Ep. 178- Does getting diagnosed with a "personality disorder" mean you're a bad person?
This episode explains what it means to be diagnosed with a "personality disorder," including how psychologists understand what personality is, when it's pathological, and how clinicians diagnose it.
Is "borderline personality disorder" or "narcissistic personality disorder" a fancy term for "toxic"? In this episode, Dr. Kibby dives deeper into the nuanced way psychologists understand personality pathology. She gives an overview of the history of personality disorders and their diagnostic criteria, peeling back the stigma to reveal what’s really happening when someone gets diagnosed. She talks about why these conditions are about persistent, pervasive patterns that impact daily life, not character flaws or moral failures. In this episode, you'll hear:
How clinicians differentiate between personality disorders and other mental health issues
The evolution from categorical to dimensional models in modern diagnostics like the DSM-5
The key features that make these patterns impairing and how they develop over time
Why some people develop personality disorders
Why flexibility and adaptation are crucial for change
Personality disorders are not about being a bad person who can't change- they’re about understanding how complex patterns shape us and learning how to rewire them.
Resources:
If you're close to someone with a personality disorder and need support, book a free call with Dr. Kibby to learn more about KulaMind
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Dr. Kibby McMahon (00:00)
Hey, little helpers. Today I'm gonna talk about what does it actually mean when someone gets a diagnosis of a personality disorder. ⁓ Through talking to a lot of you in different ways on social media and talking to different people who are not psychologists about personality disorders like borderline personality disorder, narcissistic personality disorder, I'm actually gonna do ⁓ an episode on avoidant.
avoidant personality disorder soon. We did one many years ago, but I want to do an updated one. talking to all these different people about personality disorders, I'm realizing just how scared people are of a personality disorder. And it makes total sense. just, I'm so blind by my immense, immense privilege to train in places that
really understand and love personality disorders and the people who are diagnosed with them, right? Like for me, a personality disorder is like, oh yeah, no big deal, right? It's something that I get. like, oh, I know what that means. And I feel a sense of relief when I hear it. But for many other people, it's a sense of dread, of shame, of anger. Like how dare you give me that kind of diagnosis?
So I wanted to talk about what does it actually mean when someone gets a personality disorder diagnosis from a psychologist or psychiatrist. So I'll talk a little bit about what is personality and how psychologists see this and how does it fit into mental health. ⁓ How do psychologists diagnose when someone has a personality disorder? Like, how is it different than any other disorder?
And I also, I delved a little bit into the history of it. So I'll talk a little bit about how, you know, how that personality disorder diagnosis has evolved up to the point where now we have ⁓ in the DSM-5, there's a whole new section for a different way to think about personality disorders. And so I delved into that a little bit more.
because I haven't done, you know, what we diagnosed in the way that we're used to. And I'm like, wow, like, look at this new way. Why don't I adopt this more? like how are psychologists thinking about it now? So I'm kind of just going to give a big overview about like, what is a personality disorder? And I'm talking about, let's say you're in a situation where you have a really hard time with your emotions. You...
burst out in anger, maybe you hurt yourself, you feel lonely, you feel scared of abandonment, you have really strong dissociative symptoms, right, when you're really upset, and then you go to a therapist or a doctor and they say you have borderline personality disorder. Or if you are...
married to someone or have another close loved one who is going through all those symptoms and you're like, wow, you know, I don't think this is just depression. I don't think this is just anger issues. There's something that feels more extreme or harder to treat. It's like they're not doing well in therapy. This is not going well. I think they have a personality disorder, right? What does that actually mean? And
I've been made more aware of how scary it is ⁓ for people to get that diagnosis because, know, I've just been posting on Dr. Kibby Instagram. Just, you know, in my mind, I was like, I'm going to make this the most boring, neutral content. I'm going to just read out, like do a skit where I'm like reading out my diagnostic interview manual and I'm going to act out a really stereotypical, almost like comical, like
caricature of what would be like someone with narcissistic personality disorder, right? So I was just like, I'm just gonna, you know, it's not even like I'm creating something. I'm just like kind of showing how we diagnose that and wow, you know, people are furious. People are like, you know, even just narcissists. If I talk about narcissist or narcissism, everyone just thinks of, I'm what you guys think, but everyone just thinks this is a bad person.
