Episode #45 

Understanding Personality Disorders

What is the difference between personality quirks and a personality disorder?

Why do people have personality disorders?

If you’re in a relationship with someone with a personality disorder, what is the best way to deal with that?

In this episode, Dr Julie Osborn helps demystify personality disorders, explaining some common reasons they form, some identifying factors and what you can do if you suspect you or someone you care about may have a personality disorder.

She also discusses how cognitive behavioral therapy can give you practical tools to manage the behavior associated with various personality disorders.

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Reference Guide:

Full Episode Transcript

Hi, my name is Dr. Julie Osborn and I am a Doctor of Psychology and a licensed clinical social worker specializing in Cognitive Behavioral Therapy. I'm here to bring you the power of CBT in your life.

In this podcast, I'm going to answer some questions and share with you some practical ways to apply CBT principles so you can achieve a greater level of happiness and satisfaction in your life and relationships.

So in this episode, I'm going to take a closer look at personality disorders.

I thought this would be a really good topic because I've actually had a lot of people email me questions about personality disorders, how to deal with people with personality disorders, what is a personality disorder? Lots of different questions. So I thought today I'd use the first half just to kind of educate you on your personality disorders are I think we throw a lot of words out there that we don't really understand and just kind of to explain what each of the personalities are because there's ten of them.

And then to share with you a little bit how the CBT can help make changes. If that's something somebody is looking for regarding wanting to address a personality disorder they may be struggling with. So I think this will be really interesting to everybody and something you can share with others in your life. If you find, you know, something similar or maybe even something about yourself you have been able to put your finger on, people have maybe complained or, you know, brought up things that bother them about how you communicate with them or your behavior.

And maybe you just kind of, you know, dismissed it and didn't really pay attention. So part of it is really seen a pattern of your behavior over and over again regarding if you do have a personality disorder. So let me start by saying that we all have our own unique ways of feeling and thinking and expressing ourselves. Most of the time our uniqueness is seen simply as an individual difference or something special about each of us. In fact, this is what brings interesting variety to the people in our lives.

So it's really a positive thing. One of the healthiest things we can do is achieve a fairly objective understanding of just how we are unique or different from other people. Then we can understand how our behavior impacts other people and in just the way we act accordingly. That is, we can problem solve our way through situations when we have a good understanding of our unique personality characteristics. So we're talking about here is personality style and all of us have our own style.

So that is different than personality disorders. And I wanted to address also that, you know, CBT is cognitive behavioral therapy. The behavioral part is really important. I know I focus a lot on the cognitive part, which is your thoughts. Right. But the behavior is huge because the way that you think determines your behavior, your behavior is how people judge you based on your behavior, not what you say. Right. I judge people that way many times, too.

You can say things to me, but based on your behavior is really how I'm going to judge what kind of friends you are to me, what kind of coworker, you know, that type of thing. So the behavior part is really important. And Problem-Solving, which I just mentioned a minute ago, is also part of CBT.

I work a lot with my clients learning how to problem solve, how to make good decisions based on their thoughts. So it's all a part of the CBT as we're talking here, even though I know we're really focused on personality. Some of us, though, have personalities that very significantly from the expectations found within our culture. So this can involve patterns of how you're feeling, thinking, impulse control and interpersonal functioning that caused the stress sometimes to the person, but especially to those around the person.

So it might cause you some distress, but it really causes distress to those around you as well. So if the pattern is enduring and pervasive, that is, it persists over time and can be found across a broad range of situations, not just one that it might meet the criteria for personality disorder.

One of the features of a personality disorder is that the person may not realize how their behavior affects others, and that's why it continues over time and with a variety of different people. So a person with a personality disorder may have difficulty with problem solving, which impairs their ability to adapt to life's challenges. People with personality disorders don't feel distressed about their personality traits, but may suffer from the way others react to them. Personality disorders seem to begin fairly early in life, and unless a change is made, they may continue throughout their adulthood.

