Everyone has a personality, comprised of strengths and weaknesses

Get to know anyone well enough and you will begin to see that s/he struggles dealing with certain aspects of life, work, and relationships.  These weaknesses in someone’s personality can even be so vulnerable that people can have acute episodes of anxiety, depression, and other psychiatric disorders.

In other words, no one is perfect, nor does a healthy level of functioning depend on someone moving closer and closer to perfection over time.  This basic truth makes it tricky to differentiate someone with a disordered personality from a flawed, but mostly normal personality organization.

In order to determine if weaknesses in a person’s character meet criteria for a personality disorder, one of two things need to be present: 1. You have a great deal of reliable data about a person’s life across time and context, or 2. You need a great deal of experience and expertise recognizing signs and symptoms of personality pathology.

Distress and impairment are often context-dependent

Narcissists can be extremely high achievers. Obsessive-compulsive Personality Disorder sufferers often perform well in school and save lots of money.  Borderline Personality Disorder afflicted individuals can be extremely talented performers and be quite charismatic.

Many other possible strengths and areas of success can and do emerge among people genuinely suffering from one or more personality disorder.  So, if you look only at one area of competence, you may miss the underlying personality pathology.

In fact, many people have disastrous personal lives not despite but because they are such fierce achievers in business, negotiation, litigation, etc.  Having areas of strength is often a good prognostic indicator, but it does not mean that s/he hasn’t created truly awful relationships, habits, patterns, dependencies, abuse cycles, etc. outside the pocket of tremendous success.

Next time you pass a newsstand or browse through gossip blogs and catch the latest headlines on major celebrities, recall the importance of context in evaluating someone’s personality health.  

Gossip and smear journalism is a way we humans balance our competing needs to celebrate idols while regulating negative feelings of envy.  

So many of our most celebrated heroes are extremely gifted in one or more areas of life; these same people are also complete dumpster fires in other life domains.

“Symptoms” of personality disorders feel “normal” to the experiencer, by definition

It’s essentially a psychological law that people who have personality disorders feel that their suffering is normal–at least in the sense that they don’t know it’s possible to feel any other way.  Sure, many people feel lonely, less than, or defective–but in my experience, this is reconciled with explanations of “well that person is just better at X than me.” 

It takes a lot of work and the right kind of help to realize that an impaired personality structure is the source of suffering.  Labels like “depression” and “anxiety” do help explain some of the differences in happiness and fulfillment between self and others, but the source of depression and anxiety is often quite perplexing to people with personality disorders.  It’s simpler for many to assume it’s “just genetic” or reduced to a “medical” anomaly. 

Personality is invisible to most people because they’ve always been that way.  People with personality disorders are like people walking around in their own micro-climate.  Everyone else might be talking about how hot it is, but the person with the personality disorder will be feeling cold.  What conclusion would this person come to in making sense of the differences in subjective experiences they were having?  

They likely would either be fundamentally confused about what is cold and what is hot, or believe that their brain just was naturally very bad at distinguishing between cold and hot.  They would begin to doubt themselves, not trust their instincts, which would in turn become another way in which they felt alienated from others.  

It’s very unlikely, however, that the people in this hypothetical example would conclude that they lived in a different microclimate from others at all times.

Problems with self-identity, and interpersonal functioning (the two hallmarks of personality disorders) can be either unhealthy or healthy in an infinite number of ways

If a man doesn’t want to get married, date, or have a family, does he have schizoid personality disorder? Avoidant personality disorder? Schizotypal personality disorder? Or maybe, that’s just the life he likes and wants to lead.  

On the flipside, consider a woman who is a doctor, married to a loving, successful man, and lives the exact life she always aspired to lead.  Yet, she’s not content.  She feels empty.  She doesn’t really feel as if her life is her own, and even feels suffocated by the choices she has made.  On the surface, we’d say she has it all.  However, her entire identity might be built on a false premise.  

The difference between a personality disorder and normal, everyday suffering is not always obvious from the outside.  Many trained professionals often miss defining features of a personality disorder if they don’t ask about the right history, recognize the primitive defenses, or get fooled by high status and/or achievement.  

This takes a great deal of savvy and experience to navigate.  How do you diagnose a PD when everything looks good on the outside and the sufferer doesn’t even have a clue that their experience differs from others in a very profound way?  

For these reasons, personality disorders are extremely challenging to identify, diagnose, and treat.  Some might even challenge the validity of the concept itself.  In my view, personality disorders are very valuable constructs clinically, although they can often hide in plain sight from friends, family, and even people trained to diagnose them.

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