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Studying personality disorder: why are personality disorders difficult to treat?

Reflecting on what I learned in school and some recent studies.

Personality disorder is a diathesis-stress model — biological “diatheses” are inborn vulnerabilities, and environmental stressors interact with them. There are genetic predispositions that could be identified through family history. Within a family that carries the illness and possibly family dysfunction, it’s very likely to experience the toxic interpersonal relationships and also adapt the toxicity. Disturbance of early attachment formation is considered a key driver. 44-47% of the BPD patients in a study reported memories of childhood traumas. It’s like a net itself, that an inborn vulnerability with some genetic traits and meanwhile an environment that would reinforce those traits till it’s a formed disorder.

That explains why personality disorders are very challenging to treat, “because thoughts and behaviors are deeply rooted in a person's identity, patients often lack insight into their condition, and the patterns are resistant to change” (quoted by SOL mental health). People with personality disorder usually blame others for causing their problems rather than self reflecting on their behaviors.

The treatments have to be systematic, structured and long term. But many times even within a good treatment/ environment, patients still tend to drop out and refuse to seek help, by denying either their conditions or devaluing the therapists’ / professionals’ work.

Reference article: Why personality disorders are so difficult to treat? https://www.solmentalhealth.com/blog/why-personality-disorders-are-so-hard-to-treat
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“Pure” NPD is relatively uncommon, the comorbidity rate of Narcissistic Personality Disorder is remarkably high

I’ve been looking at this inquiry: is the mind of being special (“I’m special”, “I’m different”) the seed of mental disorder?

I asked a few AI research tools, and learned about the comorbidity rate of NPD (narcissistic personality disorder): “The comorbidity rate of Narcissistic Personality Disorder (NPD) is remarkably high. In both clinical and epidemiological studies, more than 80% of individuals with NPD meet criteria for at least one additional psychiatric disorder during their lifetime, and many meet criteria for several.”

“Personality disorders: NPD frequently co-occurs with other Cluster B disorders — especially borderline (BPD), antisocial, and histrionic personality disorders. Overlap estimates often range from 25–50% depending on the study and diagnostic criteria used.

Borderline Personality Disorder (BPD) – probably the most studied overlap. Both involve unstable self-esteem, though the underlying dynamics differ. Narcissistic personality disorder and borderline personality disorder have shared vulnerabilities, such as emotional dysregulation, insecure attachment, and maladaptive self-esteem regulation.

Mood disorders: Depression is common, with lifetime rates cited anywhere from 30–50% in clinical samples — often tied to vulnerable narcissism and underlying shame or emptiness.

Substance use disorders: Elevated rates compared to the general population, sometimes cited around 25–50%, though estimates vary widely across studies.

Anxiety disorders: Also elevated, though less consistently reported than mood or substance comorbidities.

Other associations: Higher rates of suicidality (especially with comorbid depression), and frequent overlap with bipolar disorder in some samples.”

In some cases of depression and anxiety disorder, I see that beneath the symptoms of dysfunctionality, the mind says “I’m special, I’m a victim, this shouldn’t happen to me, why do I have to change, others are bad, they are not as good as me”, which is the source of the suffering and collapsing. The comorbidity rate of narcissism is linking with this observation.
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Thought breeds fear

Excerpt from the book
Beyond Violence, By J. Krishnamurti

How are you to look at fear; how are you to bring out all its structure, all its hidden parts? – through dreams? Dreams are the continuation of the activity of waking hours during sleep, are they not? You observe in dreams that there is always action, something or other is happening in dreams as in the waking hours, a continuation which is still part of one whole movement. So dreams have no value. You see what is happening: we are eliminating the things to which you are accustomed, analysis, dreams, will, time; when you eliminate all those, the mind becomes extraordinarily sensitive – not only sensitive but intelligent. Now with that sensitivity and intelligence we are going to look at fear.