It's also important to realize that the behavior of those with personality disorders may have served a positive function at one point in the person's life. But now those behaviors are an ingrained part of the personality, or they no longer serve the person well. They actually work against the person's ability to adapt. So a lot of people ask me, you know, why do people have personality disorders? You know, most people don't, which I'll talk about the statistics in a minute.

But why is that? And the research shows some can be partly genetic predisposed and then something happens in your life. A lot of times trauma that is part of the personality sort of being created as well. So to answer that question, it can be a little bit of both. It could be just, you know, going through trauma, not just trauma, but going through trauma. They can create a personality disorder for someone or for yourself. So therapists like myself help people to address a number of problems in everyday living, such as mood and thinking disorders, anxiety, impulse control problems or addiction.

Personality disorders fall into their own category, however, meaning a personality disorders may or may not be related to these more traditional areas of treatment. So, for example, a person suffering from depression may or may not also have a personality disorder. Fortunately, there is help for people suffering from personal disorders as well as their families, work colleagues and close friends. In most cases, people who suffer from a personality disorder can learn to make changes in the behavior that causes distress.

It's not really feasible to say that therapies can cure a personality, but they can help the person learn to manage life's details and responsibilities better. So it's really more therapy than anything you can, you know, maybe take some medication, help with some of the Aligarh issues, meaning like the anxiety, depression that comes from dealing with having a personality disorder, if that's you.

But it's definitely not the first route that we go. It definitely is therapy.

So come in for help.

I can tell you, in my years of practice, which had been a long time, I've had less than a handful of people, I can say, that have come to me and said, I have this personality disorder and I need help. And I do remember having a client once who was a narcissist that said he realized if I wanted help and we only had a couple sessions, I believe it was, and I said something that triggered something. He started screaming at me, got up and walked out.

I never saw him again. So it's a really difficult thing to address for yourself. You know, it's so ingrained part of, again, your personality, who you are, that you definitely can make changes and get help. But you're going to really, really have to be open and accepting, working with a professional to really go to that uncomfortable spot, a comfortable place.

So that's just been my personal experience. So I just wanted to share that with you. Just to let you know when you're thinking about do people go for help? You know, a lot of times they don't. When it comes to stories, even if you have someone close to you say you really need help, you know, you're acting, you're a narcissist or, you know, you're too dependent or borderline maybe, you know.

But a lot of times people don't go because it's pretty scary. And again, as I was saying earlier, there was a time that maybe this worked well for the person and they may think it still works well for them.

So why would I go get help? Just because it bothers you doesn't mean it's a problem. Right?

There might be one of their thoughts, CBT, that is, they have thought it's not 100 percent true. It is still a problem because it affects the people in your life that's going to affect your relationships. So a quick word of warning is listening to my podcast today. Look at it as an educational pursuit, not as an exercise in self diagnosis or the diagnosis of anyone else. Many people, when they hear the definitions of the various personality disorders, tend to personalize them that as they see themselves or others in the definition, this can be very dispiriting experience.

All of us from time to time have experiences that are common to many people, but a few experiences hardly constitute the evidence needed for diagnosis of personality disorder. We can finally some of our own behavior or the behavior of someone else. In all of the definitions I'm going to share with you today, above all, remember that you can do harm to somebody by loosely categorizing your behavior based on a few bits of evidence and that you would not want to do.

This diagnosis is best left. To someone who's trained professionally to do that and is used only when it can help the person, so with that in mind, I'm going to share with you the 10 common personality disorders. But be careful, you know, just like with anything, when we hear things were like, oh, that's me or that's my boyfriend, that's my mother. So you really have to have a lot of evidence. It's a big deal to diagnose anybody with a personality disorder.

