Over the past 10 years, more and more family law professionals are becoming aware that personality disorders are driving their cases – yet we are still discouraged from openly discussing these disorders in court and during out-of-court negotiations. Over the next ten years, I believe it will be essential for family lawyers and related professionals to understand personality disorders and start talking about them realistically so that we can adapt decisions and plans to truly help our clients and their families.
There are ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision, 2022) published by the American Psychiatric Association and used throughout the world by mental health professionals. Known as the DSM-5-TR, the current version of this manual includes the fully revised text and references and updated diagnostic criteria from DSM-5 (published in 2013). In this manual, Cluster B personality disorders (narcissistic, borderline, antisocial, and histrionic) are listed as “dramatic, emotional, or erratic.” (DSM-5, 646)
One comprehensive study identifies Cluster B personality disorders as having strong associations with “domineeringness, vindictiveness, and intrusiveness,”1 which describes many of the parties in our family law cases. This connection is too strong to ignore and avoid discussing for another ten years. In short, personality disorders are an enduring pattern of dysfunctional interpersonal behavior.
Common Misunderstandings about Personality Disorders (PDs)
Myth #1: PDs are Rare.
No, they are not. In fact, the DSM-5 refers to a study that indicates that “approximately 15% of U.S. adults have at least one personality disorder” (DSM-5, 646). This is equal to or more common than the percent of people with a substance use disorder (addiction), yet most people know little about personality disorders because they are not really part of the public discourse. In many ways, society treats personality disorders like it used to treat addictions 50 years ago, as “hush-hush.” Now, there is widespread public awareness and discussion of substance abuse, court-ordered drunk driving programs, hospital treatment programs, and insurance funding for treatment. Many families and companies can push their loved ones and employees into substance abuse treatment with “interventions.” We are just seeing the beginning of some of this awareness regarding personality disorders.
Myth #2: PDs are Obvious.
Again, no, they are not. Personality disorders are generally hidden disorders. There is a full range of severity of these disorders. Some people with personality disorders can function well in their jobs and communities but have serious problems in close relationships (e.g., interfamilial), while others cannot even work because they are so dysfunctional. These disorders are often not obvious to people who are dating these individuals until they have known them for six to twelve months. People who hire them often do not know until they are deeply settled into the job. They can get by in many settings for a long time because they look like everyone else on the surface.
Myth #3: Someone Would Know if They Had a PD.
Usually not. Most people who have one do not know they have it. Personality disorders are enduring patterns of behavior that develop before adulthood, most commonly in early childhood. These individuals lack self-awareness of their own disorders and the impact of their own behavior on those around them. When they get feedback for their negative behavior, they tend to become highly defensive rather than gain insight into their part in the problem, which is often substantial. This is a big part of why they have an enduring pattern of dysfunctional behavior; it seems normal and necessary to them. But it does not work, and they often are unhappy.
Myth #4: People With PDs Know They are Acting Inappropriately.
Usually not. This is one of the hardest things for family law professionals to accept about personality disorders. These individuals really, truly lack self-awareness of their part in their problems. They honestly believe that others have treated them unfairly, for no good reason, usually when others are reacting to or trying to set limits on their behavior. Since they cannot see their own part in their own problems, they are always searching for other explanations. Some blame life in general or the universe, while others blame specific people (these are the ones with “high conflict” personalities, who are preoccupied with targets of blame and have all-or-nothing thinking, unmanaged emotions, and extreme behaviors).
Myth #5: If One Party Has a PD the Other Party Probably Does, Too.
No, but perhaps half do. Informal polls taken at dozens of professional seminars on high conflict clients and cases usually indicate that about half of cases have two high conflict personalities and the other half have one such personality driving the case while the other party is a generally reasonable person just trying to protect the children and himself or herself. This is often true in domestic violence cases, in alienation cases, and in other cases in which a likely Cluster B party (domineering, vindictive, and intrusive) persuades the court and other family law professionals that it’s all the other party’s fault – thereby blaming the wrong party or both parties when only one is at fault.
