What is a Personality Disorder, Really? BPD, NPD, oh my!
“People with borderline personality disorder (and those like them) are like people with third-degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement”
Personality disorders can be a loaded topic. They often carry a lot of stigma and misunderstanding, both in the culture at large and even within mental health communities. But as a trauma therapist in Oakland, CA, I approach personality disorders with compassion, curiosity, and an understanding that they often develop in the context of complex trauma. These patterns aren’t signs that something is "wrong" with a person. These patterns are ways people have learned to survive in a world that didn’t always meet their emotional needs or protect their sense of safety.
a meme to keep things light
What This Looks Like In Real Life
Personality disorders often show up as patterns of thoughts, emotions, and behaviors that feel inflexible and persistent, especially in relationships. Someone might struggle with intense emotions, chronic self-doubt, fears of abandonment, or difficulty trusting others. There may be a tendency toward black-and-white thinking, conflict in close relationships, or a deep sense of emptiness or shame. These patterns usually begin in early adulthood and can cause significant distress, both for the person and the people around them.
“Trauma divides the self. What we think of as symptoms—flashbacks, numbing, avoidance—are the communications of dissociated parts of the personality.”
From a psychodynamic and depth psychology perspective, I see personality disorders as adaptations. Many of the behaviors and relational dynamics that get pathologized are rooted in early attachment wounds, chronic invalidation, or ongoing neglect and abuse. These early experiences shape how people learn to relate to others and to themselves. When someone has grown up in an environment where they had to shut down emotions to stay safe, or perform constantly to feel worthy, it makes sense that those strategies would continue into adulthood. They can become deeply ingrained patterns that are hard to shift without the right kind of support.
“A central feature of severe personality disorders is identity diffusion, reflected in chronic feelings of emptiness, contradictory self-images, and unstable relationships.”
That’s why I integrate multiple approaches in my work. DBT skills can be powerful tools for increasing emotional regulation, distress tolerance, and interpersonal effectiveness. Internal Family Systems (IFS) helps people understand the different parts of themselves—especially the parts that feel extreme or contradictory. EMDR allows us to process the trauma that underlies many of the painful beliefs and reactions that show up in personality disorders. And psychodynamic work helps us understand the deeper stories and unconscious dynamics at play. This combination allows us to work both in the present and with the past, addressing symptoms while also getting to the root of where they come from.
“The therapeutic process provides a new relational matrix in which the patient’s self can gradually consolidate and become more resilient.”
In Relationship With Those Suffering From Personality Disorders?
“Instead of asking ‘What’s wrong with you?’ we learn to ask, ‘What happened to you?’ and more importantly, ‘What did you do to survive?’”
I also work with many people who are in close relationships with individuals who have personality disorders. That might be adult children of parents with borderline or narcissistic traits, partners navigating intense relational dynamics, or people coming out of relationships that left them feeling destabilized. These clients are often dealing with their own trauma responses, confusion, grief, and questions about boundaries, responsibility, and self-worth. Therapy can help clarify what was happening in those relationships and support people in finding steadier ground.
The Take Away? You Deserve Support
Whether I’m working with someone who meets criteria for a personality disorder or someone impacted by those dynamics in others, my goal is the same. I want to offer a space that is non-pathologizing, trauma-informed, and grounded in both deep emotional work and practical support. We are not broken. We are shaped. And we can heal.