So sometimes people can have traits. But just keep that in mind. I just want to kind of be open and listen and see. So again, there's 10. So the first one I'm going to share is called Paranoid Personality Disorder. All right. So the paranoid personality constitutes only about one percent of the population, its long standing, often beginning in early adulthood. And people with a paranoid personality disorder tend to have a pervasive distrust of others. They attribute poor motives to other people without any real basis for their beliefs, and they feel that others are harming or exploiting them.

They become preoccupied with the issue of who can be trusted and who cannot. They read demeaning messages into the words and behavior of others, and they frequently bear grudges against others. They perceive attacks against them that are not apparent other people, and they have difficulty confiding in others for fear that information will be used against them. They also become angry quickly and are quick to counterattack. So that's a paranoid personality disorder. Again, it's it's only about one percent of the population.

The next one is called Schizoid Personality Disorder.

This is a rare disorder that constitutes less than one percent of the population, usually begins again in early adulthood and presents itself as a pervasive problem affecting virtually every aspect of the sufferers life. The person feels detached from virtually all social relationships. They should restrict your range of emotions around others. They almost always choose solitary activities, but they show pleasure in a few, if any, of these activities, and they're often indifferent to the praise or criticism they receive from others, they lack close friends or people they can open up to.

So it's really, you know, it's a sad thing to have this disorder. There can be some help, but again, it's less than one percent. Another one is called schizotypal personality disorder. So this also begins in early adulthood and is more common since about three percent of the population could be described by this diagnosis. So these are people that tend to be described as eccentric in their dress and behavior. They feel uncomfortable with close relationships. They tend to have odd beliefs and engage in what is called magical thinking.

That is, they draw conclusions without considering the logic behind their inferences. And their thinking and speech are often described as odd. They tend to be suspicious of others, and the range of emotion is limited. People with schizotypal personality disorder usually have a few close friends and they feel anxious in social situations.

Anti-social personality disorder, which we hear a lot, is not being anti-social, meaning you don't want to be around others here. People get that confused. So I want to clarify that about three percent of men and one percent of women can be described by this diagnosis. And the pattern becomes obvious during adolescence, if not before. People with antisocial personalities tend to violate the rights of others and they often have brushes with the law and failed to conform to social norms.

They may lie to others or can others for personal gain. They're impulsive and fail to plan ahead. They're manipulative towards others and often disregard their own safety or the safety of others. They're irresponsible with their work or financial obligations. And people with antisocial personality disorder get into fights and are irritable and aggressive around other people. A lack of remorse is one of the defining characteristics of this disorder.

So there are people like that out there. And I'm guessing we may you may have come across somebody like this in the past, but or in your life now what? You really need to be careful, be very destructive and again, very manipulative relationship. So the next personality disorder is called borderline personality disorder. So the borderline pattern becomes apparent, at least by early adulthood. And it's estimated about two percent of the population suffers from this disorder. The defining characteristic of this disorder is instability, mood, self-image and interpersonal relationships in the relationships, people with borderline disorders tend to either idealize others or devalue them.

And this can switch back and forth quickly. I always talk about this disorder's the kind of love or hate you, I've had some clients, mostly when I worked in the hospitals that were borderline, they either thought I was the greatest, you know, social worker ever. They hated my guts. So it was, you know, back and forth. They really suffer. It's a really difficult personality disorder to deal with and they can switch back and forth.

Like I said quickly, they were both being abandoned by and becoming intimate with others. Their behaviors impulsive and very self-destructive. And threats are common. Their moods can change abruptly from happiness to misery. Often over the course of only a few hours, they may feel empty inside and show frequent displays of temper as well as suspicious thinking. A lot of borderlines that I've worked with have self-harm behaviors, you know, cutting things like that. And they really struggle a lot of times.

My experience with borderline is that definitely issues from childhood has created these, you know, the abandonment issues wanting to be close, but being scared to be close so their moods can just be all over the place. And I've really worked more with clients that are maybe dating someone who's borderline than borderline clients. And, you know, they come a lot of times it's men that you are dating, someone with borderline, and they're just so confused. They do not know how to manage this relationship because one minute everything seems wonderful and then something happens.