A narcissist is someone who abuses someone else, who takes advantage, who doesn't care, and who's just evil and manipulative. Right? Yes, all of those traits tend to go with narcissistic personality disorder. But not always. Not always. But we automatically have this bias. We have this stigma, like, ⁓ personality disorder means that you're a bad person. The interesting thing I've seen with borderline personality disorder
I have been living in the dialectical behavior therapy world for too long, right? Where we talk about BPD all the time. ⁓ And it's almost kind of exciting when we are able to diagnose someone with that. Because it's like, you thought you had five different disorders. You thought you like trauma.
symptoms and substance use and self-harm. You thought you had all these different things that need to be treated with eight different doctors, but actually it's just one thing. You struggle with your emotions. You struggle with managing your intense emotions and that caused problems with your relationships, that makes you do impulsive things to try to feel better. Now we get it, right? It's this one root cause instead of 10 million trees. ⁓ But I'm learning that
There's, maybe it's new, maybe it always is the case, but there's a lot of pushback against getting the diagnosis. Any content I put out about like, here are the diagnostic criteria for BPD. People go, how dare you say that I have this horrible stigma, this horrible stigmatized diagnosis. Like I have trouble in my relationships and how dare you say that, you know, suggest that I have BPD.
And I'm like, first all, you can't diagnose yourself on anything like a podcast or internet. can't, no one could do a diagnostic assessment over an Instagram reel. Okay. But I was like, whoa, you know, people really don't like getting this diagnosis, understandably, because personality disorder sounds like you are naturally a bad person and you will never change. Right? It sounds like you as a character, ⁓
you know, you're just like who you are in your essence and your soul is bad and unlovable or broken or a disorder, right? ⁓ And I'm noticing that a lot of people with the kind of symptoms that or the traits that go with BPD like intense anger, dissociation, right? Like ⁓ intense reactions to, you know, abandonment and things like that.
people who are experiencing those symptoms, they are going, no, I have complex PTSD.
But talking to a lot of their loved ones, family members, friends, partners of people who have those symptoms, they go, I think they have borderline personality disorder, but they have not been officially diagnosed. So almost BPD is like looking from the outside in and someone who has it looking from the inside out or saying, want to be known that I'm, I wanted to be known that I'm acting this way because of my trauma.
And it's in the diagnosis, complex PTSD, post-traumatic stress disorder. But everyone else is saying, ⁓ borderline personality disorder. So I'm seeing that difference there about how terrified we are to actually get a borderline personality diagnosis. And I would say that if you know someone in your life who you think has BPD or another personality disorder, it's not a great idea to walk up to them and say, hey, I think you have
borderline personality disorder. So already there, it's just a personality disorder super stigmatized. But let me tell you a little bit about what it actually means with personality disorder. And I'll say upfront, I don't love the term personality disorder. I hope it does change. ⁓ But this is how we think about that. We don't think about it as like this person is doomed and a terrible person and evil. ⁓ We think about something different.
Look at
So the whole field of personality research is really interesting. As you are probably used to, when people think of personality, they think of like categories. They think of profiles, right? Characters. The popular, you know, Buzzfeed and what is it? The Myers-Briggs quiz about personality is like, what box do you fit in? Are you an E, an F, J, whatever? I don't even know.
But what is your tribe? Who are you? Is the idea that you as a character can be categorized in something. And so that's one way to think about personality. But research over time has shown that that doesn't really hold up as well as seeing personality traits. So what that means is it's not like you is X. You are in this category. It's more like you are a combination.
of different patterns of behaving, thinking, reacting to feelings, relating to other people, right? You have a, you have different patterns of behavior and a personality. And I think that Walter Mischel, one of my old professors was one of the pioneers of this area ⁓ where he was like, you know what? Personality is environment.
and your tendencies and your patterns. So if I'm an extrovert, right, and that's my personality, that's a personality trait that I have, that might mean that in most situations, most social situations that I'll go into, I am more likely to go up and socialize with the person I see in there, right? But of course, sometimes the situations matter, right? If it's a situation where I walk in and it's like,
that people don't like me, I don't fit in, I'm not gonna be as extroverted, right? So that trait is expressed differently in different situations. So it's like a nurture, nature nurture kind of idea. But this idea that there's some personality traits that are really strong that like a super extrovert will be social in every situation possible, right? But there's also situations that are really impactful.
even if you're an extrovert or introvert, there's some social situations like, I don't know, getting up on stage in front of a critical audience. You know, someone's not going to be, whether you're going be extroverted or not. you know, the situation will kind of determine what behavior you're going to engage in, like how social you're going to be. Right? So thinking about it that way, it's like these longstanding patterns, right? What are you most more likely to
How are you more likely to act? Now, there has been research showing that, you know, we have certain tendencies even when we're little, and then we become more stable, and then we change a lot, we, you know, experiment, the environment has its ⁓ effect, and it's more stable by adulthood. Now, this doesn't mean these patterns can't change, right? I am sure that a lot of you listening, me too, like...
