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