In this video/post, I discuss the presuppositions that you must work through before discussing personality pathology, followed by a little taste of what you’re getting into.
How does your personality become “disordered”? (Length: 21:00)
In order to have a conversation about personality disorders and the development of them, there are two steps of topics that you need to address first, before you can get to this topic.
- Does personality exist?
- Can it be disordered?
If you ever want to talk about personality pathology with anyone, then these topics need to be addressed in this order.
1. Does Personality Exist?
The question of whether personality exists is actually a very controversial topic. If you talk to 10 different health professionals about whether personality exists, you’ll get 10 different answers.
My perspective is that, yes, it exists. Secondly, how do we define it?
The simplest way I can describe personality is like this.
If you put person 1 into environmental stimulus A, then you will get behavior X. And no matter how many times you do this, you will always get behavior X, with only a little bit of variance.
In fact, this observation/assumption that people have certain preferred behaviors forms the whole basis of psychology.
So you need to come to a loose agreement on this point before proceeding to the next step.
2. Can Personality be Disordered?
Here, we can talk about personality like it is a constitutive physical element of a person, like a liver or pancreas, all of which can have a pathology.
If there are different types of personality disorders, then they can be identified as discrete pathologies. In psychology, this is called differentiating.
The way we define these disorders is by the descriptions in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This is called diagnosing. As the name implies, the way that these criteria are created are both rationally and statistically derived.
In studies of personality, it has been widely found that people who have behavior A also have behavior B. This is called clustering, which is also described in the DSM. It should be noted that there are also individuals who don’t fit into a cluster. They appear to have pathological behaviors from many clusters, and so the pathology is not easily identifiable.
Once you can agree about whether a person displays behaviors that match a certain cluster, then you are at the point where you can begin to discuss a specific personality disorder.
Dealing with People who have Personality Pathologies is Difficult
We can imagine this as a sliding scale. On one end is the person who has the perfect personality, and on the other end is the completely mad psychopath.
A person with a perfectly developed personality might be described as always knowing how to handle any situation, no matter how ambiguous or weird it is. They have no difficulty in coping skills. They always manage other people with just the right amount of sophistication and assertiveness. Such a person does not exist. All people have some degree of personality pathology, which is another way of saying that no person has a perfectly developed personality.
We talk about personality disorders as a cluster of maladjusted behaviors that causes problems for that person and/or others. We also talk about this as being an ego syntonic behavior, which means that the person is unaware of how they are causing problems for others.
In contrast to other psychological pathologies, like Alzheimer’s, Autism, schizophrenia, etc., a personality disorder is the clinicians’ way of calling the person a supreme jerk.
Your neural pathways become less and less plastic as one grows older, so the old proverb, “You can’t teach an old dog new tricks”, is actually true.
A personality pathology is the way you are, and if the way you are is ‘broken’, then that is a trait that is not likely to change.
So this is why personality disorders are so difficult to deal with.
Can Personality Pathologies be Remedied?
The diathesis stress model is based on the fact that we don’t know the exact percentages of factors that contribute to a personality disorder, environment and genes and heritability. Personally, I estimate this to be 90% heritability and 10% environment, and science is slowly coming around to this estimation.
Richard Grannon is a big fan of Freud, and they both claim that behaviors are slowly grown, and then adamantly defended after they are engrained. The iceberg analogy applies here. There are a lot of things lurking beneath our conscious awareness, and as one grows older, their ego becomes increasingly invested in not changing those subconscious issues.
Are people with personality disorders completely incapable of comprehending and/or changing their pathology? No, probably not in most cases. But because they have built up an ego investment in these maladaptive coping skills and fortress of defenses around these traits, it is very VERY difficult to address, and it is unlikely that they will be able to change it.
Digging deep into the issues that cause a pathology are by nature very painful, so most people will instinctively resist this process. Going back to the medical model, it’s like a surgery.
The only way a person is going to change is if they run into a situation in which their maladaptive traits become extremely costly to them, and then this motivates them to change. Even then, the stuff deep down inside that is causing their pathology will probably remain, and they will simply change their social behaviors in order to find a new coping mechanism. It’s classical conditioning like Pavlov’s Dog.
One of the best treatments for this is Dialectical Behavioral Therapy, as presented by Diane R. Gehart in this video.
Shawn Smith and Richard Grannon have a lot of knowledge about the topic of personality disorders. I’d like to make a viewer interactive session with the three of us. If you are interested in learning more, I recommend you to check out their YouTube channels.