What is fear? How does it come? Fear is always in relation to something; it does not exist by itself. There is fear of what happened yesterday in relation to the possibility of its repetition tomorrow; there is always a fixed point from which relationship takes place. How does fear come into this? I had pain yesterday; there is the memory of it and I do not want it again tomorrow. Thinking about the pain of yesterday, thinking which involves the memory of yesterday’s pain, projects the fear of having pain again tomorrow. So it is thought that brings about fear. Thought breeds fear; thought also cultivates pleasure. To understand fear you must also understand pleasure – they are interrelated; without understanding one you cannot understand the other. This means that one cannot say, ‘I must have only pleasure and no fear’ – fear is the other side of the coin which is called pleasure.

Thinking with the images of yesterday’s pleasure, thought imagines that you may not have that pleasure tomorrow – so thought engenders fear. Thought tries to sustain pleasure and thereby nourishes fear.

Thought has separated itself as the analyser and the thing to be analysed – they are both parts of thought playing tricks upon itself. In doing all this it is refusing to examine the unconscious fears; it brings in time as a means of escaping fear and yet at the same time sustains fear.

Can the mind look at fear without the centre? Can you look at that fear without naming it? The moment you name it ‘fear’, it is already in the past. The moment you name something, you divide it off. So, can you observe without that centre, not naming the thing called fear, as it arises? It requires tremendous discipline. Then the mind is looking without the centre to which it has been accustomed and there is the ending of fear, both the hidden and the open.
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Beyond relief

Only when start to embrace a state beyond relief, which is something one committed to uphold and live out for a long period of time, will anything of real come to be. The danger or relief , is what causes most to aboard any effort, for it looks for a result so it quite. When ever you wake up to do something for a long period of time a certain state of brain comes to be alive and only when this is there, result comes to be. If not one just escape by the relief and by that nothing really comes to actually take shape and form and birth you. Now contemplate…what is that you are willing to give the time and the commitment to live out .
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The toxicity of comparison- social comparison bias

Social comparison bias can also be related with how our child schemas(maladaptive schemas) formed, such as defectiveness and shame.

Here is an article discussing the social comparison bias and the toxicity of it: https://thedecisionlab.com/reference-guide/psychology/social-comparison-theory
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A paradigm that might explain some stressful situations in our daily life, worth a study

A friend who is also a psychotherapist shared with me her recent studies on bully at workplaces and mentioned this “victim- persecutor- protector” paradigms (widely known in psychology as the Karpman Drama Triangle), which is a toxic social dynamic where three roles continuously interact to create conflict, avoid responsibility, and generate emotional chaos. It is a dilemma that commonly plays out in modern workplaces, families, and relationships.

Here is an article that explains this phenomenon: https://lksquaero.com/the-victim-rescuer-persecutor-paradigm-2/

There is so much to look into this when I looked up some research about this paradigm. The contemplation is, when this paradigm becomes a creation, what is the transformation of it?
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Dv home

The whole effort is hold this space that is held by the trustees so that it will be a space where you can come and be. It’s not just a place where you come to learn and partasipated in the discipline but also a space to rest and be held in this truth. All learning ends , and in the end of this learning one wakes up to this space where the demand just be will come to be and lived. For this most must work in a way that life lets you out, and in that space where you are out , you can for the first time embody all that can be for one self and all and in that find this space to live this truth and be in this space…with this the truth of Zazen will be lived.
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The trustee

One of the highest attainment one can arrive at is, when one can rest in this truth one is trusted, trusted for all that can come to be will come to be. For only when one comes to be a trustee the highest possibility comes to be, and in this the awakening comes to pass. There is no such thing as personal enlightement, all that is , is what is trusted on to oneself for all, that actualise it self as one self. For this the trustee needs a space in whcih one can just be and one can pay attention to one self , and in this rested state meditation flowers. This is the highest understanding that most miss, with is just to sit and do nothing and just be, for in this state of being one is waking up to all that can be when this bowing to be a trustee is absolute. This period of just being and just sitting is the period that one needs a space where one is held for this. The effor of master and the trustee is to hold such a space for all , to hold this light of what can be held in its totality. This is what the dv home is.
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