They don't even know what happened or they said something or body language or thing. And the person with borderline personality, you know, just overreacts and get rageful and angry and and can get suicidal pretty quick also often. So I've had more people actually that I've been able to help them see that maybe their partner or whoever in their life is borderline.

And that's what's happening because they don't understand what's going on. And it's really, really difficult to manage.

You also hear a lot of times with borderline that they have a hard time regulating their emotions again. So that's why it's so up and down. Cognitive therapy can be definitely helpful. There's also no therapy just to share.

That's called dialectical behavioral therapy, which is the BTE. And that is a type of therapy that CBT is part of that. But it's definitely the specialty for borderline personality disorders. So that is something to be mindful of. There's also even inpatient programs, intensive outpatient programs that help people with borderline personality. So there's a lot of treatment out there. More than any other person is sort of that I know of regarding inpatient outpatient. So, again, there's a lot of hope, a lot of the treatment, again, sometimes the medication can be used for any of these disorders, but definitely with borderline.

I know that. And if it's yourself or someone else, you know, definitely take the time to seek out help in. And you don't have to suffer because there's nothing pleasant about, you know, what I described about your moods just being all over the place, wanting to be close, but being scared. And it's really hard to have good relationships. And this is going on another personality disorders, histrionic personality disorder. So about two to three percent of the population would be diagnosed with histrionic personality disorder.

There's a problem which begins to show itself by early adulthood as well. The defining characteristic of this disorder is excessive expression of emotions and attention seeking sufferers may feel uncomfortable when they're not at the center of attention. So they'll do things to become the center of attention. They'll use their physical appearance to draw attention to themselves, sometimes addressing very sexual with women. They're often theatrical and dramatic, and they're suggestible and easily influenced by others as well. They express your emotions in a rapidly shifting manner.

People with histrionic personality disorder may think that the relationships are more intimate than they really are. I've met some people with histrionic personality and I remember being in a get together once and this person, you know, was just having a good time. And all of a sudden she was like laying on the floor saying she had a headache. And it was just the whole behavior of getting attention and, you know, distracting other people, you know, give me help, give me help so it can come in many different ways.

But I just I always remember that sticks in my mind.

And, you know, it's hard to really pinpoint that unless you know what you're looking at. Right. You might be like, oh, my God, poor so-and-so has got a headache. Let's help her. But you need to you know, once you're around the person over and over and over again and you see this, it's easier to figure out maybe what's happening. So, again, do you not diagnose anybody? But it's just to give you some insight and get educated.

Another one that we all hear a lot about is narcissistic personality disorder. So this is fairly rare. Believe it or not, it affects about one percent of the population. It seems like it's more, but it first appears by early adulthood. So a loose definition of narcissism is self-love. People with this disorder have a great need for admiration from others, but with little capacity for empathy. They tend to be grandiose in their fantasy world and superior to others in their thoughts.

They're preoccupied with fantasies of unlimited success and power, and they have a sense of entitlement. That is, they feel they deserve special treatment. They believe they're special, unique. And others may describe them as arrogant. They tend to exploit others and manipulate them, and they lack empathy for the feeling of other people. They're also another trait I wanted to add is I've always noticed when I've been swung around like this is I always say they always kind of want to one up you.

So they're not really super interested in what you have to say, your experiences. And if you're sharing something that you've experienced, you've you've done, you know, they'll say, oh, I've done that also. But, you know, it was much bigger. And, you know, like they say, the grandiosity, it's always going to be a better story than yours. So that's why I say they kind of always want to update you and you kind of get lost in the relationship and, you know, you don't feel important because they're just wrapped up in themselves.

So it is not a personality. People like being around and there's not a lot of, you know, give and take. Right. Because the narcissist is just all about them feeling special and thinking they're always right about everything. Another personality disorders, avoidance. This is another rare disorder that describes less than one percent of the population. So again, it becomes apparent really hit people with this disorder are inhibited or timid. They feel inadequate but are sensitive to negative criticisms unless they are certain they will be like they tend to avoid involvement with other people.

