Personality Disorders – Let’s Talk About What They Are and How to Treat Them

A patient arrives at their first session in distress. Their partner has left them and they’re seeking therapy because the thing they’ve feared the most is happening. In fact, it keeps happening. Every time they’re in a relationship they push their partners away with their “clinginess.” But everything makes them feel they have to do this. They believe they’re unloveable and would be nothing without a partner. They have to cling otherwise they’re alone, in the void. They’re constantly anxious around romantic partners and scared it will end. They’ve felt this way for as long as they can remember. Their mother drank a lot, every night in fact, and their father wasn’t around. They’ve been digging around on the internet and think they may have Borderline Personality Disorder. It’s gotta be true because, hell, they believe the worst about themselves. Plus, isn’t it untreatable? They feel like they should just end it all. “I mean, isn’t personality something you like born with?”

What is Personality?

In Western society, personality goes a long way. We often chirp that personality matters more than looks. We even attribute personalities to animals—that dog’s got personality. When people act out with ruthless ambition, we label them narcissistic or antisocial, often pointing to politicians and tech billionaires as prime examples.

Neuroscientist Andrew Huberman has suggested that online interactions often bring out “borderline traits” in people. To Huberman, the emotional instability, erratic behaviors, and hostility seen in heated online debates mirror the symptoms of borderline personality disorder (BPD).

Unfortunately, this diagnosis carries a heavy stigma and is frequently misunderstood, with many believing it is untreatable. This isn’t so—BPD and narcissistic personality disorder (NPD) are treatable, though antisocial personality disorder (ASPD) is generally not (Fox 2021). It’s also understood that personality disorders may stem from childhood traumas, which can take the shape of large events as well as chaotic households. What separates one person from another in these cases does actually come down to temperament, which is an inherent part of personality.

So, what exactly is personality? While there have been many theories, psychologists have usually understood it as a spectrum of five traits, influenced by both genetics and environment. The Five Factor Model identifies these traits as:

  1. Openness to experience – imaginative, creative, and curious
  2. Conscientiousness – hard-working, perseverant, and well-organized
  3. Extraversion – talkative, active, and optimistic
  4. Agreeableness – trusting, lenient, and good-natured
  5. Neuroticism – worry-prone, self-conscious, and emotionally reactive

These traits are universal. We all have them. However, they come in degrees and possess both advantages and disadvantages. Psychologist Jordan Peterson points out that these traits come with both advantages and disadvantages (Petersen 2025). For instance, neuroticism might seem negative, but a certain level of worry can be protective. Similarly, agreeableness sounds beneficial, but excessive agreeableness can lead to people-pleasing and self-sacrifice.

Personality is more than just these traits—it is how they manifest in response to internal and external stressors. Internal stressors include emotions, memories, and body balance, which includes levels of sleep, nutrition, and exercise. External stressors involve environmental conditions, social interactions, and time-sensitive challenges. These traits interact with an individual’s cognitive schema, which is a fancy way of saying that how you perceive the world is rooted in what you believe about yourself. This consists of:

  • Core beliefs
    • Maladapted: “I am unworthy”
    • Adapted: “I am worthy”
  • Intermediate beliefs
    • Maladapted: “Drinking helps me socialize”
    • Adapted: “I have nothing to prove”
  • Automatic thoughts
    • Maladapted: “The world is unfair”
    • Adapted: “I can acknowledge the role of luck without it upsetting me”

This schema, shaped by reinforcement from our environment, determines how we perceive and interact with the world.

 What is a Personality Disorder?

The term “disorder” suggests deviation from a norm, but mental health is rarely black and white. While various mental illnesses have existed for centuries, psychology as a formal discipline is relatively young. The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in the 1950s, provides a classification system for mental illnesses.

Initially, personality disorders were vaguely defined by internal and external stress responses. Over time, the DSM refined its understanding, incorporating factors such as interpersonal functioning and severity of impairment. Personality disorders are now categorized into three clusters:

  • Cluster A (odd or eccentric) – Includes paranoid, schizoid, and schizotypal personality disorders.
  • Cluster B (dramatic, emotional, or erratic) – Includes BPD, NPD, histrionic, and antisocial personality disorders.
  • Cluster C (anxious or fearful) – Includes avoidant, dependent, and obsessive-compulsive personality disorders.

However, the DSM-5-TR’s categorical approach has limitations. As Fox notes, it often struggles to distinguish between medical and psychiatric conditions, leading to inconsistencies in diagnosis (Fox 2021). The DSM-5-TR (2022)  introduces an alternative model that characterizes personality disorders as impairments in personality functioning combined with pathological traits.

