Personality Disorders or Problems with Character

The Diagnostic and Statistical Manual of Mental Disorders fifth Edition (DSM-V-TR) defines a personality disorder as a durable or stable pattern of feelings, thoughts, habits, beliefs, and behaviours in a given person with three defining characteristics. Firstly, they differentiate the person from their particular cultural environment. Secondly that the patterns are extensive and not amenable to change. Finally, that they lead to distress or difficulty in the given person’s capacity to participate in their lives in ways that are both personally satisfying, and that broadly facilitate helpful or satisfying relationships (American Psychiatric Association, 2022). The post to follow will unpack this definition and explore where issues with personality disorders or problems in relation to character come from.

To start, I’d like you to watch the following video. While you do, consider what you’re seeing and how it might apply to you, or to people in general.

You may have come out of that feeling a bit confused, or perhaps you’ve been able to grasp the metaphor. Either way, I’m going to spend some time talking about how an artisan shaping a beautiful metal teapot relates to your and my character, and what it means for the issue of personality problems.

What is a personality disorder?

Consider that, like the teapot which needs to be fit for purpose, we all come into adulthood with varying degrees of readiness for the demands which it places on us. While the teapot needs to be free of holes so that it can hold tea without leaking and finding itself empty. We need to be able to skillfully deal with inevitable conflicts in our relationships in ways that ensure that we keep and nurture those relationships that enhance our lives, while ending or supporting a healthy distance from those that don’t. A teapot needs a spout that can pour hot liquid without spilling it. A person needs to be able to accurately name the feelings they’re experiencing, the source of these feelings, allowing them to appropriately address these issues in ways that leave them feeling resolved or satisfied.

We’re all wonky teapots in one way or another. None of us come into adulthood perfectly fit for purpose. Like a teapot with a handle that makes it a little awkward to hold. Some of us are excessively fearful. As a result, we tend to turn down or avoid opportunities that might hugely help us. This is because we see them as dangerous. Some of us aren’t fearful enough, and so we routinely don’t see the dangers we’re confronted by. This allows us to take risks that at some point lead to reputational and/or bodily damage.

In these different examples, I’m not referring to chance or one-off experiences where a person might have failed to take action on an opportunity and now sits with the regret of having lost out on it. I’m talking about observable patterns in someone’s life, where for example, they routinely are consumed by angry and resentful feelings leading to a pattern of engaging with the people they come across with hostility, suspicion, or cynicism. It’s the person who habitually finds themselves in one unhappy relationship after the next. Or the person who often acts without considering consequences leading to difficult life circumstances and/or regret. It’s the teapots with round bottoms that struggle to stay stable.

At their core, character issues, or personality disorders refer to difficulties that people have, in varying degrees, to adaptably confront the everyday (and sometimes extraordinary) issues which we’re confronted with in adulthood. People with personality difficulties, struggle to shift between angrily (and perhaps by also displaying their hurt) confronting and unpacking a situation where their husband repeatedly behaves in selfish ways, to gently correcting their three-year-old who is having difficulties with the idea of sharing. They might as a matter of course, avoid both situations hoping they will get better on their own. They may confront both by shaming, or insulting their partner or child, hoping that if they can just elicit enough shame in this person, perhaps they’ll never behave that way again. Neither of these approaches, are likely to yield fruit.

A personality disorder refers to ongoing and predictable ways of responding to challenges, or to particular types of challenges, which are ineffective, and which cause more suffering than they ease. The goal of treatment is to flip this pattern on it’s head. To support a given person, in their efforts to adaptably, and effectively face the challenges they’re confronted by.

How do personality disorders come about?

To understand a personality disorder is broadly to understand trauma. Coming back to our teapot, we can think about trauma in two different ways. We get big or obvious traumas, such as the deformities that might come about if the artisan got frustrated and gave the teapot a big, out-of-place knock with the hammer. We could imagine here an unsightly dent, or a broken and nonfunctional handle

Psychologists refer to this sort of trauma as “Big T” trauma. These are memorable, formative events such as physical or sexual abuse or neglect, a home invasion or some other experience of crime,  experiences of natural disasters, or prematurely losing important loved ones (Thongrakyooa, Laurujisawat, & Chandarasiri, 2023). It’s easy to see how experiences such as these can have lasting effects on somebody. The little boy whose dad died when he was eight, will potentially forever have an experience of the balance of his childhood, his teen’s and twenties of absence of all of the things his father meant, and would come to mean to him.

“Small t” trauma by contrast, is equivalent to an artisan who struggles to skillfully form the lid to the teapot. So instead of a lid the fits well, you might struggle to get it in place when you’re returning it after filling the pot with water. These types of trauma are less easy to see because they can be subtle in the ways that they occur (Straussner & Calnan, 2014). An example of a “small t” is the parent or caregiver who routinely shames their child or teen as a means of discipline. Shame is a feeling that is particularly insidious because it is associated with a belief that there is something deeply wrong with the little boy, girl, or teen who is the target of the discipline. Unsurprisingly, early and ongoing experiences of shame have been associated with later difficulties with depression and anxiety (Farr, Ononaiye, & Irons, 2021).