I may have been introverted or shy as a kid. And then when you got older, more extroverted, right? These are long-standing patterns. I've probably been more extroverted in the past few years than not. now that's my personality or my personality trait, right? It's these long-standing patterns across different situations and across time, right? So it can change. It's just behavior.
And it's predicting behavior, which is something that human beings love to do about each other. If I walk into a room and I see someone, I'm like, is that person going to come up and say hi or not? Are they going to be mean or not? Predicting their behavior and what they're likely to do is something that we want to know. That's why we love the idea of categorizing personality, like who are you? What are you going to do? Predicting other people's behavior. So.
One second, I'm looking at notes.
And so if personality is just stable patterns in behaving, thinking, feeling, you know, reacting to other people the way you see yourself, right? What is a personality disorder? Why did we say that there are some bad personalities and some good personalities?
we experts see it, see personality disorders in this way. That if someone has a pattern of behaving, like thinking, reacting to emotions, relating to others, seeing themselves, ⁓ that is
long-standing, so persistent, meaning it's been there for a long time, most of their adult life, or pervasive. Sorry, let me do that whole part over again. a psych, sorry.
So we would say that personality disorders are patterns of behavior that are persistent, pervasive, and impairing. So what that means is if someone's cluster of personality traits are persistent or present for a long period of time, right?
Most of the diagnosis is ⁓ of a personality disorder has to be like adulthood and up. Of course, you see personality earlier, but for some reason, we don't officially diagnose ⁓ teenagers with a personality disorder. So have they been for most of their adult life and most of their life this way? Have they behaved this way? Has it? So that's persistent. Pervasive is across different situations. Right. So as we talked about, ⁓
you know, it's a personality trait is how likely are you to act this way across different situations, right? Out of nine out of 10, I'm going to be, nine out of 10 situations I'm to walk into, I'm going to be social, right? That's, you know, high extraversion. But a personality disorder is, it's got to be pervasive. It's got to be in most situations, at work, at home, with new people.
When you're happy, when you're sad, right? It's like, how are you all the time? And then impairing is really interesting. That's the interesting piece that makes context really important. Does this personality trait get in the, or cluster personality traits, get in the way of the person's life, the way they want to live it? So what that means is taking into account their social environment.
their culture and what makes them happy, so to speak. What is in line with their values? For example, someone who is attention seeking, who's really good at drawing attention to themselves, very dramatic, very showy, very flirtatious, seductive. ⁓ If they are an actress,
that is not going to cause them as much impairment, right? Because that personality, maybe she or he is like that all the time, right? You know, ever since they were born and ever, you know, in all different situations, on stage, off stage, whatever, they are, you know, they draw attention. Well, if they're a famous actress that is totally fitting, right? It's in context. It's, it actually works for them.
But the impairment is when it doesn't work, right? Let's say that person doesn't want to be an actress anymore and they want to be, you know, maybe a therapist or a librarian or something that doesn't require drawing attention to them. Then it might cause impairment because their need for attention is going to get in the way of those goals, ⁓ get in the way of that life. As you can imagine, this has
know, culture has a lot of impact on this, right? Like, aggression is a really interesting piece, right? There's personality traits around how aggressive are you gonna be? How like, you don't wanna dominate or you're gonna show anger and things like that. Well.
If you lived in Japan versus America, the same personality trait, the same amount of aggressiveness is going to be read very differently, right? It's going to cause different problems, right? There are many people who are in, who come from ⁓ cultures where anger expression is more allowed, like ⁓ some Middle Eastern cultures.
or South American cultures where, you know, people are just louder and angrier and able to show more of that frustration. And it is not seen as bad or problematic, but they're here and they are close with someone who is, I don't know, from the Midwest of America where everything is supposed to be like really, really nice and really, really polite. That's going to be a clash, right? I'm even thinking about like some people who are from
Middle Eastern who get married or are friends with people who are like Japanese or Chinese, right? That could sometimes feel like a clash because there's just different expectations around if you're close to someone, how aggressive can you be? So it's really more about how do you tend to behave all the time and how rigid is it? Like how intense is it? And does it get in the way of your life?
