I heard this in a group:
A patient was saying that she used to have a lot of friends in college, but lost them after graduation. She hadn’t been able to make new ones because she was weird and no one liked her. When the therapist challenged that idea, she said that she had a personality disorder — so how could anyone ever get along with her? There’s something wrong and pathological about her personality.
Only about a hundred things went through my mind when I heard this comment. There is such gravity to a personality disorder diagnosis… and it’s easy to understand why someone would think this.
There were a couple of things that I felt she was saying:
- having a personality disorder means that she is somehow broken or defective
- having a personality disorder means she can’t have relationships
- the personality disorder is not something that she can overcome.
I’m going to avoid diving into labeling theory… but I think that diagnoses are ultimately meant to guide treatment. You’re really saying “here are a cluster of common symptoms” so that you can research and treat individuals with those characteristics. It’s not adequate to just describe someone as being sad, because the other presenting symptoms make a huge difference. Maybe the individual has major depressive disorder, or maybe they have PTSD. The approach to treatment is not the same! Many diagnoses do carry a negative connotation, but I really believe the intention is to help you. To improve your treatment, to give professionals an idea of where to start and what questions to ask, and as a general warning of other possible common symptoms that may not have been noticed yet. And while I’d say that most disorders are on a continuum, a guide is needed for drawing some kind of line between healthy/unhealthy. Maybe it’s a really fuzzy line… maybe the line moves based on the individual… but there has to be some kind of line. If you can’t draw one, how do you know when you are done with treatment? How can you gauge if you are where you need to be?
Given that this line is so fuzzy, different professionals may diagnose you differently. Ideally this shouldn’t happen… but since the DSM-IV is just a guide, it is an issue. A diagnosis can’t dictate whether or not you can form new relationships. Not only that… but who said individuals suffering from a PD can’t have meaningful relationships? It’s not the case at all. And maybe the label does suggest that there is something wrong with your personality and therefore you’re not compatible with everyone else… but:
- Everyone has something. You know, baggage. Negative stuff from previous relationships, insecurities, neuroses, obsessions, issues, addictions — whatever. Something.
- The absence of a personality disorder does not make you like-able by default. Anyone can cut off friendships, sabotage relationships, isolate, alienate others (and the list goes on…). Anyone!
Can you overcome a personality disorder? Sure. I think so, but others will disagree with me. Can you overcome an eating disorder? How about an addiction? It’s a tough question to ask. Maybe someone with schizophrenia has to take meds forever, or maybe someone with anorexia can never go on a serious diet. It’s a grey area (imagine!). The statistics may not be in your favor, but because diagnoses are so subjective, it’s hard to accurately research recovery rates. With eating disorders, there is at least some measurable criteria (weight, binges/purges a week, caloric intake) – but even that isn’t concrete. Also, eating disorders are based on present symptoms. If you’ve recovered / been in recovery for several years, maybe your chart say “history of bulimia,” but often not. There is no “recovering/recovered from bulimia” diagnosis. However, PD diagnoses do somewhat take your history into account. Often you can go into a treatment program for anorexia, and come out 8 weeks later without the AN diagnosis (instead it’d be EDNOS). It doesn’t quite work like that for personality disorders.
Maybe having these caveats mentioned when you’re originally diagnosed would be helpful — I don’t know. Would they? Some professionals don’t even tell patients their full diagnoses (Axis II disorders are sometimes left out), but I usually feel that ignorance does NOT equal bliss. Personality disorders have a bad rep. With such a loaded diagnosis, maybe it would help to be reminded that diagnoses aren’t designed to label you as broken, defective, or unrepairable.