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When Teenagers Don't See The Problem in What Feels Right

Personality Disorders are among the most serious mental health issues that a person can have. They tend to be life-long disorders that are very resistant to treatment. When it comes to teenagers they are only technically eligible for a personality disorder diagnosis after they turn 18 years old but often enough everyone sees the writing on the wall long before their 18th birthday. Personality disorders are usually compared to mood disorders. In a mood disorder a person feels disturbed by symptoms that feel outside of the way that they really are. It makes people say things like "I'm too depressed to be myself". In other words, the mood disorder interferes with the way they really are.

Personality disorders go much deeper. The problematic emotional, cognitive, behavioral and relational patterns may cause a lot of problems in the person's life but these patterns don't feel wrong to the person who has them. This kind of disorder almost always has roots in early childhood so that people who know the person with a personality disorder often say things like "Yea, I know, but they've always been that way." with a resigned tone in their voice as if to say "There's nothing to do about it. They're just like that". Most of the time people with personality disorders feel forced to participate in psychotherapy by someone else since they don't see the problems in themselves. People who know them can easily become exasperated because they seem to be supremely unreasonable or beyond any ability to notice what's happening and change. Again, what makes these disorders so serious is that the disorder doesn't feel like a disorder to the person who has it. ​

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There are three main "clusters" of personality disorders and the Diagnostic and Statistical Manual of Mental Disorders -5 or simply, the DSM-5, organizes them into clusters. Cluster A: The Odd or Eccentric Disorders. Cluster B: The Dramatic, Emotional or Erratic Disorders. and Cluster C; The Anxious or Fearful Disorders. 

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I find psychodynamic psychotherapy most beneficial in cases of personality disorder because of the emphasis on what psychodynamic psychotherapists call mentalizing (helping people to develop an ability to think about the workings of their own minds), containment (being able to emotionally hold the person in distress while maintaining composure and empathetic attunement) and intersubjective work (helping the patient develop insight into their relational patterns by drawing attention to how these patterns play out in the psychotherapeutic relationship that's happening now). Ideally, it's work that needs to happen at least twice a week and over the long-term to have an effect. With these circumstances in place I have experienced people with personality disorders gain valuable insight and create positive change in their lives. It's actually fascinating work!

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Below is a list of typical personality disorder symptoms divided by cluster that may help you decide if your teenager may benefit from psychodynamic psychotherapy for personality disorders. Remember to view them through the lens of the way people are deep down and not as something happening to them.  

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