Right? So that's why, that's what a personality disorder means to us. And that's why it's different than another kind of mental health disorder that's more episodic. And that means like a shorter period of time. Right? So if you go through a trauma, you were assaulted or there was an accident or something like that. And after that, you have a period of year where you are exploding in anger. Right?
that is going to be seen and get a diagnosis of maybe a trauma disorder because it's like, before the trauma, the behavior was different and now they're more likely to explode in anger. Right. But if someone has been exploding in anger most of their life across different situations, right. And if there's no like real clear timeline for when that started, then it's like, ⁓ OK, it's not like a ⁓
an acute problem that ⁓ is bound to certain situation or time, it's something that they've been struggling with for a while.
So it really, and the key part that clinically that I feel ⁓ is important with a personality disorder is how rigid does it feel? Like how in your face and inflexible is this trait? And that could go with any trait. That could be any personality. So a lot of the cool recent research on what makes a
mental health disorder, what makes someone more prone to pathology versus not is flexibility, adaptability. Can you adapt to new challenges, new situations, new needs, right? Or are you stuck kind of doing the same thing even when it's not working in new situations, right? So actually people who are more flexible and adaptable
to a situation ⁓ tend to, by the research, be ⁓ less likely to have a mental health disorder. But people who have a harder time adapting are more likely to have a disorder. So an example from myself is I have a real big tendency to be hard on myself. It's a very known thing among my friends, people who love me, that I
Really like I beat myself up inside a lot ⁓ Wake up and think am I not doing more? Why didn't I do enough? ⁓ You know all the time, right and In a certain context and You know in my am I like that across now. I'm thinking I'm diagnosed myself. Okay. Have I been that persistently? Yes Yes. Yes, like most my adult life across different situations
Hmm mostly around work. I'm not as hard on myself when it comes to social. So good. Okay. I'm not so pervasive Okay, so it's a personality trait that's really dominant in work, right? So I'm like, I'm so hard on myself ⁓ And in certain situations at certain times that was not impairing I grew up in grad school that that personality trait was really helpful. I want to say like for my happiness, but just
functioning in the to get my goals, right? Like when it comes to like whether it's impairing. The more I beat myself up, the better I did. The more I thought, oh my God, I'm such a piece of shit. Like why didn't I publish more papers and why didn't I get that grant? This person's better than me. Of course they are better than me. I'm just useless, right? Actually those thoughts would sometimes often would
make me do more and will make me achieve and then I would get the reinforcement. Right? So, you know, it'd be like, yay, you did more things, right? So people liked it and I got rewarded for being so hard on myself in that chain of behaviors. Now, now it's not that helpful. It's even impairing, right? Like me, I'm doing my own thing now. ⁓ And actually me waking up with thoughts, negative thoughts about myself, my productivity.
⁓ It does get me to do stuff, it's a little bit... It's probably, you know, more holds me back. More holds me back from doing things, right? Taking risks and things like that. ⁓ So now the question about whether I have a disorder or not is can I adapt? You know, something that worked for me, a pattern of behavior that worked for me in the past is not working now. So can I change it?
Can I think differently? Can I start to treat myself differently? Can I start to adopt the thinking patterns and behavior patterns that will actually help me towards my goals of building KulaMind in this podcast and things like that, right? Which, know, in academia, you could be really self-deprecating, know, the neuroses is good, but in business and, you know, being public like this, you know, talking content and stuff like that, I got to even act like I have zero self-doubt.
And you have to be almost like narcissistic. Like have to be delusionally like self-confident, right? So my negative thoughts are not that helpful. So can I adapt is the question. And that is, I mean, this is the difference between disorder or not, but this is really what comes up when it comes to personality disorders. So for people who...
