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  • Writer's pictureDeric Hollings

Personality Disorders



Recently, I became a certified personality disorder treatment provider after having taken a course taught by Gregory W. Lester, Ph.D. A lot has changed in the behavioral health field since I first learned about working with personality disorders in 2009.


Perhaps it would be of interest to the reader to learn a bit of what I discovered from the course. Before I share, it may be helpful to know what a personality disorder is.


Defining terms


The American Psychological Association defines a personality disorder as “any in a group of disorders involving pervasive patterns of perceiving, relating to, and thinking about the environment and the self that interfere with long-term functioning of the individual and are not limited to isolated episodes.”


During the personality disorder course, Dr. Lester stated that people with personality disorders aren’t sick, they’re inappropriate. Interference of perception, one’s ability to relate, and cognitive dysfunction of this sort relates to who the person is, not necessarily what the individual has.


The American Psychiatric Association clarifies this matter by stating, “Personality disorders are long-term patterns of behavior and inner experiences that differ significantly from what is expected.” Although it is a frowned upon term, personality-disordered people are considered “abnormal.”


Perhaps it may benefit the reader if I elucidate this point. “Normal” may be defined as conforming to a type, standard, or regular pattern characterized by that which is considered usual, typical, or routine.


Therefore, abnormal simply means deviating from the normal or average. As an example, if there are 100 people in an auditorium and 10 of them are left-handed, we can conclude that these 10 lefties deviate from the standard or average norm and as such are abnormal.


There is no moral merit to being right-handed. The lefties in the auditorium aren’t bad, wrong, or evil people. They merely defy the typical pattern of people who are assessed in this example.


Likewise, and given that an estimated 9 percent of adults in the United States (U.S.) have at least one personality disorder, it’s accurate to state that personality-disordered people aren’t the average in the U.S. They are therefore abnormal.


A blend of genetic and environmental factors influences personality disorders which include:


Cluster A –

·  Paranoid personality disorder

·  Schizoid personality disorder

·  Schizotypal personality disorder


Cluster B –

·  Borderline personality disorder

·  Histrionic personality disorder

·  Narcissistic personality disorder

·  Antisocial personality disorder


Cluster C –

·  Avoidant personality disorder

·  Dependent personality disorder

·  Obsessive-compulsive personality disorder


Noteworthy, during the personality disorder course Dr. Lester estimated that within the general population somewhere between 15 and 19 percent of people meet the criteria for a personality disorder. Even still, this range is the abnormal exception and not the rule.


Dr. Lester further stated in the course that illness is acquired and disorders are developed. Often, I observe significant focus relating to “mental health,” though I rarely witness similar attention directed toward mental illness. According to the Mayo Clinic:


Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.


One source claims that 19.86% of adults in the U.S. experience a mental illness, equivalent to nearly 50 million people. Per his course, Dr. Lester departs from the Mayo Clinic’s assertion that mental illness and mental health disorders are synonymous.


The construct of a personality disorder


In order to understand deviation from the Mayo Clinic’s concept of mental illness and personality disorders presumably serving the same definition, it’s worth understanding that illness is categorized by symptoms and disorders are designated by characteristics.


As an example, major depressive disorder symptoms include symptoms such as depressed mood, anhedonia, insomnia, fatigue, etc. These signs of mental illness may be treated with psychopharmacological intervention (medication).


However, similar intervention strategies are largely ineffective at treating characteristics of a personality disorder. Although some qualities of a personality disorder may be reduced through use of medication (e.g., SSRIs may diminish impulsive aggression), this sort of intervention cannot effectively treat a disorder.


Admittedly a reductionist explanation for why this may be, personality disorders are constructed of four main elements which medication isn’t currently capable of altering in any meaningful way. People with a personality disorders experience:


1. Excess of what they do and deficiency of what they can’t do

2. Deficiency of observing ego (not insight)

3. Insufficient problem solving

4. Too much drama



Think of a normal personality that contains an abundance of traits. An individual may use extroversion, introversion, conscientiousness, openness, compassion, and other traits when interacting with the world.


However, an abnormal personality is one that contains inadequate trait variety and instead maintains a single go-to trait with which the person engages reality. Because of deficient trait composition, the individual uses this single trait in excess.


To conceptualize this matter, consider that Abraham Maslow is credited with having stated, “If the only tool you have is a hammer, it is tempting to treat everything as if it were a nail.” A personality-disordered person uses a single trait to approach a diverse array of problems in life.


This dysfunctional pattern unfolds without self-correcting capacity. Noteworthy, Sigmund Freud’s concept of the ego addressed the rational part of one’s psyche that mediates between irrational desire and moral constraint.


Dr. Lester stated that people with personality disorders lack the natural ability to mediate in such a way, because they’re deficient in what he refers to as an “observing ego.” This is different from insight, because insight relates to understanding while a normal observing ego is said to regulate trait diversity.


Here, the act of switching to an appropriate trait and not simply comprehending a matter is the major difference between insight and the observing ego. Because of deficient traits and the lack of an observing ego, and considering the overuse of a single trait, personality-disordered people struggle with problem solving.


In this construct of a personality disorder, drama results from wielding a metaphorical hammer when confronted by dilemmas inherent in life. It’s the process of escalation, upset, and creation of additional problems which encompasses “drama” in this regard.


There’s no medication of which I’m aware that instills traits, installs self-corrective capacity, fosters problem solving, and reduces intrapersonal and interpersonal drama. Therefore, the treatment—or at minimal management—of personality disorders is through psychotherapeutic intervention.


Ultimately, psychiatric treatment of mental illness reduces symptoms and psychotherapeutic treatment of personality disorders improves adaptability. This was something I didn’t fully understand in 2009.




Controversially, Dr. Lester stated that people with personality disorders have something wrong with who they are. As a mental health professional that has now been properly trained to work with these disorders, it’s my job to help people get better than who they currently are.


My aim is to do so through use of rational compassion and improved understanding about personality disorder treatment. If you’re looking for a certified personality disorder treatment provider, I invite you to reach out today by using the contact widget on my website.


As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.


At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!



Deric Hollings, LPC, LCSW





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