Why Personality Disorders Are So Hard to Treat

Personality disorder is a psychological concept that popular culture loves to borrow. You have probably heard terms like borderline personality disorder or antisocial personality disorder thrown around — but do you really understand how these conditions affect a person's life, and what they look like in reality? Today I'll walk you through the four most common personality disorders, along with what they mean when it comes to treatment.

What is a personality disorder?

Research suggests that close to 9% of people are affected by a personality disorder. A personality disorder is a long-standing pattern of thinking and behaviour that interferes with a person's social life, work or daily functioning. Those affected often lack the capacity for self-reflection, and when problems arise they tend to lay the blame on the outside world.

Obsessive-Compulsive Personality Disorder

People with obsessive-compulsive personality disorder fixate stubbornly on detail and live by perfectionism. They strive for order, efficiency and flawlessness, while holding themselves to extremely harsh standards. That excessive fixation can leave them unable to enjoy whatever they are doing, and can even undermine their productivity at work. The pursuit of perfection means they can't finish their work on time, which only creates more distress. A strong need for control leaves them anxious in real-world settings, and standards that are too high and too rigid also strain their relationships with family and friends. Unlike obsessive-compulsive disorder (OCD), people with obsessive-compulsive personality disorder do not regard their compulsive tendencies as a problem; people with OCD, by contrast, recognise that their repetitive behaviours are harmful and will therefore actively seek help.

Borderline Personality Disorder

Borderline personality disorder is characterised by deeply unstable emotions and self-image. Those affected tend to have a very poor sense of self, believing they are unworthy of love, feeling empty, and convinced that no one can understand them. Their relationships with family and friends swing between two extremes — at times they are intensely dependent on another person's presence; yet when faced with criticism or separation, they can be overwhelmed by extreme negative emotions, flipping 180 degrees in their attitude and thinking in black-and-white terms, finding it hard to accept the contradictions of human relationships. This pattern of thinking has a negative effect on their social and working lives. The instability of their emotions, relationships and self-image puts them at higher risk of suicide or self-harm, which is why borderline personality disorder has become one of the personality disorders that psychologists are most concerned about.

Narcissistic Personality Disorder

To those around them, people with narcissistic personality disorder come across as selfish and arrogant. They see themselves as supremely important and special, and often harbour fantasies of success and brilliance. They believe they deserve the admiration and special attention of others. Their excessive self-centredness leaves them without empathy for others, and they will selfishly exploit other people to achieve their own ends. People with narcissistic personality disorder struggle to accept criticism from others, often responding with contempt or rage, and so they too face difficulties in their social lives.

Antisocial Personality Disorder

Antisocial personality disorder is probably the personality disorder that turns up most often in film and television. Those affected disregard society's rules and laws, dismiss other people's needs and rights, lack empathy, and feel no guilt or remorse after committing a wrong. They tend to act impulsively, with no sense of responsibility, and will harm or deceive others to satisfy themselves; their temper and emotions are aggressive. These personality traits do carry a certain allure, which is why people with antisocial personality disorder can form relationships with others very easily — though those relationships rarely last. One point worth noting is that antisocial personality disorder bears a certain relationship to crime, which can be traced back to the distorted views those affected hold about the social order and human relationships.

Treatment and its challenges

Personality disorders are mostly treated through psychotherapy. Although there is at present no evidence that personality disorders can be cured, psychotherapy can still effectively reduce the severity of symptoms and help those affected adapt to normal life. One of the difficulties in treating personality disorders is that those affected usually do not believe there is anything wrong with them — so on the one hand they won't seek help on their own, and on the other they may not cooperate with a professional's treatment plan. As the family or friends of someone affected, we all need to appreciate the struggle they face in treatment, to offer them a little more encouragement in daily life, and to let them know that even with a diagnosis of personality disorder, they are still worthy of love.

TreeholeHK offers a psychological service tailored to your personal needs, giving you space to talk things through. It provides appropriate guidance and emotional support, helping you make sense of past experiences, come to know yourself, and draw on your inner resources to meet life head-on.