And why it’s time to stop using the term like an insult
Being diagnosed with a personality disorder can often lead to feeling judged or shame. In casual contexts people might say someone is “so borderline” or “has narcissistic traits” without really understanding what that means. At worst, these labels become shorthand for “difficult” or “too much.”
But that’s not what a personality disorder is and it's not helpful for healing.
In my work as a psychiatrist and therapist, I’ve worked with many people who’ve been diagnosed with personality disorders or who worry that they might have one. What I always try to offer first is this: compassion. Underneath every diagnosis is a person and story, usually one of pain, unmet needs, and strategies that made sense at the time.
Put simply, a personality disorder is a long-standing pattern of thinking, feeling, and behaving that creates suffering for the person themselves, for the people close to them, or both. These patterns often show up in how someone relates to others, regulates emotions, sees themselves, and copes with stress.
They’re called “disorders,” but at their core, they reflect adaptive responses. The traits that form the constellation of the diagnosis were ways of surviving environments that were, at some point, unpredictable, unsafe, or emotionally invalidating.
For example:
Someone with borderline personality disorder (BPD) may have learned to be hyper-attuned to signs of abandonment because they experienced deep, painful losses or inconsistent care-giving early in life.
Someone with avoidant or obsessive-compulsive traits might have learned that being emotionally self-contained, careful, or perfectionistic was the safest way to navigate an unpredictable world.
People with narcissistic traits often carry a deep, buried sense of inadequacy and use grandiosity or control to protect against shame or vulnerability.
These aren’t character flaws. They’re patterns of protection.
Many people with personality disorders have been told, explicitly or implicitly, that they’re “too much,” “manipulative,” “unfixable,” or “broken.” Some have had painful experiences in therapy, where their struggles were pathologized instead of explored.
I’ve had clients come to me in crisis, not because of their symptoms, but because they were shamed for having them. I've also seen the relief that comes when we shift from blame to understanding that their condition is treatable and not their fault.
The good news is: people with personality disorders can and do get better. I’ve seen it. It’s not always a quick path, but it’s absolutely possible. The work often involves:
Developing awareness of the emotional patterns and beliefs that drive behavior
Building capacity for reflection, especially in the heat of the moment (something we focus on in therapies like Mentalization-Based Therapy)
Creating secure, trusting relationships, often starting in the therapy room
Naming and grieving past wounds, especially those that shaped a person’s sense of self
Rewriting the internal narrative and developing a cohesive sense of self
Personality disorders don’t mean someone is broken. In many ways, they reflect how resilient someone has been. They’ve survived. They’ve adapted, and with the right support, they can build new ways of relating that feel less reactive, less painful, and more authentic.
If you’re someone who’s been diagnosed with a personality disorder, I want you to know this: your pain is real, but so is your strength. You’re not defined by a diagnosis. You’re allowed to grow. You’re allowed to change.
If you’re someone supporting a loved one who struggles with these patterns, know that compassion and boundaries can coexist. People aren’t their worst moments and healing almost always happens in connection.
If this resonates with you or someone in your life, you're not alone. These struggles are more common than most people realize and more treatable than they’re often made out to be. Therapy can offer the space to feel seen, not judged, and to write a new story.