Personality disorder diagnosis’ can bring stigma, difficulties accessing help, and some experts argue they hide the real underlying mental health issues for suffers – but others say their diagnosis was pivotal to understanding themselves and how to navigate their lives better. So do personality disorders exist, and should they be diagnosed?
What Are Personality Disorders?
Personality disorders are roughly defined as a very deeply ingrained pattern of behaviour that is not in line with what is considered within the norms and guidelines of acceptable behaviour, which can cause long-term difficulties in personal relationships or in functioning in society. In simpler terms, you might look for or receive a diagnosis of a personality disorder if you find yourself consistently behaving in ways that are considered bad or dangerous.
People commonly diagnose personality disorders such as obsessive-compulsive personality disorder—which reflects a more ingrained, personality-based form of OCD than the more widely recognized condition—as well as emotionally unstable personality disorder (formerly known as borderline personality disorder) and narcissistic personality disorder.
There are currently 10 officially recognized personality disorders, grouped into three clusters: A,B, and C. Cluster A personality disorders involve unusual or strange thinking or behaviour; Cluster B often involve strong emotions and problems with self-control or relationships; Cluster C involves ongoing/ near constant nervousness and fear.
The Case For Personality Disorders
Supporters argue that personality disorders are real and diagnosable mental health conditions that can seriously affect people’s lives. For many, having a name for their struggles can be a relief. A diagnosis can open the door to targeted treatment, community, and self-understanding. When you get a good grasp of why you behave a certain way, why it’s so hard to change, you can begin to bring in the sort of self-compassion, as well as the structure and support you might need to make change.
From a clinical perspective, researchers have also found patterns—brain differences, genetics, and childhood experiences—that correlate with certain disorders. This gives some weight to the idea that these are more than just social labels; they’re legitimate medical issues.
The Case Against Them
But critics raise some compelling points. One major issue is that personality disorders are diagnosed based on subjective criteria. What one clinician sees as “emotionally unstable,” another might see as a perfectly understandable reaction to trauma.
The trauma aspect is very important here – how do we differentiate between CPTSD, PTSD, and some personality disorders?
Emotionally Unstable Personality Disorder is diagnosed through symptoms such as:
- A strong fear of abandonment with the possibility of controlling or manipulative behaviours to ensure they don’t get left
- A pattern of unstable, intense relationships, sometimes switching from thinking their partner is perfect to thinking they’re terrible very quickly.
- Quick changes in how they see themselves and their identity, or not feeling they have an identity at all.
- Periods of stress-related paranoia and loss of contact with reality.
- Impulsive and risky behaviour.
- Threats of suicide or self-injury.
- Wide mood swings that can include periods of being very happy, irritable or anxious, or feeling shame.
- Ongoing feelings of emptiness.
- Inappropriate, strong anger.
Theoretically, different traumas could cause any of these responses to become ingrained into someone’s personality. Emotionally unstable personality disorder is very common in women in domestic abuse shelters, who have often spent significant periods of their life in traumatizing environments.
Another concern? Culture. Behaviours considered disordered in one culture might be normal or even valued in another. Who gets to decide what a “disorder” is? Historically, clinicians and systems have used diagnoses to pathologize women, queer people, neurodivergent individuals, and other marginalized communities. They often labelled women as ‘crazy’ simply for expressing anger, which encouraged suppression—and eventually, explosive outbursts. Critics argue that personality disorders often reflect cultural bias more than scientific objectivity.
A personality disorder diagnosis’ can also have a detrimental effect on people’s lives. Accessing healthcare, getting mental health support – even immigrating can be made more difficult by a diagnosis of a personality disorder.
The Middle Ground
Like many debates in mental health, the truth might lie somewhere in between. Maybe personality disorders do describe real patterns that some people experience—but maybe the way we define and treat those patterns needs a serious rethink.
Some professionals advocate for moving away from rigid labels and focusing more on underlying traits (like emotional dysregulation or impulsivity) that show up in different ways in different people. Others suggest a trauma-informed approach that sees “disorder” as a signpost, not a sentence.
So… Do They Exist?
If you asked me directly, I’d say I tend to believe that we shouldn’t diagnose most personality disorders the way we currently do. After spending time working with asylum seekers and women in refuge housing, I’ve come to see that what we often label as ‘personality disorders’ could be understood more compassionately—as responses to trauma, undiagnosed neurodivergence, or a mix of both.
But the answer might depend on what we mean by “exist.” Are personality disorders a scientific reality like diabetes? Probably not. For some, can they provide a useful framework for understanding certain patterns of suffering? Yes, definitely.
At the end of the day, whether you think personality disorders are real or not, one thing is clear: people are struggling, and they deserve compassion, not just a label.
If any of this feels familiar—or if you’re simply curious about how therapy might support your mental health journey—we’re here to help.
At Garden Room Therapy, we offer a warm, non-judgmental space to explore your experiences and work toward meaningful change. Reach out to book a free assessment or to learn more about how therapy can support you in building a more balanced, connected life. 🌿
If you would like to learn more about personality disorders, you can click here.