For example, you know, I was thinking about when I was younger and I was going through a lot of difficulty with my, ⁓ my family at home, right? There was a lot of chaos, emotional chaos, explosions and fights and things like that. I was really impulsive and angry. So I would get into more arguments. I would in any kind of argument, I would storm out and I would leave and I would, you know, just yell more, right? And so I was more...
angry and emotionally explosive. And I probably would get the personality disorder diagnosis. I would probably have BPD as a teenager if that was allowed to be diagnosed. But I probably looked exactly like someone with BPD. Probably had it, right? But as I grew up, as I got out of certain situations, ⁓
As I realized that that's not helpful just to get angry and storm out, I've tried to work with it. I'm still more angry or more combative or confrontational than I'd like to be, I guess sometimes, but I am not like I used to be when I was a teenager. So the idea that when you have a personality disorder, that means you're just a bad person and you can never change, it's not true. It just means that are you able to change these longstanding patterns of behavior? Not easy, right? But the...
the difference between someone who gets a diagnosis of a personality disorder or not is were they able to change? Were they able to take in feedback, take in the negative consequences of their actions and find different ways of acting? And I also, so the rigidity and inflexibility is really, you when I feel that in a patient, that's when I'm like, ooh.
Hmm, this feels a little bit more personality sort of and what that looks like is there are People who let's say
For example, the heart on yourself thing or over thinking ⁓ how much people like them or rejection or things like that, like feeling criticized and getting really anxious about that. So there are a lot of patients that I've worked with who worry about being rejected by others. It's a really common worry, obviously. But for some people, they go, yeah, I have some insight on that. They demonstrate insight.
They go, like, yeah, I really do have this tendency. I really think that everyone hates me. And I know that's not always true. just can't help but feel it. And I like to change that. I like to try to not feel that way or not think that way. People that I've worked with who have more of a personality disorder, that insight is a little bit harder to get. It's like, no, everyone hates me.
No, I am or ⁓ sometimes a lack of lack of accountability, a lack of insight can really block being able to see and try to change that behavior, right? They're like, no, it's everyone else's fault. They're all jerks. I'm I'm great. And ⁓ they're going to reject me. And that's definitely true. And I'm here in therapy to make other people ⁓
do better, not myself, right? So I don't know, I'm just Mr. Pollock, but I'm here because everyone else is a jerk, not me, I'm doing fine. ⁓ And not being able to have insight on your own behavior, take accountability. And when I say take accountability, I mean like, ⁓ I behave this way and there's a consequence, right? Like I was mean to people and then they stopped hanging out with me, right? There are certain people who have
a lack of that, a lack of that ability to say, OK, when I do something, it has an effect on the world. ⁓ That makes it harder to change. It makes that behavior more rigid because it doesn't seem to be in anyone's control but the outside world. If it's like, everyone abandons me and it's really because everyone else is terrible. I didn't do anything. I don't understand why everyone just leaves me.
that makes it more likely that person's gonna keep acting that way because they're just, you know, they put the whole control on the outside of them, right? It's something that they can do differently to change that outcome. So I feel like the rigidity, like I'm kind of keep doing this, I keep doing this, and lack of insight are really key diagnostic ⁓ signs of when someone has a personality disorder.
And the end flexibility is interesting. Most patients I will see change a lot. most patients change, right? And it's interesting to watch them change because sometimes they might come in being totally worried about what other people think of them, really socially anxious. And then when they start to change and work on it, other things emerge, right? Like trauma responses or some other kind of symptom. But there's still an evolution.
there's still a change in the way they tend to behave, the way they think or feel. ⁓ People with personality disorders, that change is really, really gradual and slow. my gosh, I remember some lovely patients I really miss who it was like for an entire year, every week we talk about.
the interaction they had with a doctor, their spouse, their kids, their boss, and ruminating over, they said this thing and it means they hate me, they hate me. And we would work on it, we'd be like, okay, is that true? And then they kind of come to like, okay, maybe it isn't true, maybe I'm just reading into that. ⁓ And then the next week we'll be right back to ground zero.
this person said this and they hate me. And I'm like, do remember what we learned where not everyone hates you? There's some evidence that actually people love you a lot. And they go, no, no, they hate me. And we would go and we would just, it would be like Groundhog Day, right? And so that was like this really big inflexibility with that personality trait. So those are what I see as a personality disorder. Not that these are bad people. Like the people that I'm describing are like,
some of the nicest people I've ever met, right? They were like, the disorders that they're too nice, right? It was just, you know? but, and it's not like that person couldn't change or, you know, people can't change. It's just slow because these are ingrained habits, right? If you're gonna tell me that I have a disorder of the way I walk and I'm gonna have to change that, it's like, this is the way I walk all the time ever since I was an adult. ⁓
You know, like you're gonna make me change the way I walk. It's like, it's gonna take a really, it's gonna take a really long time, right? It's gonna be slow incremental changes. So that is what a personality disorder is. And there's actually like a whole bunch of them. It's like, we only seem to, maybe it's just me, but we only seem to talk about cluster B, the dramatic ones, right? Borderline and narcissistic, but they are.
