Question 1

Hi Paul, what contributes to developing a personality disorder, and as a parent is there anything I can do to prevent my child from developing one?

Paul Emmelkamp · Accepted Answer

In the last decades, the traditional assumption that the family is primarily responsible for the development of personality disorders has been challenged.  For example, although it may be tempting to assume that aggressive and abusive behaviour in adult victims of child abuse is caused by these traumatic experiences in childhood, the evidence is correlational at best, which does not rule out other explanations such as genetic factors or gene-environment interaction. There is now considerable evidence that part of the personality disorder is related to genetic factors. Of course, providing a safe structured family environment may reduce the risk that children eventually will get a personality disorder.

Question 2

If the individuals themselves are unaware they have a problem, do most PD's go undiagnosed? Even if the person sees a therapist, how is it possible for the therapist to know?

Paul Emmelkamp · Accepted Answer

A well-informed psychtherapist will recognize a personality disorder.

Question 3

How can you create a boundary without wounding the person with BPD? For instance, "you can't call or text me everyday, its too much" - how can you reword it, without it going into their defensive triangle?

Paul Emmelkamp · Accepted Answer

Good question which is difficult to answer, because not all persons with BPD are comparable. If the person acknowledges him/herself that he/she has been diagnosed with BPD, you can even discuss your worries with him/her in the context of the PD and say that you understand that this statement of yours may hurt him/her, which you understand, but that it is better for your relationship is etc...

Question 4

My child has many of the features of a borderline personality he is 21 and refusing to go to treatment and we had to ask him to move out to find his own place.  How do I not feel guilty and still help him?

Paul Emmelkamp · Accepted Answer

That is indeed difficult. Perhaps it helps if you realise that it is an illness. If you continue to feel guilty you may consider going to therapy yourself to learn how to cope with this difficult situation.

Question 5

Why would a vulnerable narcissist want you to be angry or abusive toward them?

Paul Emmelkamp · Accepted Answer

Not every vulnerable narcist wants you to be angry or abusive towards him/her.

Question 6

At what age do most personality disorders start to take shape and how soon should you get help?

Paul Emmelkamp · Accepted Answer

Usually this starts gradually in adolescence. Whether mental health care is needed depends on the suffering of the individual and his/her environment.

Question 7

Is it possible to treat someone with a personality disorder so they no longer have it? That is, can it be “fixed”?

Paul Emmelkamp · Accepted Answer

There are now a number of evidence-based treatments for a number of personality disorders. Results of these therapies result in less complaints, but generally do not change the personality fully.

Question 8

What are the most common types of personality disorders and what are the signs someone might have one?

Paul Emmelkamp · Accepted Answer

That is a difficult question which is not easy to answer, given that there are a number of different personality disorders officially acknowledged as such. It is difficult to find an open access publication in which these various personality disorders are described. You might find some of this information in Wikipedia:
https://en.wikipedia.org/wiki/Personality_disorder

Question 9

What are the personality disorders often involved in intimate partner violence (if any)?

Paul Emmelkamp · Accepted Answer

A number of studies have revealed that a substantial proportion of wife batterers are characterized by Cluster C personality disorders. In incarcerated spousal killers, murdering one’s wife is better predicted by avoidant personality traits than by psychopathic traits. Other research showed that obsessive-compulsive PD was the most prevalent personality disorder in men convicted for severe intimate partner violence (see Emmelkamp & Meyerbröker, Personality Disorders, 2020).
https://www.routledge.com/Personality-Disorders/Emmelkamp-Meyerbroker/p/book/9781138483057

Question 10

Is it known what causes avoidant personality disorder and how can it be treated? Thank you for taking my question.

Paul Emmelkamp · Accepted Answer

A central characteristic of avoidant PD is social avoidance, together with hypersensitivity to negative evaluation, fears of rejection, and feelings of inferiority. There is some research to suggest that temperamental vulnerability might increase the risk for avoidant PD. Children who are behaviourally inhibited, shy, or hypersensitive to harmful stimuli might be vulnerable to develop avoidant PD. A number of studies have evaluated the effects of psychological treatments with patients with avoidant PD as the primary complaint. The results of these studies show that various behavioural strategies (exposure and social skills training) are moderately effective (for review see https://www.routledge.com/Personality-Disorders/Emmelkamp-Meyerbroker/p/book/9781138483057

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