Everyone has a personality.
This term describes individual differences in behavior, emotion, and thought
that make each person unique. Yet however different they are, most people find
a niche in the world that suits their traits. Not everyone succeeds. Community
studies suggest that about one in ten have a diagnosable personality disorder (PD). That term describes a personality that
does not work, in which problematic traits lead to impulsive behaviors,
dysregulated emotions, and abnormal thinking patterns. Yet while these
disorders are frequent in mental health clinics, it is easier to focus on
symptoms such as anxiety or depression, so PDs are not always recognized.
This book aims to explain why patients with PDs have traits
that do not fit in with social expectations, why they fail to find a niche, and
how treatment can take account of these factors. I begin by reviewing research
on the relationship between personality traits and disorders. Both traits and
PDs have a major heritable component accounting for about 40% of the variance
between people. This does not mean that PDs are entirely genetic or that they
can only be treated by drugs. But it does mean that psychotherapy, which is the
main form of treatment for PD, should not try to change personality traits, but
help patients make their personality work for them. I show that PD can be best
understood in its social context. This conclusion is supported by the fact that
these conditions vary greatly in prevalence over historical time as well as
between different cultures. I also propose that modernity is a major factor in
changing prevalence, and that some personality traits are amplified by living
in a world where one has to find one’s own place and build an identity.
The book goes on to describe social factors influencing the
most clinically important PDs. Borderline personality disorder (BPD) is marked
by severe dysregulation of emotions, a wide range of impulsive behaviors, and
dysfunctional intimate relationships. Since BPD patients are often suicidal,
most research has focused on this category. Narcissistic personality disorder
(NPD), commonly seen in psychotherapy clinics, can be understood as an extreme
form of culturally driven individualism. Antisocial personality disorder, most
common in prison populations, is also affected by levels of social integration.
The book then develops a biopsychosocial model of PD based on interactions between heritable traits, life experiences, and the larger social environment. It ends by describing how psychotherapists can benefit from this model, particularly in helping patients find a niche compatible with their personality.
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