If we took this example and imagined how events would unfold for this person. Ongoing and repeated experiences of being shamed, likely lead to internalizing of a belief that there is something wrong with me, or there is something bad about me. In addition, that “I” need to do something to be seen as okay, or to feel okay about myself. This little boy, girl, or teen is not a passive recipient to this message. For reason’s such as temperament, attachment style and others that I won’t cover in this post. They may choose to try to live up to the expectation that they don’t make mistakes, they may choose to rebel, they likely respond behaviourally so, in any one of a number of different ways that create a predictable outcome in the situation.

The outcome being that they experience conditional validation from said caregiver, or from others such as friends or members of a different sex. In addition to internalizing a belief that makes them sensitive to experiences of shame, they likely also develop a predictable way of responding to situations where they feel ashamed (with the hope of potentially finding validation). This is where the pattern of behaviour originates.

Eventually, this person comes in to adulthood. They carry with them an intrinsic sense that they are shameful in some way, and a learnt way of addressing these feelings. The challenge they face now is that adult relationships are complex. While they are certain to find others who are a lot like the caregiver who created the scar they carry, there will also be many others they are likely to come across that are benign, or even potentially able to help them to heal from these early experiences. How does our person deal with this complexity?

They likely resort to going back to what is familiar and by virtue of familiarity, less frightening. They potentially stay with people who bully or shame them. They may themselves become bullies or perpetrators of shame. They likely do what they’ve come to learn was helpful to them earlier. They try to be compliant in the hope that they’ll receive the same response they did when they were younger. Or rebelling against the humiliating other in the crude, or impulsive ways that worked previously in achieving them some sense of worth and value.

I feel it’s important for me to note here, that I’ve massively simplified an immensely complex process for the purposes of trying to illustrate how personality or characterological difficulties or vulnerabilities originate. But the jist is, that rather than being able to engage in adult experiences with the complexity of thought and behaviour that they require, our traumatized person participates in simplistically ineffective ways that result in them having repeated experiences that mirror those from their youth, or themselves becoming perpetrators who are either in unsatisfying unions, or where they are shunned by others.

So now what? We’re here, what do we do?

The short answer is to seek help. If you’ve identified or been made aware of unhelpful or distressing patterns in your life, you don’t have to struggle alone. The challenge with these sorts of issues is that they are often nowhere near as simple as the examples or formulations I’ve provided in this post. They can be dealt with, but you need a psychologist, and time to explore what’s happened to you, the various effects that it’s had on you, and the many things that might exist out of your awareness that support these ongoing unhelpful patterns or experiences in their existence.

Conclusion

To bring this post to a close:

1. Personality challenges originate from trauma, specifically “small t” trauma although “big T” traumas, especially where they’re repetitive can have the same outcome.

2. They include learnt and often well-worn and predictable behaviours combined with internalized beliefs about the self and the world.

3. These behaviours become especially non-functional in adulthood when the traumatized individual comes in to contact with people and experiences that differ from those under which the non-functional beliefs, feelings, habits, behaviour, and thoughts originally developed.

4. Familiarity, fear, and a desire for predictability support and perpetuate these non-functional ways of engaging with life.

5. These issues have been hugely simplified for the purposes of illustrating them in the current post, and it’s important to appreciate that they are generally more complicated when confronted in the real world.

6. Psychologists can help in unpacking traumatic experiences whether they belong to the big or small family of “Ts”. They can also help people who are struggling find more adaptable and healthy ways of taking part in their adult relationships and experiences.

   
   

I again have neglected to cover the biological, or genetic components to this issue. This is again, not because these issues are unimportant, but rather because my aim in my posts is to explore the psychological (and to a degree social) origins of the various challenges that we face.

References

1. American Psychiatric Association. (2022). Personality Disorders. In A. P. Association, DSM-5-TR (pp. 734-778). Washington, DC: American Psychiatric Association.

2. Farr, J., Ononaiye, M., & Irons, C. (2021). Early shaming experiences and psychological distress: The role of experiential avoidance and self-compassion. Psychology and Psychotherapy: Theory, Research and Practice, 94, 952–972.

3. Straussner, S., & Calnan, A. (2014). Trauma Through the Life Cycle: A Review of Current Literature. Clin Soc Work J, 42, 323–335. doi:10.1007/s10615-014-0496-z

4. Thongrakyooa, K., Laurujisawat, P., & Chandarasiri, P. (2023). Prevalence of small t trauma in depressed adolescent and early adulthood patient in King Chulalongkorn Memorial Hospital. Chula Med J, 67(3), ;167-174.