Understanding Personality Disorders

Personality refers to the unique ways of thinking, feeling, and behaving that distinguish one individual from another. These traits are enduring and persist throughout the lifespan, profoundly influencing how a person relates to others, navigates home life, responds to environmental events, and manages emotional reactions. Personality development is shaped by various factors, including childhood events, family experiences, genetic influences, and inherited patterns.

While it is difficult to rigidly define what constitutes a “healthy” personality, individuals who adapt more easily to life’s events and maintain healthy relationships across social, family, and intimate spheres may be viewed as having well-adjusted personalities. Everyone experiences challenging days or areas of struggle, but a personality disorder represents a more persistent and pervasive pattern of thinking, feeling, and behaving that significantly deviates from cultural and social expectations. For a diagnosis, these patterns must cause marked distress or difficulty and persist over an extended period, typically beginning in adolescence or young adulthood, and often resulting in significant life challenges.

Types and Clusters of Personality Disorders

In contemporary discussions, narcissistic and borderline personality disorders are among the most recognized. However, there are a total of eleven personality disorders, which are organized into three clusters:

• Dramatic-Erratic (Cluster B): Includes disorders characterized by unpredictable or emotional thinking or behavior.
• Odd-Eccentric (Cluster A): Involves disorders with unusual or eccentric behaviors.
• Fearful-Anxious (Cluster C): Encompasses disorders marked by anxious or fearful thinking or behavior.

For more detailed information on these clusters, please refer to additional resources.

Seeking Accurate Diagnosis

It can be tempting to label oneself or others with titles like “narcissist,” but it is important to consult with a licensed mental health provider before reaching any conclusions. For example, someone with obsessive-compulsive disorder (OCD) might mistakenly believe they have avoidant personality disorder due to their obsessions or compulsions about social events, when in fact the type of support needed can be quite different. Accurate diagnosis ensures that appropriate and effective help is provided.

Evolution of Personality Disorder Treatment

Historically, personality disorders were viewed as fixed and unchangeable. Early psychiatric treatments ranged from vague and limited approaches such as psychoanalysis, which often proved ineffective, to more dramatic interventions like “truth serums,” hypnosis, or attempts to uncover suppressed trauma memories. These methods generally failed to produce meaningful change.

Over time, more structured therapeutic methods were developed. Cognitive Behavioral Therapy (CBT) emerged as one prominent approach, though it was not always fully effective on its own.  Many “integrated”  therapies were created, leading to a variety of outcomes change.

Dialectical Behavioral Therapy (DBT): A Game Changer

In 1993, Marsha Linehan developed Dialectical Behavioral Therapy (DBT), a treatment that combines mindfulness with CBT and other skills to enhance coping in individuals with borderline and other personality disorders. DBT skills focus on improving emotional regulation, distress tolerance, and interpersonal effectiveness. The therapy is now considered a gold standard for treating personality disorders and has demonstrated effectiveness with many other mental health conditions as well.

Linehan emphasized not only teaching skills, but also the critical role of the therapist as an “effective coach” who balances acceptance and change. Using a dialectical, or balancing of opposites, approach, the therapist builds a strong therapeutic relationship by validating the client’s current struggles while encouraging change in unhelpful behaviors. This dual focus is essential in guiding clients toward a “life worth living.”

My Professional Journey

In my early years as a clinician, I was driven by a desire to help individuals living in complex situations—those who needed support and often felt overwhelmed by strong emotions they struggled to manage. Many experienced anxiety, depression, chronic suicidality, or self-harm behaviors. Treatment frequently felt confusing, like trying to address one problem while another emerged, with no clear path forward. While I achieved some progress, I lacked a structured framework for meaningful progress. 

That changed in 2002, when I was fortunate to attend training in the relatively new therapy, DBT, led by Marsha Linehan and her team. The therapy provided a logical, structured approach that produced tangible results. This experience inspired me to pursue advanced and ongoing training in DBT, which is renowned for its effectiveness in treating conditions such as borderline personality disorder and supporting individuals in building healthier, more fulfilling lives.

The Influence of DBT Training

DBT has brought significant positive changes to my professional practice. Its fundamental principles: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness—not only offer my clients valuable strategies but also shape my overall approach as a therapist. I have directly observed how DBT instills hope and drives transformation, helping clients lead more balanced and rewarding lives. Witnessing clients regain control over their emotions brings me great satisfaction.

Personal Experience and Empathy

My personal encounters with suffering and change, in addition to formal training, have deepened my empathy and insight. Many of us, or those close to us, experience challenges with emotional regulation and relationship difficulties. Realizing that these struggles are common has strengthened my commitment to supporting others through similar situations. It is crucial to understand that personality disorders are mental health conditions, not reflections of poor character, and they deserve respect and skilled care.

Love for the Therapeutic Process

With decades of clinical experience, I find the DBT process especially rewarding due to its dynamic, collaborative, and tailored nature. Every session presents an opportunity not only for my clients to grow but for me as a clinician as well. Treating personality disorders demands patience, creativity, and perseverance. The distinct challenges these cases provide continually push me to learn, adapt, and enhance my therapeutic methods.

Conclusion

Working with personality disorders feels both meaningful and rewarding. My LCSW qualifications and DBT training have given me powerful tools, while my own life experiences have fostered deeper empathy and commitment. Most importantly, my passion for the therapeutic journey drives me to empower clients on their path toward healing, self-discovery, and lasting positive change.