By P. Casey Arrillaga, LCSW, LCDC
Personality disorders are often stigmatized and misunderstood, not only among everyday people but even within the professional community. When most people hear the term personality disorder, they picture someone difficult, dramatic, or even dangerous. These stereotypes, unfortunately, have done real harm.
In this post, we will explore the truth about these disorders and how they can be helped, including in residential treatment. This post will be the first in a series over time, in which we will explore some personality disorders in depth, such as Borderline Personality Disorder and Narcissistic Personality Disorder. This blog series is here to offer education, compassion, and—most importantly—hope.
For people living with a personality disorder, daily life can feel confusing, overwhelming, or lonely. And for their loved ones, it can be hard to know how to help. Sometimes family members feel a similar mix of difficult emotions. It can be tempting for everyone involved to blame and shame the person with the disorder. This only makes this worse, because shame is often at the root of personality disorders [1] [2].
In reality, personality disorders are not character flaws—they’re deeply rooted patterns of thinking, feeling, and relating to others that often develop in response to early life experiences, trauma, and unmet emotional needs. As we’ve talked about in earlier posts about trauma (here’s another post on this), it doesn’t matter if others think the person in question has had a traumatic life. What is important is that the person who developed the disorder experienced what was happening around them as unsafe. Based on this, they started to change their personality and how they view the world in a misguided attempt to feel safer.
Personality disorders thus affect how people relate to themselves, others, and the world around them. This can show up as intense mood swings, fear of abandonment, perfectionism, chronic emptiness, impulsive behavior, or difficulty trusting others. These patterns are usually long-standing and feel like “just how I am.” But under the surface, there’s often a world of pain, sensitivity, and a deep desire for connection. Many people with personality disorders also struggle with depression [3], anxiety [4], substance use [5], or trauma-related symptoms [6], making it harder to find the support they deserve. They may go to residential treatment for substance use but never get to the underlying sources of pain. This can lead to feelings of hopelessness for that person and frustration for those who love them. It doesn’t have to be that way.
One of the most damaging myths about personality disorders is that they are untreatable. In truth, many people with personality disorders make significant improvements in their quality of life and relationships with the right kind of help. Evidence-based therapies—like Dialectical Behavior Therapy (DBT), Schema Therapy, and Mentalization-Based Therapy—have been shown to reduce distress, improve functioning, and support long-term healing [7]. Treatment may take time, but change is absolutely possible. Recovery doesn’t mean becoming a different person—it means becoming more fully yourself, with greater emotional balance, self-understanding, and freedom from harmful patterns.
For family members and friends, it’s also important to know that support is available. Learning about personality disorders can shift the way you see your loved one—not as manipulative, difficult, or broken, but as someone coping with deep emotional pain. Education, therapy, and support groups can help you set healthy boundaries, offer support without enabling, and take care of yourself in the process.
At Windmill, we see our clients at human beings, not pathologies. Where some professionals may shy away from doing the more difficult work, we embrace it. This means that we work with clients who experience the pain of personality disorders and help them find their true selves underneath. This includes creating hope, using evidence-based practices, and helping them find better relationships with both themselves and those who love them. Since people with personality disorders often struggle with substance use as well, our residential setting provides safety and support to untangle and address both issues.
We are also proud of the support we offer families. Our weekly family workshops and SMART Recovery Family & Friends meetings create a forum for our clients and their families to learn and practice new tools and ways of understanding each other. These resources are available indefinitely, because our alumni and families are welcome to keep coming to these meetings for as long as they like after treatment has concluded.
Whether you’re just beginning to explore this topic or you’ve been living with these challenges for years, we invite you to stay curious, compassionate, and open to the possibility of change. Personality disorders are not a life sentence. With support, recovery is not only possible—it’s happening every day. If you or someone you love is struggling, don’t hesitate to reach out and get help. Our admissions team can walk you through what to expect and answer any questions. Call 830-251-5606 or contact us online.
References:
[1] Jørgensen, C. R., & Bøye, R. (2024). “I am ashamed that I exist. I feel like apologizing for existing”: The phenomenology of shame in patients with borderline personality disorder: A qualitative study. Personality Disorders: Theory, Research, and Treatment, 15(3), 181.
[2] Fjermestad-Noll, J., Ronningstam, E., Bach, B. S., Rosenbaum, B., & Simonsen, E. (2020). Perfectionism, shame, and aggression in depressive patients with narcissistic personality disorder. Journal of personality disorders, 34(Supplement), 25-41.
[3] Köhne, A. C., & Isvoranu, A. M. (2021). A network perspective on the comorbidity of personality disorders and mental disorders: an illustration of depression and borderline personality disorder. Frontiers in Psychology, 12, 680805.
[4] Shah, A. Q., Prasad, D., Caropreso, L., Frey, B. N., & de Azevedo Cardoso, T. (2023). The comorbidity between Borderline Personality Disorder (BPD) and Generalized Anxiety Disorder (GAD): A systematic review and meta-analysis. Journal of psychiatric research, 164, 304-314.
[5] Stetsiv, K., McNamara, I. A., Nance, M., & Carpenter, R. W. (2023). The co-occurrence of personality disorders and substance use disorders. Current psychiatry reports, 25(11), 545-554.
[6] Bozzatello, P., Rocca, P., Baldassarri, L., Bosia, M., & Bellino, S. (2021). The role of trauma in early onset borderline personality disorder: a biopsychosocial perspective. Frontiers in psychiatry, 12, 721361.
[7] Hernandez-Bustamante, M., Cjuno, J., Hernández, R. M., & Ponce-Meza, J. C. (2024). Efficacy of dialectical behavior therapy in the treatment of borderline personality disorder: a systematic review of randomized controlled trials. Iranian Journal of Psychiatry, 19(1), 119.
Q: Are personality disorders permanent and unchangeable?
A: No, personality disorders are not a life sentence. With the right support, many people experience meaningful recovery and positive change. Professional help, compassion, and persistence can make a significant difference.
Q: Can people with personality disorders live fulfilling lives?
A: Absolutely. Many individuals with personality disorders go on to build healthy relationships, pursue careers, and experience joy. Recovery is possible, and hope is well-founded.
Q: Is it shameful or weak to seek help for a personality disorder?
A: Not at all. Reaching out for support is a sign of courage and self-awareness. Everyone deserves help and understanding, and seeking treatment is a powerful step toward healing.
Q: What should I do if I or someone I care about might have a personality disorder?
A: Don’t hesitate to seek support—contact a mental health professional or reach out to resources like the admissions team mentioned above. Early intervention and compassionate care make recovery more likely and less daunting.
About The Author
P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.
Created specifically for those who have loved ones that struggle with addiction.