The DSM-3, I think in the 80s, yeah, I think in the 80s, that was the first time. The DSM-3 was the addition of the Diagnostic and Statistical Manual that said, here are the disorders, and their personality disorders, and they're different from regular disorders, other disorders, and they clustered it into three different clusters. ⁓ Cluster A is the odd or eccentric.
paranoid, schizoid, schizotypal. ⁓ I could do an episode on each one of those, so I won't go deep into that. But cluster B is dramatic and emotional, borderline, narcissistic, histrionic, and antisocial personality disorders. ⁓ That, as you can imagine, there are a lot of emotion dysregulation, unstable sense of self, impulsivity and stuff. then there's ⁓ cluster C, anxious or fearful, avoidant, dependent, obsessive-compulsive personality disorder.
Honestly, I wanna do an episode on all of this. And it's now we're like, this is really weird because...
you know, is, are there, why do we have 10 different, you know, boxes to put people in? Because we know that a lot of them overlap, right? Like traits overlap a lot, right? So the categories, the categorical diagnosis of personality disorders has been kind of questioned for really good reason. Like, does someone just have borderline personality disorder? Do they also have like histrionic traits?
Right? Or sometimes they're antisocial. Sometimes they don't have remorse for what they do. Right? So there has been more movement from a categorical diagnosis of borderline personality, sorry, disorders. Like, do you have it or not? Yes or no? To let's look at the different personality traits, the different ways of someone can behave and let's understand how much do you fall into that on a dimension?
Are you like this only sometimes and it's not that big of a deal? Or are you like this in every situation really extremely no matter what? So that shift is happening in the DSM-5 where there's a dimensional way of measuring it. So it's not like, you have borderline personality disorder or not? It's do you have some traits of borderline personality disorder? And how intense are they? How impairing?
And there's so much debate in the field, right? So if you're like, I think I have borderline personality disorder, know that, or someone you love, know that psychologists are banging their heads and being like, wait, we can't just say someone has a personality disorder or not. And someone will say, yes, we can. So even if you get the diagnosis or hear the diagnosis, it's like...
It almost like is not as helpful. What is more helpful is this dimensional model of any kind of disorder. And it's really a, what that means is instead of do you have this disorder or not, but do you have these patterns? Do you have patterns of ⁓ not paying attention to other people's feelings? Do you have patterns of exploding and anger? Do you have patterns of being really paranoid? And
How bad are they? Do they get in the way of your life? And how long have you been this way? How long have you acted that way? That's more important for treatment and understanding what's going on. So much so that in the DSM-5, they're like, OK, fine. We have these 10 disorders. ⁓ But there's a section three that proposes a new way of looking at personality disorders.
That's called the alternative DSM-5 model for our personalized disorders. what that says is, OK, let's diagnose them differently. Let's have criterion A, which is levels of personality functioning.
So the different levels of personality functioning are self-functioning, which is a combination of your identity and self-direction, meaning can you achieve goals? Can you plan? Like, can you inhibit behavior? Or are you just impulsive, right? Interpersonal functioning, which is empathy and intimacy, getting close to people, ⁓ is actually three subdomains.
comprehension and appreciation of others' experience, tolerance of different perspectives, and understanding the effects of one's own behavior on others." Ooh, I like that. That's the empathy element, right? And, ooh, I love that. I just, because I love empathy, I think it's so cool. I think it's so interesting when people aren't able to do that, aren't able to say, I have an impact on other people. They're just like, I don't know, it just seems like they act in a vacuum where it's like,
I don't know, people are just terrible and there's nothing I did wrong. And I was like, wow, that really strips away your agency. If you don't see that, what you do affects other people and vice versa. Anyway.
Sorry, just checking. All right.
So the levels of functioning is around the self and interpersonal functioning. ⁓ then it's the question of how bad is the dysfunction? How severe ⁓ is it when you can't ⁓ take accountability for the way you impact other people? So levels of functioning. then criterion B is pathological personality traits. Then they're like, OK.