The Alternative Model of Personality Disorders

This new model focuses on how personality dysfunction manifests in maladaptive responses. People with personality disorders often develop these maladaptive responses as a result of ineffective or inattentive parenting, trauma, or environmental reinforcement. However, there are personality traits that predispose folks to developing these traits (Fox 2021).

The model assesses personality dysfunction based on:

  1. Impairments in self-functioning – Identity and self-direction issues
  2. Impairments in interpersonal functioning – Problems with empathy and intimacy
  3. Pathological personality traits – Maladaptive traits such as emotional instability, impulsivity, manipulativeness, or detachment

These impairments create surface-level behaviors that can be observed, such as excessive emotional reactions, impulsivity, and relationship instability. For instance:

  • Borderline Personality Disorder (BPD): If a person experiences conflict with a friend, they may react with extreme fear, leading to impulsive anger or self-harm due to abandonment fears.
  • Narcissistic Personality Disorder (NPD): If a person feels criticized, they may react with defensiveness, entitlement, or even aggression to protect their self-image.

However, personality disorders are not rigid. People don’t always behave the same way in every situation. This is where the Cognitive-Affective Processing System (CAPS) Model becomes useful.

The CAPS Model: Understanding Personality in Context

The CAPS model explains how an individual’s personality responds to different situations. It recognizes how mental representations—including thoughts, feelings, memories, and self-perceptions—shape behavior. These representations, called Cognitive Affective Units (CAUs), include:

  • Thoughts and expectations
  • Beliefs and values
  • Emotional responses
  • Self-regulation strategies

For instance, if someone smells a familiar scent, it might trigger memories and emotions associated with that scent. Similarly, if someone feels unheard in a conversation, it could activate memories of past neglect, leading to an intense or seemingly disproportionate emotional reaction. After all, every stimulus activates an emotional reaction, even if the person doesn’t directly feel it or if they do feel it and respond to it in appropriate ways.

This model applies to both stable and impaired personalities. The difference is that a stable individual can self-regulate, while an impaired individual struggles with emotional instability.

One way to apply this model in therapy is through If-Then Statements:

  • If a person is criticized, then they may feel worthless, leading to avoidance or aggression.
  • If a person is ignored, then they may feel abandoned, triggering impulsive behaviors.

These if-then statements are a strong marker of an impaired personality because they show how someone experiences life as automatic, compulsory, or out of the person’s control. As if they have to feel a certain way and don’t have a choice in the matter. Understanding these patterns of reactivity helps clinicians and individuals recognize maladaptive responses and work toward healthier coping mechanisms.

Treating Personality Disorders

While personality disorders are challenging, they are treatable with the right therapeutic approach that includes unconditional positive regard. The most effective treatments tend to blend multiple modalities, including:

  1. Dialectical Behavior Therapy (DBT): Originally developed for BPD, DBT teaches emotional regulation, distress tolerance, and interpersonal effectiveness. It’s a skillset that could benefit anyone—so much so that teaching DBT in schools might significantly reduce the need for therapy later in life.
  2. Acceptance and Commitment Therapy (ACT): ACT fosters cognitive flexibility, helping individuals align their actions with personal values while developing psychological resilience.
  3. Somatic Experiencing and Mindfulness: These techniques help individuals develop interoception (awareness of bodily sensations) to regulate their emotions and heal trauma.
  4. Narrative Therapy and Schema Therapy: By identifying and restructuring maladaptive core beliefs, individuals can create new, healthier narratives about themselves and their world.

 Conclusion

Personality disorders are complex, but they are not a life sentence. By understanding personality traits, cognitive schemas, and the interplay of stressors, individuals can learn to navigate their behaviors more effectively. With evidence-based treatments like DBT, ACT, and somatic experiencing, people with personality disorders can develop healthier ways to interact with themselves and others.

If you think you have a personality disorder, seeking professional support can help you gain clarity and take steps toward meaningful change. Remember, personality is not fixed—it evolves, and with the right tools, so can you.

Article by: Reuben Brody, LCSW – Asheville, NC

Rubin Brody - I am a Licensed Clinical Social Worker Associate (LCSWA),

Reuben Brody – Reuben is a Licensed Clinical Social Worker Associate (LCSWA), and received his Master of Social Work from the University of Denver’s Graduate School of Social Work. His modalities include cognitive approaches like Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT), mindfulness, narrative therapy, and Cognitive Behavioral Therapy for Insomnia (CBT-I).

Works Cited
Fox, D.J., Ph.D. 2021. Antisocial, Narcissisctic, and Borderline Personality Disorders: A new conceptualization of development, reinforcement, and expression, and treatment. New York: Routledge.

Petersen, J. 2025. Self Authoring. Accessed February 21, 2025. https://www.selfauthoring.com/.