Is it a chemical imbalance? A neurological thing? All I know is they’re not like other mental disorders and they’re difficult to treat.
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One of the things that makes them so difficult to diagnose and to treat is that we don’t understand them at all except for clusters of symptoms which often heavily overlap anyways. Although we don’t perfectly understand things like depression, anxiety, bipolar, or ocd either… we have a wide variety of treatments options, both chemical and therapeutic that we know work based on mountains of research (for example, we know SSRI’s slow down the reuptake of serotonin, so they can be very effective at treating serotonin imbalances, and we know CBT has proven to reduce intrusive/rumination thought loops when practiced consistently for several months).
With personality disorders, it seems like the only obvious trend is that people who tried the most treatments are the people who’ve had the most success; essentially throwing everything at the wall and hoping something will stick.
That’s a really big question with a not so simple answer partly because we’re still learning and personality disorders are so varied.
So here’s one theory, which hopefully can answer why they can be difficult to treat.
Do you remember learning that fire burns you? Or that falling over hurts? These are all things you learnt- mostly we aren’t born with these lessons, but we don’t remember how we learnt them, how we know fire isn’t something we should touch, but we get the result in the same way.
That’s partially because we don’t always learn things directly and consciously- like a teacher telling us to learn something. Most things we learn indirectly- we do something, we are aware of the result, and we do more of it or less depending on the consequences.
The same can be true with personality traits and how they are exhibited. If we display a trait in a certain way and we find it gets us a good result, we repeat it. If we display a trait in a certain way and we get a negative result, we avoid it. Depending on how good the reward or how severe the punishment can effect how severe the avoidance or celebration of it.
So with personality disorders we can see traits that are harmful, or taken to harmful extremes due to these consequences experienced when young which people may not be aware of. For instance, being told consistently that a person shouldn’t, doesn’t deserve or should be punished for being upset or angry can lead to a person not trusting their own emotions, or trying to exhibit the emotions they think other will want- which is common in many versions of BPD. Finding peace in the control of cleaning, or even safety in cleaning especially in comparison to chaos or poor hygiene in their life apart from this can lead to needing this control through cleaning routines, common in OCPD.
As for what makes them hard to treat- these are largely not episodic disorders. Episodic means they appear for a time, and may go away, and importantly there was a time where the disorder did not have an effect or has less of an effect. So many people who experience anxiety recognise times where their anxiety lessens. People with depression may notice a change, or people around them may notice a change from where they were before
Personality disorders are more often continuous- they don’t have a break. Treatment therefore becomes hard because a person with a personality disorder may not notice anything is wrong- because the beliefs, feelings and actions they are doing is what they are always doing, and in many cases has been helpful for them in the past.
Certain personality disorders are the result of trauma, usually experienced at a young age. When we’re young our brains are still developing. Childhood and younger are the most crucial when it comes to our personality, why we do the things we do and have the thoughts that we have.
Borderline Personality Disorder is classified as a disregulation of your emotions, meaning you don’t know how to properly process them and therefore experience them in their extremes. Happiness feels like euphoria, sadness feels like hopelessness and anger feels like rage.
Through different types of childhood trauma, you never learn how to properly process your emotions. Neglect leads to a fear of abandonment. A fear of abandonment leads to pushing people away before they get too close to hurt you. This leads to self sabotage and suddenly you find yourself tumbling down a rabbit hole where one problem causes another and before long, every aspect of your life is affected.
It’s very complicated and complex and that’s what makes it so difficult to treat. Personality disorders cannot be treated with meds because it’s not caused by chemical imbalances that can be fixed with medicine. Meds are only used to treat symptoms caused by the disorder, such as mood disregulation, impulsivity etc. The standard treatment for personality disorders is therapy, sometimes more intensive forms of therapy than traditional. Treatment lies in changing thought patterns, which happens through dealing with and healing from the trauma. Nothing about it is clear cut or easy.
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