Personality Disorders do not go away on their own

Personality Disorders do not go away on their own. We have to work very hard to change them.

Why don’t they go away on their own?

The thinking patterns, coping mechanisms, behaviors, and deficits that are associated with the personality disorder are encoded in the brain as a set of maladaptive habits. As these habits started in early childhood and have been practiced over and over again, they are now the person’s automatic fallback responses.

This is somewhat similar to being born left handed, but being forced to use your right hand for everything since childhood. In the beginning, this will feel unnatural and awkward. By adulthood, the brain will have created multiple neuronal networks that support using the right hand automatically.

Becoming right handed does not wear off with time. Instead it feels normal and natural. The person would have to work very hard to stop their automatic right handed responses and relearn how to use their left hand for everything.

How do you change these maladaptive personality disorder habits?

Step 1—Bring the habits into awareness.

The whole point of forming habits is to free up our cognitive capacity to deal with novelty. Anything we do repetitively is no longer novel. It would be a great waste of time if we could not form habits because we would have to make 100’s of decisions every day.

To change a habit (which by virtue of being a habit is now automatic and done without awareness), we have to bring it into awareness.

Step 2—Make a decision.

Once you realize that you have been habitually and automatically doing a particular behavior without thought, you can revisit this behavior and decide if you want to change it.

Step 3—Decide on a more productive behavior.

You cannot just give something up. You need to decide what you want to do instead. This involves thinking about possible alternative behaviors that would improve your life and choosing one to replace the maladaptive old one you are giving up.

Step 4—Inhibit the old behavior and substitute the new.

Now we are up to the hard part. We have to stay aware. We cannot rely on our first response to situations because that is the response we want to change. When we are tempted to do what feels natural, we have to stop, and substitute the new behavior. We may have to do this 100’s of times for each new habit we want to form.

Why is this so hard?

Imagine you are on a nice big smooth road through the jungle. It is very simple to get through the jungle by staying on this road. Unfortunately, it does not go where you want to go. Every time you take it, you end up someplace you do not want to be.

To get where you want to go, you have to hack a new road through the jungle. Every foot is hard. You have to cut down trees and use a machete to chop away bushes and anything else in your way.

This is very hard work and it may take years to complete. It is very tempting to take the easy path instead, the one you do automatically. It takes grit, persistence, and lots of motivation to keep building the new road.

Punchline: Once you have a personality disorder, you will have it forever unless you are willing to do the hard work necessary to change. Personality disorders can be thought of as deeply ingrained habits—and we all know how hard it is to change our habits.

Elinor Greenberg, PhD, CGP