Excellent, I loved this! Thank you Sorbie and Orestis. Orestis, one question for you. Where does this idea come from, that in order for “personality disorder” to apply, “all aspects” of a person’s personality should be disordered? We don’t really apply this sort of rule to other problems. Eg, if someone has a “movement disorder” or “neurodevelopmental disorder” that doesn’t mean that all aspects of their movement or neurodevelopment should be disordered. Why cannot “personality disorder” apply to “some aspects” of personality?
That's a really good point and I should have phrased my idea better there. Essentially, what I meant is more like "personality disorder should exhibit non-specific impairments in personality to count as a disorder of personality". I expand briefly below on why this is the only definition of "personality disorder" that makes sense to me.
1. Personality is broad and encompasses virtually all psychological domains (e.g., domains of affect, cognition, perception, and so on). If only or primarily one of these domains is impaired, then the impairment can be clearly and specifically denoted as an impairment in affect, cognition, perception, and so on. If we call that impairment however as a "personality impairment", then we lead to the conclusion that all of the disorders that are defined by that impairment are personality disorders (e.g., an emotional disorder being a personality disorder, a cognitive-perceptual disorder being a personality disorder... and so on). Importantly, this also applies if we accept that personality is stable (at which point any mental disorder that is stable enough becomes a personality disorder, e.g., treatment-resistant depression being a personality trait disorder).
2. The same applies for your cases of movement disorder and neuro-developmental disorder. Note how these are also not specific disorders but actually classes of disorders. The movement disorders include more specific disorders like Parkinson's and restless leg syndrome; while the neuro-developmental disorders include more specific disorders like autism and schizophrenia. I guess in a way, then, we can define personality disorder as the class of all mental disorders but that's a bit strange-sounding to say the least.
3. Alternatively, we can try and define personality disorder like the specific cases of disorder I just outlined (e.g., autism, schizophrenia, and so on). But that's a bit difficult once again because there are many domains of personality and the moment we select one of them (say, self-interpersonal functioning) to define personality disorder, then we are not actually talking about "personality" per se but rather about a specific aspect of personality (here, mentalizing and relating to self and others, which defines the relational disorders). So, my main argument is this: the moment a disorder can be primarily or only defined by a specific domain (e.g., affect, cognition, etc), then it's a disorder of specifically that domain (i.e., emotional disorder, cognitive disorder, etc). But the moment a disorder cannot be defined by any of those domains (because, the disorder has instead non-specific impairments across all of these domains), then it could be, at least in principle, defined as a disorder of "personality".
4. This last idea is worth restating (so that I can better understand it myself and not give straw-arguments): If a disorder can be coherently defined by one particular domain (of personality), then it's a disorder of that domain (of personality). But if a disorder cannot be coherently defined by only one domain of personality (because it has non-specific impairments across all domains), then it's a disorder of personality. One other way to think about this is psychometrically: most disorders can be placed in specific dimensions of psychopathology; but if a disorder is so transdiagnostic that it reflects non-specific impairments across all of these dimensions (e.g., the p-factor), then it could be defined as a disorder of personality. This is actually an interesting hypothesis that was advanced by Donna Bender, one of the main architects of AMPD: Bender, D. S. (2019). The P-factor and what it means to be human: commentary on criterion A of the AMPD in HiTOP. Journal of personality assessment, 101(4), 356-359. Finally, this is a hypothesis I test in my thesis, where I examine whether "borderline" patients have such strong trans-diagnostic problems that are in a sense unclassifiable (i.e., they transition between various different psychopathology states, meaning that they exist on the border of many psychopathologies, and they thus cannot be defined coherently by one primary difficulty; and they thus may be said to have problems in "all" of their personality domains).
Let me know what you think! But I agree that in the context of the interview my answer was brief and didn't sound as complete.
That’s helpful! I’ve been thinking of the idea that personality disorder may be thought of as the class of mental disorders that are stable enough and broad enough (involving multiple personality domains) so that they can neither be characterized as acute/episodic nor as problems restricted to a particular domain. This isn’t as stringent as “across ALL domains” but somewhere close to it. I don’t think, eg, that treatment-resistant depression by itself is a “personality disorder” (in my sense; it’s stable enough but not broad enough) BUT in some people depression acquires a broader scope, such that now it is no longer just a disorder of neuroticism but also a relational disorder. That’s when it crosses over to the psychodynamic idea of “depressive personality style.” What do you think of that?
That's a really nice definition and it aligns extremely well with Kernberg's view in the following sense: a "pathological personality organisation" is something that is both broad (i.e., has many impaired aspects of personality) and it's stable. So, by this clear definition, any mental disorder that affects in a stable manner various domains of personality (ways of thinking, feeling, behaving, relating, desiring, defending, and so on) is a disorder of personality organisation (see also here https://substack.com/home/post/p-200616363). That's why we can have neurotic personality organisations (what you describe) and even psychotic personality organisations (i.e., even in the absence of a major psychotic episode).
