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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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.
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