Personality Disorders

Austin Therapy for Personality Disorders

“Your mind is like an unsafe neighborhood; don't go there alone.” ― Augusten Burroughs

Unfortunately, the term personality disorders can be a stigmatizing label, both in the mental healthy community and the culture at large. It is not my intention here to disparage certain personalities and characteristics but to provide information for those who are struggling. If there’s one thing I’ve come to know during my education, training and experience, it’s that we all have valid reasons for what we do. The work of therapy is discovering those reasons and developing the freedom to think and behave in different ways.

When we use the terms “personality disorders” or “character disorders” it refers to those individuals for whom ways of thinking, feeling and behaving have become so rigid as to form the very structure of their personality. Additionally, it also implies that they have been unable to change their habitual ways of being in the world and relating to others.

It would beyond the scope of this page to provide an exhaustive list of all personality disorders—the DSM is one resource for those who are interested. Personally, I prefer to think in terms of the personality organizations listed in Nancy McWilliams’ Psychoanalytic DiagnosisSo here, I’ll describe characteristics of a few of the more common personality presentations that bring people to therapy.

Borderline Personality

People with borderline tendencies can be passionate and vivacious but they also struggle with difficulty managing feelings and unstable relationships with others.

Borderline individuals struggle to manage their emotions due to being born with a more sensitive temperament in combination with insensitive, or even downright neglectful and abusive, parenting. Simply put, they did not learn how to feel, contain, and use their emotions in healthy ways. As a result, feelings feel overwhelming, all-encompassing, and scary. If this describes you you may find yourself drinking, binging, cutting, or yelling as a way to process emotions.

The second characteristic of unstable relationships with others is often characterized by a push-pull dynamic of “come here, now go away.” In attachment terms, borderline individuals struggle with disorganized attachment. That is, there’s a simultaneous need to be close to another person and separate from them. Additionally, it’s common to see dynamics of splitting good and bad, as in, “you’re the best friend/partner/therapist I’ve ever had,” which turns into “you’re bad because you weren’t available when I needed you,” a week later. As we might imagine, this can be tremendously difficult for the other person in the relationship. Therefore, individuals who struggle with borderline symptoms often cycle through one relationship after another.

Therapy helps borderline individuals learn to manage and contain their feelings. They also develop capacities to view relationships in a more integrated way, that is, that all people are a mix of good and bad and it’s important to tolerate frustraion.

Narcissistic Personality

People with narcissistic tendencies often come across as confident and authoritative but they struggle to understand and value others’ feelings and opinions. This causes them to be perceived as cold, uncaring or even cruel in relationships.

Narcissistic individuals can be grandiose—seemingly impervious to what others think of them, or fragile—easily slighted by others’ remarks. In both cases there’s an underlying low self-esteem and lack of empathy for others. This leads to one-sided relationships. The narcissistic person often expects the other person to meet their needs but is unable to, or unwilling, to reciprocate. In fact, individuals with this particular personality organization rarely seek therapy on their own. It’s often a frustrated and dissatisfied partner, friend or family member who suggests the narcissistic individual talk to someone.

If they commit to a course of treatment, therapy has a lot to offer the narcissistic person. They can learn to be more kind, caring and empathetic in relationships and develop a more realistic sense of self-esteem.

Avoidant/Schizoid Personality

Individuals with avoidant/schizoid dynamics can be quiet and thoughtful self-sufficient people. They are often introverts and loners which leads them to struggle with loneliness, isolation and feelings of being misunderstood by others. At the heart of this personality type is a fear of closeness with others which causes the individual to distance, physically or emotionally or both.

The avoidant person often comes to therapy because their isolation has reached a critical point. Lack of love and care from others has led them to feel depressed, empty and dead inside. They’re often aware they’re missing something other people seem to enjoy. And in fact, humans are social animals. We all need meaningful friendships and romantic relationships in our lives.

In therapy, individuals with avoidant and schizoid tendencies benefit from addressing their fears and blocks to closeness. Through the relationship with the therapist they can learn to accept care and rely on another person in a healthy way.

If you or a loved one are struggling with entrenched personality problems please read more about Katrina and how she approaches therapy. Then reach out to get started.