This interview is the first time that I actually even understood what the projective identification that previous misapprehension posts described, because to me the role of the therapist described by Orestes Zavlis is obviously obvious. I mean, if the therapist doesn't do that in terms of containing the client's emotions, then what are they even doing? I struggled with the concept of cliff falling, and I still don't quite understand what it was meant by that, but this clarified a lot for me.
But I've got a question about ego syntonic versus dysonic, because there is something I don't understand. What if a person accepts that something is part of them very much (descriptively), but it's broadly undesirable? Is that syntonic or dystonic? Surely a lot of stuff is like that. For example I'm kinda ADHD scatty mentally, loud in volume and physically fat. I don't love those things, I'd rather dial them down (not remove) but they're OBVIOUSLY me.
2. For the ego-syntonic vs. ego-dystonic, I would say you're clearly dystonic. Recall that "accepting a trait" is not the same as finding that trait "desirable". Finding the trait "desirable" is the definition of ego-syntonicity (as in, this trait or aspect of me is something that I enjoy about myself). The moment you accept something about yourself but you do not desire it, you are ego-dystonic. Finally, ego-dystonic aspects of the self can be described as symptoms (i.e., you have an ADHD or neurotic symptom that you wish to get rid of) whereas ego-syntonic aspects of the self can be described as parts of your character (i.e., you have a particular character trait that you do not wish to be cured off). Hope this distinction clarifies things!
Yes it clarifies. My confusion was about the term “accept as part of me”. Maybe undesirable is a wrong word then. Perhaps: “objectively negative (=leading to undesirable consequences at least sometimes) yet impossible to get rid of without changing what and who I am - and possibly actually impossible to get rid of at all in dispositional sense”. If a person LIKES who/what they are overall (as much as who/what can be captured), they'll be aware that those traits/characteristics are BOTH identity-essential and “negative” in terms of consequences? The "me" who wasn't scatty or loud (dispositionally, not behaviourally) wouldn't be me? Possibly I'm complicating lol but I think I'm aiming at traits that one both negatively assesses AND doesn't want to get rid of.
And yes I had read Sophie's essay (that's how I got here in the first place) but I didn't understand the process she described until I read about it here.
Thank you for this Sorbie and Orestis. Reading it, I was immediately reminded of Sorbie's comment "You can learn to tolerate it when people get you wrong" (from "you were the borderlne all along"). Read together, these two posts are powerful tools to stabilizing self and people we care about. Bravo! and thank you.
Excellent, I loved this! Thank you Sorbie and Orestis. Orestis, one question for you. Where does this idea come from, that in order for “personality disorder” to apply, “all aspects” of a person’s personality should be disordered? We don’t really apply this sort of rule to other problems. Eg, if someone has a “movement disorder” or “neurodevelopmental disorder” that doesn’t mean that all aspects of their movement or neurodevelopment should be disordered. Why cannot “personality disorder” apply to “some aspects” of personality?
That's a really good point and I should have phrased my idea better there. Essentially, what I meant is more like "personality disorder should exhibit non-specific impairments in personality to count as a disorder of personality". I expand briefly below on why this is the only definition of "personality disorder" that makes sense to me.
1. Personality is broad and encompasses virtually all psychological domains (e.g., domains of affect, cognition, perception, and so on). If only or primarily one of these domains is impaired, then the impairment can be clearly and specifically denoted as an impairment in affect, cognition, perception, and so on. If we call that impairment however as a "personality impairment", then we lead to the conclusion that all of the disorders that are defined by that impairment are personality disorders (e.g., an emotional disorder being a personality disorder, a cognitive-perceptual disorder being a personality disorder... and so on). Importantly, this also applies if we accept that personality is stable (at which point any mental disorder that is stable enough becomes a personality disorder, e.g., treatment-resistant depression being a personality trait disorder).
2. The same applies for your cases of movement disorder and neuro-developmental disorder. Note how these are also not specific disorders but actually classes of disorders. The movement disorders include more specific disorders like Parkinson's and restless leg syndrome; while the neuro-developmental disorders include more specific disorders like autism and schizophrenia. I guess in a way, then, we can define personality disorder as the class of all mental disorders but that's a bit strange-sounding to say the least.
3. Alternatively, we can try and define personality disorder like the specific cases of disorder I just outlined (e.g., autism, schizophrenia, and so on). But that's a bit difficult once again because there are many domains of personality and the moment we select one of them (say, self-interpersonal functioning) to define personality disorder, then we are not actually talking about "personality" per se but rather about a specific aspect of personality (here, mentalizing and relating to self and others, which defines the relational disorders). So, my main argument is this: the moment a disorder can be primarily or only defined by a specific domain (e.g., affect, cognition, etc), then it's a disorder of specifically that domain (i.e., emotional disorder, cognitive disorder, etc). But the moment a disorder cannot be defined by any of those domains (because, the disorder has instead non-specific impairments across all of these domains), then it could be, at least in principle, defined as a disorder of "personality".