They're preoccupied with being criticized or rejected by others, and they feel inadequate. When people are being compared or evaluated, they're reluctant to take risks for fear of being embarrassed. So that's a tough one, too. You can imagine that even though it is less than one percent, it's going to be it's you know, it's a very lonely life, just avoiding the world that you're living in and that you need to function on a daily basis. Another one is called the Pen and Personality Disorder.

So this disorder may affect less than three percent of the population and it appears also by early adulthood. So is characterized by an excessive need to be taking care of people with this disorder tend to cling to others in a show of submissive stance and their interpersonal relationships. They have a fear of separation and they require others to assume responsibility for most life activities, dependent personalities have difficulty making everyday decisions, and they have difficulty in disagreeing with others for fear of being rejected.

They're preoccupied with the fear of having to take care of themselves. They lack confidence in their own judgment, so they have difficulty in initiating projects. They will go to any lengths to get nurturance from other people. So it is less than three percent of the population. But that's someone that, again, it's both diagnosed and you want to be careful. But it's all of these traits. It's not just one thing about being dependent on somebody. It's lots of things and it affects their behaviors and really pursuing or and building any self-confidence.

Right. It's just I need to be taken care of. And what do I need to do to keep that going? The next one's a really good one to talk about, because this is obsessive compulsive personality disorder, which is not the same as obsessive compulsive disorder OCD. I have a podcast if you want to listen about that called It's Not Me, it's my OCD. But this is definitely different than that. And this disorder, which really usually shows itself in adulthood, affects one percent of the population.

So people with this diagnosis are preoccupied with being orally imperfect and they need a sense of mental and interpersonal control. They have difficulty with flexibility and openness, and they often get so involved in rules, procedures and organization that the point of the activities lost. So they're not even enjoying what they're doing because you're so wrapped up in just how it's got to be. Others may describe them as workaholics. The rigid often feel miserable and they have difficulty in throwing out things at work.

They find it difficult to delegate tasks. You know, it's just you're so wrapped and think about, you know, being so wrapped up in how everything needs to be that you're not even you're just not present and you're just not enjoying whatever you're working on. Say you're going to have a party, right. You're so wrapped up or let's say, you know, a party or say a holiday. People get very wrapped up, say, with Christmas, it's got to be just perfect.

I want the house to look perfect. I'm going to dress who's going to come the food. You're so wrapped up in the outcome and what's going on that you don't even enjoy the holiday and you feel miserable. That's where you feel misery because it's so exhausting and where's the joy? So that's something to really, you know, figure out. Again, it's less than, you know or about one percent of the population. It's not a lot. But if that's something that you've been struggling with and again, you know, let me say this, even as a clinician that, you know, most people that I meet, like I said, you know, don't come in saying I have this personality disorder I want to work on.

They come in because they're anxious, they're depressed, they're having a hard time with relationships. They don't communicate well. So that's why talking about just diagnosing it takes time. And also, you know, you got to remember when you go into therapy, based on what you tell the therapist is how they can help you, I always say I can only help you with what I know. I don't have a crystal ball. I can't read your mind a lot of times if I have family members that are involved or, you know, they're like, oh, talk to my wife or whoever, I can get so much information from other people that are with this particular person more time.

But it does take time unless they're very apparent in their own behavior with me to really be able to diagnosis. So it's a big deal. But but it is also a big deal if you do have a personality disorder because it affects your life on a daily basis and all your relationships and your ability to do things and find happiness. So it's something, again, I just wanted to share today to kind of more educate you and kind of clarify what all these are, because we all hear them being thrown out all over the place.

I think they're the ones that are most prevalent that we hear about is, you know, narcissism, borderline antisocial. Those are the ones I hear talked about most. Those are the ones you might see in movies. More so. So I as to what you know again and people, what is this? I'm not really sure. Do I have it? I have some people say, do I have heard of some people get very angry that someone has said to them, you know, you're borderline or I think you're a narcissist.