How much does this get in the way of your life for yourself and your relationships? And then what personality traits do you have and how are they problematic? So what I like about this is there's a lot more adherence to evidence-based personality frameworks. So it's much more based on the five factor model of personality, which is the
is the model of personality that has the most science backing, right? It has the most research. It's the most like, you know, well-researched, right? Myers-Briggs is crap. It doesn't actually like, I don't know. There's like no research showing that, you know, any of the different categories mean anything and whatever, but the big five is really good. So the big five is describing five different traits ⁓ that the acronym is ocean.
So it's openness, which is curiosity, creativity, appreciation of beauty, like being open to new experiences. ⁓ Conscientiousness, being reliable, hardworking, punctual, being self-regulating and stuff. ⁓ Extroversion, being social. As you can imagine, social, fun, loving, shit. ⁓
Agreeableness, which is good natured, being nice to people, how much, like how kind you are really, how agreeable you are to other people. And neuroticism, that is like how much negative affectivity do you have, like how worried and nervous or neurotic you are, right? Emotional in the negative way. So those are the big five traits and they've mapped on to, well, what does that look like if,
fits a problem. So in ⁓ the alternative DSM-5 model for personality disorders, the pathological traits are negative affectivity, which is, I'm going to read this out loud. So I'm reading it directly. A disposition toward frequent and intense negative emotions. That's like neuroticism. And also, the other. ⁓
Detachment, a pattern of withdrawing from social interactions and emotional expression with pleasurable experiences restricted. Antagonism, behaviors marked by disregard of others and doing things against harmony. Disinhibition, an inclination towards immediate rewards over long-term planning, impulsive. And psychoticism, a pattern of unusual perceptions, thoughts, and behaviors, might seem to sectorate and disconnected from shared social cultural expectations.
Psychoticism is the stuff you see in schizotypal and schizoid, like people who believe that they are aliens or believe in paranormal, but in like a culturally ⁓ strange way, I guess. ⁓ So those are the different personality traits. And they combine to make the different diagnosis that we have.
So for example, when you look at our categorical disorders, like narcissistic personality disorder, right? Instead of just like you have it or you don't, the alternative model for personality disorders in the DSM-5 is like, okay, let's look at how they're functioning, right? Criterion A. They often have impairments in empathy, recognizing other people's feelings, and...
Impairments in the self like self-esteem. All right, so How bad is their dysfunction in that level right in that in that area? And then the what personality traits they have so people with narcissistic personality sort of might have a ⁓ A lot of antagonism and specifically the grandiosity one, right? They might also have the manipulativeness in antagonism so it's more of like
Which cluster of these personality traits do we have? And then how intense is it? How much does it get in the way of your life? So you could think about that a little bit more when it comes to personality disorders, because I think it's really... by the way, ⁓ all of these personality traits, there's actually a self-report questionnaire, like a little survey where you can take it and see where you fall on all those different... ⁓
personality traits that I mentioned. It's the measure is called the personality inventory for DSM-5. I will link it in the show notes so you can... I mean, I wouldn't diagnose yourself, but you could see what questions and what kind of personality traits they're asking for and they could see and, you know, for example, it's like, rate how much this applies to you. Like, I don't get as much pleasure out of things as others seem to from very false like...
really not like me to very true, very much like me. So you could, know, try it out for yourself and see what personality traits you have and how, you know, extreme they are.
I really do want to get across the idea that a personality disorder diagnosis ⁓ isn't a scar letter. It isn't a mark of shame of you are a bad person and you or your loved one is a bad person and they can never change. They can change. ⁓ it's not, you know what? I also think that like there's some people who've said online in the comments that
being diagnosed with borderline personality disorder meant to them that it's their fault. The way they're acting, way they're ⁓ hurting themselves or yelling at people or trying to avoid bandimit, it's their fault because they're a bad person. Whereas complex PTSD means that it's not their fault. It's been something that's done to them. ⁓ No, that's not...
I want to break that down where personality disorder doesn't mean like you're a bad person and everything's your fault. ⁓ Personality disorders we know are a mixture of temperament, biology, how you were born, ⁓ early environment, and developmental learning. So for example, if you have borderline, you got in diagnosis or someone's got a diagnosis of borderline personality disorder, their temperament,
was like, if they were born, they're probably more emotionally sensitive, right? My son and me like definitely have this trait, right? Like when my son is upset, everyone knows it. When he's happy, everyone knows it, right? Big emotions. But then early environment, like was that person traumatized? Was that person invalidated? Did they go through hardship like poverty, chaotic environments, war, know, oppression, racism, right? Did they, did...