4. This last idea is worth restating (so that I can better understand it myself and not give straw-arguments): If a disorder can be coherently defined by one particular domain (of personality), then it's a disorder of that domain (of personality). But if a disorder cannot be coherently defined by only one domain of personality (because it has non-specific impairments across all domains), then it's a disorder of personality. One other way to think about this is psychometrically: most disorders can be placed in specific dimensions of psychopathology; but if a disorder is so transdiagnostic that it reflects non-specific impairments across all of these dimensions (e.g., the p-factor), then it could be defined as a disorder of personality. This is actually an interesting hypothesis that was advanced by Donna Bender, one of the main architects of AMPD: Bender, D. S. (2019). The P-factor and what it means to be human: commentary on criterion A of the AMPD in HiTOP. Journal of personality assessment, 101(4), 356-359. Finally, this is a hypothesis I test in my thesis, where I examine whether "borderline" patients have such strong trans-diagnostic problems that are in a sense unclassifiable (i.e., they transition between various different psychopathology states, meaning that they exist on the border of many psychopathologies, and they thus cannot be defined coherently by one primary difficulty; and they thus may be said to have problems in "all" of their personality domains).
Let me know what you think! But I agree that in the context of the interview my answer was brief and didn't sound as complete.
That’s helpful! I’ve been thinking of the idea that personality disorder may be thought of as the class of mental disorders that are stable enough and broad enough (involving multiple personality domains) so that they can neither be characterized as acute/episodic nor as problems restricted to a particular domain. This isn’t as stringent as “across ALL domains” but somewhere close to it. I don’t think, eg, that treatment-resistant depression by itself is a “personality disorder” (in my sense; it’s stable enough but not broad enough) BUT in some people depression acquires a broader scope, such that now it is no longer just a disorder of neuroticism but also a relational disorder. That’s when it crosses over to the psychodynamic idea of “depressive personality style.” What do you think of that?
That's a really nice definition and it aligns extremely well with Kernberg's view in the following sense: a "pathological personality organisation" is something that is both broad (i.e., has many impaired aspects of personality) and it's stable. So, by this clear definition, any mental disorder that affects in a stable manner various domains of personality (ways of thinking, feeling, behaving, relating, desiring, defending, and so on) is a disorder of personality organisation (see also here https://substack.com/home/post/p-200616363). That's why we can have neurotic personality organisations (what you describe) and even psychotic personality organisations (i.e., even in the absence of a major psychotic episode).
Thanks for the interesting exchange, Awais!
This interview is the first time that I actually even understood what the projective identification that previous misapprehension posts described, because to me the role of the therapist described by Orestes Zavlis is obviously obvious. I mean, if the therapist doesn't do that in terms of containing the client's emotions, then what are they even doing? I struggled with the concept of cliff falling, and I still don't quite understand what it was meant by that, but this clarified a lot for me.
But I've got a question about ego syntonic versus dysonic, because there is something I don't understand. What if a person accepts that something is part of them very much (descriptively), but it's broadly undesirable? Is that syntonic or dystonic? Surely a lot of stuff is like that. For example I'm kinda ADHD scatty mentally, loud in volume and physically fat. I don't love those things, I'd rather dial them down (not remove) but they're OBVIOUSLY me.
Thanks for the thoughtful engagement! Two responses:
1. For the ''cliff-falling'' bit, that's Sorbie's term and she explains it thoroughly here: https://substack.com/@sshawrichner/p-202147026
2. For the ego-syntonic vs. ego-dystonic, I would say you're clearly dystonic. Recall that "accepting a trait" is not the same as finding that trait "desirable". Finding the trait "desirable" is the definition of ego-syntonicity (as in, this trait or aspect of me is something that I enjoy about myself). The moment you accept something about yourself but you do not desire it, you are ego-dystonic. Finally, ego-dystonic aspects of the self can be described as symptoms (i.e., you have an ADHD or neurotic symptom that you wish to get rid of) whereas ego-syntonic aspects of the self can be described as parts of your character (i.e., you have a particular character trait that you do not wish to be cured off). Hope this distinction clarifies things!
Yes it clarifies. My confusion was about the term “accept as part of me”. Maybe undesirable is a wrong word then. Perhaps: “objectively negative (=leading to undesirable consequences at least sometimes) yet impossible to get rid of without changing what and who I am - and possibly actually impossible to get rid of at all in dispositional sense”. If a person LIKES who/what they are overall (as much as who/what can be captured), they'll be aware that those traits/characteristics are BOTH identity-essential and “negative” in terms of consequences? The "me" who wasn't scatty or loud (dispositionally, not behaviourally) wouldn't be me? Possibly I'm complicating lol but I think I'm aiming at traits that one both negatively assesses AND doesn't want to get rid of.
And yes I had read Sophie's essay (that's how I got here in the first place) but I didn't understand the process she described until I read about it here.
Thank you for this Sorbie and Orestis. Reading it, I was immediately reminded of Sorbie's comment "You can learn to tolerate it when people get you wrong" (from "you were the borderlne all along"). Read together, these two posts are powerful tools to stabilizing self and people we care about. Bravo! and thank you.
Thanks for your kind words — glad you found our work useful!