The diagnosis of a personality disorder is more subjective, based on who determines what’s “normal.” Mindpath Health’s Leela R. Magavi, MD, and Julian Lagoy, MD, explain what it means to have a personality disorder and available treatment options in this article appearing in The Mighty.

Our personalities are what define us as individuals. It’s our way of thinking and feeling emotions and behaviors that make each of us different. An individual’s personality is influenced by their life situations, surroundings, and inherited characteristics.  

What do we mean by ‘personality’?

In traditional psychology, the “Big Five” theorizes that people’s personalities can be described by variations across five basic dimensions; agreeableness, conscientiousness, extraversion, openness, and neuroticism. 

Personality theories have been written within a confined context by classic psychologists, most of whom were white, straight, male, wealthy, and from democratic and industrialized countries. Western ideas about personality may not be applicable to other cultures. There isn’t a one-fits-all approach to personality theories in cultural, socioeconomic, political, religious and historical contexts. 

How should we define personality?

While some diagnoses of mental health conditions are classified based on brain biology, the diagnosis of a personality disorder is more subjective, based on who determines what’s “normal.” There is no single medical test to diagnose any personality disorder. Instead, a patient gets labeled on the sole clinical diagnosis of a mental health professional following a comprehensive psychiatric interview based on a flawed definition “normal.” 

Why do we call some mental illnesses personality disorders?

In 1952, the first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published, a handbook used by health care professionals as an authoritative guide to the diagnosis of mental disorders. The manual is revised every decade — we’re currently on the fifth version of the DSM, which was published in 2013. 

The DSM is a guideline, a diagnostic manual, and for some, may not be the most accurate psychiatric “bible” because of how it was written.  

What is borderline personality disorder?

People with borderline personality disorder (BPD) have difficulty regulating their emotions, which can lead to impulsive behaviors and difficulty in relationships. They may also experience intense bouts of anger, depression or anxiety; feelings of emptiness and fears of abandonment, and experience dissociation. 

Certain events during childhood may play a role in causing BPD, including a chronically misattuned caregiver, loss, neglect, and emotional, physical, and sexual abuse. Some people are more likely to develop BPD due to their biology or genetics, and harmful childhood experiences can further increase the risk. 

Personality disorders and trauma

Rather than being a sign of a “defective” personality, what psychologists and psychiatrists used to think of as a personality disorder is usually the result of developing in a traumatic or difficult environment. BPD is a perfect example: A child may not have the chance to learn to regulate their emotions or self-soothe, due to no fault of their own. 

“What distinguishes personality disorders from other mental disorders is that personality disorders are usually caused by a difficult upbringing and trauma in childhood whereas other mental illnesses have an organic or genetic cause (i.e. schizophrenia),” said Julian Lagoy, MD, a psychiatrist with Mindpath Health. 

Personality traits are hereditary and frequently linked to trauma or neglect from a primary caregiver. Attachment is the deep connection established between a child and their primary caregiver that affects a child’s development and their ability to express emotions and build meaningful relationships later in life. The lack of attachment early in life may be linked to BPD. 

“Individuals with personality disorders may have endured trauma early in their life or had insecure relationships with their primary caretakers; consequently, they perceive love and care differently,” said Leela R. Magavi, MD, a John Hopkins-trained psychiatrist. 

Borderline personality disorder is treatable

Contrary to what many people, including some medical professionals, believe, BPD is one of the most treatable mental illnesses. People with BPD can be treated with a combination of psychotherapy, peer and family support, and medications. 

Dialectical behavior therapy is considered the gold standard for BPD treatment. Marsha Linehan developed dialectical behavioral therapy for people with BPD because she understood that with the right tools, it can be treated effectively. In dialectical behavioral therapy, people are taught tangible skills to help manage their emotions and interpersonal relationships, and learn more helpful ways to manage their world. 

Read the full The Mighty article with sources. 

Leela Magavi, M.D.

Newport Beach, CA

Dr. Leela Magavi is a native Californian and Hopkins-trained psychiatrist committed to providing compassionate, evidence-based care to individuals of all cultural, political, religious, sexual, and socioeconomic backgrounds. She completed her adult psychiatry residency at Georgetown University Hospital, during which time she also had the invaluable experience of caring for veterans at Washington, D.C. VA. As a resident, she was awarded ... Read Full Bio »

Julian Lagoy, M.D.

San Jose, CA

Julian Lagoy, M.D. is a board-certified psychiatrist. He received his bachelor’s degree in philosophy from the University of Notre Dame and his medical degree from St. George’s University. Dr. Lagoy completed his psychiatry residency at Virginia Tech Carilion School of Medicine. Dr. Lagoy has published in multiple medical journals and has presented his research at the American Psychiatric Association National ... Read Full Bio »

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