People get very offended for many different reasons and they'll come in and they don't see it then maybe because they don't want to or it just sounds so horrible. Right. So it takes a lot of work, figure all this out and then to be working with all the other symptoms that are going on, it's definitely worth your time if you're questioning this at all. So I hope just explaining all of these was really helpful to get some clarification.

So staying on track with what I just share with you, I wanted to talk about as a therapist and attempt to achieve behavioral changes with my clients. I usually really assume the absence of a personality disorder is not the first thing I look for because it is a major task to work with clients and making significant life changes without going through the hurdle of addressing a personality disorder as well. So people with personality disorders often like the feeling of distress. As I mentioned, that motivates major changes within the therapeutic setting.

However, this is where my CBT helps me. When the focus is on specific behaviors that can be changed to bring about smoother life adjustments, I can have greater success in working with people who have personality disorders. So it's not just that. I'm going to just focus on that. Let's look at the behavior in the distress that comes from it. People can recognize when they have a recurrent pattern of difficulty in their lives, and this recognition can serve as the motivator for change in therapy.

So as a therapist, I'm able to find those areas that help a client recognize the need for change. So, for example, if I was working with someone who had a dependent personality disorder, they may come to understand that they may well lose their significant relationship unless some changes occur in their need to be taken care of. While their internal needs for dependency may persist, even after therapy, changes in the prison's overt behavior can go a long way in resolving the situation.

When the outer behaviors are changed, the internal needs me then undergo adjustments in a healthier direction. And another example, someone with paranoid disorder, for example, can activate their sensitivity so that they become attuned to the needs of other people in a productive way. People with schizotypal that I spoke about earlier can transform a pattern of odd beliefs into more creative and socially approved set of responses. Those with borderline personalities can use their tendency toward rapidly shifting moods to be more spontaneous and sensible in their responses towards others.

Negative symptoms associated with these disorders can be turned into positive qualities, which can help the person in adapting to life's demands. So as a professional, I can provide a setting to address. The problems can be addressed when it seems like maybe otherwise it would not be, and a feeling of safety and trust can be built between me and my client. And this can open the door to try new behaviors with support which have seemed impossible until now. And a whole new world can wait for those who give it a try.

So being a trained therapist and working with someone, it's not so threatening if I'm like, we need to change his personality. You know, you have this personality disorder instead. There's so many things you can work with regarding the behaviors. And a lot of times which I share with my clients is that a behavior can usually be changed quicker and necessarily easier, but quicker than thoughts. So if someone's really struggling with changing their thinking or doing the homework, I'll say, let's just pick one behavior you want to change.

And then that's where I bring in the problem solving. I do an action plan, which I've talked about before, which is looking at what you want to reach your goal, you know, what's the progress, what you know are possible distractions or problems that might come and how are we going to address that? So there's tons of tools with the CBT that I work with my clients that we can work around and address the behaviors. So, again, it's not so threatening and there's a lot of hope for for those with personality disorders.

It's not it's not that you're stuck with something. You know, we can all make changes. It just might take time. And it's really important, whether it's with me or a therapist out there that you really find someone you can really trust. That is going to be one of the core things. I'm feeling safe and trustworthy to have that relationship with your therapist. You're willing to step out of your comfort zone and to try something different and not allow the Procyon disorder to run your life, because it will.

And if you're relating to anything I say today, you probably can see that for yourself.

So, as always, I hope this podcast was helpful. If I didn't address a certain question you have or any thoughts you want to share with me, I'm always looking forward to hearing from you in the emails. I just love getting them and giving me different ideas.

If you have a question, you can email me at MyCBTPodcast@gmail.com. And you can rest easy knowing I'll always keep your name confidential and never share it on the air if I share your email.

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And remember, make decisions based on what's best for you, not how you feel