Did they go through some stress that they weren't able to handle? And also, I think what's really important is the developmental learning. So.
As I mentioned, there are certain ways of behaving, personality traits, that work. So me being hard on myself works. And then I work harder. And then people are excited that I work harder. And I get reinforced. When you think about emotionality, if a kid
is really emotional and screams and screams and then gets what they want, that is part of how the environment is like, ⁓ that worked. That got what you needed, right? It was reinforced. And people with personality disorders might have a lot of that reinforcement, right? With narcissistic personality disorder, for example, being arrogant and being really fixated on social status and being the best and special, well, you can imagine how reinforced that is.
Right? Not that person's fault. It's like they were naturally good at soccer. I don't know. And then everyone's like, yay, you're the best at soccer. Oh, I love it. Oh, look at my son. He's the best at soccer. Right? There's got so much reinforcement. And then a lot of that reinforcement is like, oh, being really good at soccer is really good. I'm going to keep doing that. I'm going to tell everyone that I'm the best at soccer, you know? And then later on when...
they're not playing soccer anymore or they're with people who don't like to compete or, and the person's bragging about their soccer skills. It's like, you have to adapt, right? Like that person has just been, has learned that this coping is really effective for a long period of time across different situations. And now it's not, now it's changed. And now they have to learn something different. And do they have the ability to adapt?
That's the question about how those change. I feel like I was gonna go into more treatment about this, but I think I'll save that for another episode if you're all interested. But ⁓ right now, there's a lot of treatments. There's all the treatments that I obsessed over and fought my way into trying to learn it, which is really exciting. I looked at the list of like,
evidence-based treatments for personality disorders. And I was like, I think I was trained in all of them. So dialectical behavior therapy is the most common one and the most evidence-based one is most popular. Mentalization-based therapy, schema therapy and transference-focused psychotherapy. So DBT, mentalization-based therapy and schema therapy are all like cognitive behavioral therapies. Transference-focused psychotherapy is more a psychodynamic. And that's what I learned in my internship at.
the Personality Disorders Institute. those do help and people with personality disorders do change. So if you or someone you love have gotten the diagnosis and are just like, my God, what does this mean? It means that that person has a behavior or a set of behaviors that are persistent, pervasive and impairing, meaning
they behave that way for a long period of time in most situations and it gets in the way of the life that they want. That's really all it means. And so when someone says, I got a BPD diagnosis, I'm like, okay, that tells me that you've had a lot of these traits for a long period of time and we should just be really cognizant of that. ⁓ If they have more, you know, PTSD, then I'm like, ⁓ it...
I'm going to assume that it might look a little bit differently, most, but more that these symptoms really started after a specific event, a trauma. So as you can see, like.
At least I don't think that that means that you're good at bread from that person. It does mean something different about the treatment, right? If I get someone who will have a BPD diagnosis, I'm gonna think, okay, this person is gonna need a longer therapy than probably the stupid eight sessions you get from some benefits or insurance. They're gonna need like more intense treatment, they're gonna need more help. And we should watch out for self harm or other kind of
⁓ tendencies where, you know, we might get, ⁓ they might be unstable and they might be at harm versus like a ⁓ trauma diagnosis. ⁓ And if someone gets a BPD diagnosis, I'm to be like, let's look for DBT. Let's look for dialectical behavior therapy. If they have trauma diagnosis, like a CPTSD, I'm going to be like, they're going to, we're going to need trauma treatment and it's going to be different kind of treatment. So that's really what I...
When psychologists get the diagnosis, it's not like, this is going to be a shitty patient. But it's more like, OK, what is their biggest problem? What is impairing their life? And what is the best way to treat it? What's going to help them the most based on the research? Love to hear your thoughts. I'd love to talk to you more about it. You could always, especially on Spotify or YouTube, can put your comments in this episode. I'd love to hear what you think.
Um, but if you've enjoyed this, you could send this to a friend or anyone that you feel like would be like do with a little bit of, um, you know, deeper insight into a lot of personality disorder is. And if you can leave a five-star rating, Apple, Spotify, would be awesome. Um, I'm going to probably talk about avoidant personality disorder or maybe treatments. I'm going to delve into this. So if you guys have a request for what you want me to talk about next, please let me know.
and I'll see you next week.