Myth #6: You Should Offer Them Insight Into Their Behavior.
This will fail! Since they lack self-awareness and have an enduring pattern of behavior that they rarely change, any feedback – even “constructive” feedback – feels like a personal attack to them. Not only do they not benefit from the feedback, but it harms your relationship with them. Most people put their energy into trying to get those with personality disorders to “just stop” whatever extreme behavior they are engaged in. But, similar to alcoholism and addiction, it’s more helpful to learn new behaviors than to try to stop old behaviors. Try to focus these individuals on what to do – rather than what not to do – now.
Myth #7: You Should Tell Them How You Feel About Them.
This really blows up! People with PDs chronically feel stuck in the past because they do not go through the normal grieving and healing process. Their unresolved feelings are often so negative, they just trigger a bigger emotional upset for them, and they cannot easily calm themselves. They can also do anger and upset better than ordinary people, usually because it has been a life-long struggle and their emotions remain unresolved. It is better to calmly focus on the future and what you would like them to do or set limits by talking about the positive and negative consequences of future non-compliance with various rules.
Myth #8: Having a PD (or Just Traits of One) Should Not Affect the Children or Parenting Plans.
We now know this is not true! Research involving more than 900 children of parents with traits (subclinical levels) of three PDs with hostility and unpredictability has shown that PDs can have a huge impact on children. “For the first time, subclinical levels of Borderline, Antisocial, and Narcissistic PD symptoms in parents have been documented to predict behavioral and emotional difficulties in their children as early as the preschool age. When parents were not cohabiting, the variance of the children’s emotional problems explained by parental symptoms increased more than six times.”2
Myth #9: PDs are Immutable.
Not necessarily. Historically, many people (including therapists) thought that personality disorders were unchangeable and therefore therapy was pointless. However, over the past two to three decades, breakthrough treatments have succeeded at improving the behavior of some people with personality disorders. For example, there is a fairly successful treatment approach for borderline personality disorder called Dialectical Behavior Therapy, or DBT, which has helped many people overcome the diagnosis with improved self-awareness and self-control. Also, some people with other personality disorders have made progress in therapy, including those with narcissistic personality disorder. However, the vast majority of people with personality disorders neither seek nor receive treatment and remain stuck in dysfunction.
Myth #10: People With Personality Disorders Could Change if They Wanted to – or Received a Lecture.
Unlikely. Remember, a personality disorder is an “enduring pattern” of dysfunctional behavior. They cannot see their part in their problems and conflicts. In many ways, this problem is like that of alcoholics and addicts, who cannot see the connection of their own behavior to their problems in life. It is even more difficult with personality disorders because the person has experienced their own patterns of behavior as normal and necessary (usually since early childhood). There is no obvious cause of their difficulties, so people assume their behavior is knowingly bad and intentional. In reality, this is the problem: they cannot connect the dots from their own behavior to how others respond, and how they could change. They usually have to be forced into treatment by loved ones, employers, or court orders, just like substance abuse treatment.
Managing this Hidden Problem Going Forward
Hopefully, over the next 10 years, society and especially family law professionals will come to understand this problem and help parents deal with it in a structured, treatment-focused way, rather than responding with ignorance, judgment, tolerance, or helplessness. We can and should talk more about personality disorders. We have made a lot of progress as a society with drug and alcohol understanding and treatment, so we know we have the potential to manage this hidden problem that affects so many children and parents today.
1 Wilson S., Stroud, C. and Durbin, C. Interpersonal Dysfunction in Personality Disorders: A Meta-Analytic Review, Psychology Bulletin, July 2017; 143(7): 677-734. doi: 10.1037/bul0000101.
2 Berg-Nielsen, T.S. and Wichstrom, L. “The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissistic personality disorders: at the mercy of unpredictability.” Child and Adolescent Psychiatry and Mental Health. 2012; 6:19. doi: 10.1186/1753-2000-6-19
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