Published on March 17, 2022

Personality Disorder

Watering Can and Flowers

Everyone has had experiences with people who have a hard time getting along with others. People who have persistent difficulty getting along with others may have a personality disorder. These are people who have had a pattern of difficulties throughout their life based on factors from very early in life, even before birth.

The Diagnostic and Statistical Manual of Mental Disorders defines personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” (p 645)

When a person is born, it is like their parents are planting a garden. This could be thought of as a personality garden, the material that will eventually grow into a person’s personality. The genetic material they give their child is the seed that is planted in the garden. Sometimes a part of their garden may have some bad seed that doesn’t take root very well.

It is the parents' or caregivers' job to cultivate, water and fertilize the garden of the personality during a person’s childhood, especially during the early years when the seed is first taking root. Sometimes parts of the garden get neglected. The parents or caregivers don’t water parts of the garden equally. Or perhaps the parents don’t have adequate resources for watering the garden.

When a part of the garden with bad seed is not watered or cultivated adequately that part of the personality garden doesn’t grow well. While the rest of the garden is growing and maturing this section remains empty or underdeveloped. The first seven years of life, and the first three years especially, are vitally important in the development of the personality. If this neglect continues throughout this time the personality will be left with an empty spot that is very difficult to recover.

When a person reaches adulthood having a section of the personality garden underdeveloped, the person experiences an emptiness within themselves. They are then motivated to get this emptiness filled. This is experienced as an emotional or psychological need. Depending on where the bad seed and neglect happened within the personality garden the need will differ. This is the essence of a personality disorder.

People with personality disorders are not behaving badly on purpose, or consciously, most of the time. They are simply motivated by this internal need. Those working with these people may be able to figure out what the need is and learn to manage their behavior to have a successful interactions.

Our current diagnostic system has 10 personality disorders, some of which are more common. Research suggests that approximately 15 percent of U.S. adults have a personality disorder. The two that seem to be most widely noticed, because of their particular pattern of behavior, are borderline and narcissistic.

When we think about the parts of the garden that have been affected in these we can better understand the needs that motivate them. The borderline personality appears to be motivated by the need to be nurtured or feel special. Their behavior pattern works towards helping them be treated special by other people. The narcissistic personality appears to be motivated by the need to be the best. Their behavior pattern works towards helping them be perceived as the best at whatever endeavor they are involved in at the time. Of course, this is a simplification of these complex personalities, and there is a wide variety within each of these diagnoses. But understanding this very basic element of the personality can help others interact with these people more successfully. This is a way to interact that recognizes their needs and uses this knowledge to interact peacefully. It does not change the person.

There is another way of thinking about the interactions of those with personality disorders that is a more general approach, one that lays out a good model for healthy interaction in any situation. This can be called the triangle game. Because those with personality disorders are coping with a sense of emptiness they often are uncertain of who they are or how they should handle situations. Therefore, they use interactions styles that allow them to feel like they know who they are within a given situation by playing a particular role.

There are three basic roles they play, which interact with each other in a way that forms what can be thought of as a triangle. These roles are the persecutor, the victim and the rescuer. The persecutor is the one that knows who they are because they are the ones in charge of the situation. The victim is the one who knows who they are because they are the one always being hurt or exploited. The rescuer finds identity in fixing the problem. It is easy to see how these interact; the persecutor needs a victim, the victim needs a persecutor to blame and rescuer to save, the rescuer needs a victim to save.

People can play different roles depending on the situation, and often people will change to meet their immediate needs. One good example is the domestic violence cycle, where the abuser can move from the persecutor to the rescuer very quickly when they feel they are about to lose their victim. They will work to keep people playing this game because their sense of identity and wholeness depends on it. They will also quickly become the victim if their victim stands up for themselves and is seen a persecutor.

Not everyone who plays this game has a personality disorder. Often a person with personality disorder will pull others into the complimentary roles in the process of finding their identity. Those pulled into the game will almost always be unhappy eventually. One simple way of thinking about changing this interaction to be more healthy is to refuse to play any of these roles: refusing to play the victim, blaming the other person, refusing to play the persecutor by being in charge of others or refusing to play the rescuer by fixing a problem that other person should take care of themselves.

Learning to not play these games can take some work. Recognizing the game in others, and in oneself, and learning alternative approaches can be very difficult and may require some professional help. Those with personality disorder can make changes in their behavior, but it is a long process that requires consistent desire for change, which begins with acknowledging the need for change, which is difficult for those with personality disorder because self-evaluation is often limited by the disorder itself.

It is often people with a tendency to be passive who find themselves in relationships with someone with a personality disorder. They may want to work on making the relationship more healthy, or they may desire to leave the relationship. Either will likely be difficult and may require assistance. Outpatient psychotherapy can be a vital part of this change. Medication does not have any effect on personality disorders, though it may help other symptoms a person may have concurrently.

For those who need more intense treatment for mental health conditions, MyMichigan Health provides an intensive outpatient program called Psychiatric Partial Hospitalization Program at MyMichigan Medical Center Alma. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MyMichigan’s comprehensive behavioral health programs may visit www.mymichigan.org/mentalhealth.