Trauma and Personality Disorders: Myths and Misconceptions

Trauma and Personality Disorders: Myths and Misconceptions

I wish here to briefly reiterate some of the points made in that article and attempt to clarify some of the conceptual confusion that exists around notions of trauma and how it relates to personality psychopathology.

1. The fact that trauma is a relevant etiological factor in a variety of personality (and other mental) disorders does not negate the existence of personality disorder.

A popular refrain is that if a patient has experienced trauma, then the diagnosis is “trauma” (or “complex trauma”), and personality disorder should not be diagnosed. In reality, personality disorders have long been associated with childhood abuse, neglect, trauma, and other developmental failures. The psychiatric and psychodynamic literature going back many decades has focused on these factors as etiological in personality disorder—long before the rise of “trauma-informed care.”

2. Personality disorders are so-named because they reflect a fundamental disturbance in the patient’s modes of relating to self and others.

Traumatized individuals often experience gross disturbances in their object relations, i.e., their ability to relate in healthy and functional ways to themselves and to other people in the world. These impairments comprise the basic essence of the problems called personality disorders.

3. Reductionistic traumatogenic theories of personality disorder fail to account for the complex etiologies of personality disorders.

An abundance of research conducted over the past half-century has confirmed that personality disorders are caused by a complex interplay of genetics, biological factors, trauma, abuse, neglect, and pathology of attachment. It is commonly accepted that heritability levels for most personality disorders are roughly 50%. Some individuals with personality disorders do not have a history of trauma. Any accurate conceptualization of personality pathology must account for the existence of these cases.

4. Trauma is one cause of personality disorder; it is not a disorder in and of itself.

Trauma has been associated with a vast array of mental disorders, but it is not a mental disorder in its own right. Psychotherapy does not treat “trauma,” which is an event(s); it treats the consequences of trauma in the form of psychopathology, including personality pathology. The American Psychiatric Association recognizes no such diagnosis as “trauma” or “complex trauma.” Posttraumatic stress disorder is one pathological manifestation of exposure to trauma. Other pathological manifestations include personality disorder.

5. A biopsychosocial approach to personality disorder is needed to account for the heterogeneity of these disorders.

There is no singular cause of personality disorder, and most personality disorders develop in the context of a complex interplay of biological, psychological, and social forces. Traumatogenic theories inaccurately assert the primacy of trauma in all cases.

Unfortunately, the current zeitgeist in mental health asserts that trauma is a universal causal factor in mental disorder, a claim that is simply unsupported by the scientific evidence. A historically- and theoretically-informed perspective acknowledges the relevance of trauma in the etiology of personality disorders alongside a variety of other biological and psychosocial factors. In some cases, no trauma has occurred.

It is important that patients and clinicians alike have a conceptually sound understanding of the nature and causes of personality pathology. This offers the best opportunity for effective treatment and recovery.