alcoholism and other addictions are substance abuse disorders and that there is treatment. Rather than judging people as having bad character traits, they realize that they have more of a medical problem in need of a structured treatment program. Ever since Betty Ford, the wife of President Gerald Ford, publically admitted in 1978 that she was an alcoholic and addicted to pain medications, society has made a tremendous shift in awareness and empathy for those with addiction problems. Of course, there are still many people who use a judgmental approach, but much less than forty years ago.
Avoid Labeling People
Now, some individuals are learning from the internet and other sources that they may have a personality disorder, especially borderline personality disorder. Yet with society having so little understanding of these disorders, when personality disorders are discussed—even in an educational way—there is a lot of understandable fear and resentment by those who realize they have such a disorder. There is an understandable concern about not wanting to be publically labeled, just as people used to label, disparage, ostracize and give up on people who were alcoholics or addicts—mostly out of frustration because they didn’t know that anything could be done for them.
Similarly, personality disorders have traditionally been seen as hopeless. Borderline personality disorder has a history of mental health professionals avoiding clients with this disorder, because of their potential for endless anger and blaming the therapist. But now, over the last 10-20 years, successful treatments are becoming established for this and other personality disorders, such as Dialectical Behavior Therapy, Schema Therapy, other cognitive-behavioral therapies and psychodynamic therapy with a well-trained therapist. So there is now hope in more and more cases.
A Private Working Theory
The solution is to talk more, not less, about personality disorders in general and their dynamics, so that the public becomes more educated. But don’t openly tell someone (or those around them) that you believe so-and-so has a personality disorder, whether in your workplace, community or extended family. Unless a person openly identifies himself or herself as having a personality disorder, others who suspect this is the case should simply have a “private working theory” about it. And don’t think in terms of trying to figure out which personality disorder someone has, because many have more than one and there’s a lot of overlap of traits. Only trained professionals should diagnose mental disorders.
Just use your Private Working Theory to adapt your own behavior, rather than trying to change them, such as: don’t try to give them insight into themselves, focus more on the future than the past, and discuss their choices and consequences, rather than trying to tell them what to do. Communicate with empathy, calm attention and respect as much as possible. You’ll have a much better result than if you vent your frustration openly (regardless of how powerful your frustration may be).
However, there may be some exceptional cases in which you think someone in a position of significant power over others has such a disorder, such as a candidate for an upper management position in a business or a politician running for office. Then, it may be best to say “I have a concern that so-and-so may have a personality problem and should not be put in a position of authority.” And even then, you can still convey compassion for the person. They just might not be the best person to be in that position, and they may not even realize that themselves.
The key with all of this is to encourage public education and discussion about personality disorders in general. But do it with compassion and avoid directly labeling any private individual in a public manner. Society needs to catch up to the reality and widespread nature of these disorders. Hopefully, someday there will be widespread treatment available when appropriate and containment when necessary—all provided with compassion. No one chooses to have a personality disorder.
1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Washington, DC: American Psychiatric Association, 2013).