Episode 005 - What is a Personality Disorder, Anyway?
🎙️ Episode Overview:
Episode 5 explores the meaning and usefulness of the term “personality disorder,” contrasting traditional diagnostic perspectives with the interpersonal and developmental lens of Interpersonal Reconstructive Therapy (IRT). Ken and Eliza discuss how personality is inherently relational—shaped by early attachments and sustained through habitual patterns of relating to self and others. They guide listeners through both the DSM-5-TR’s definition and IRT’s more nuanced approach, emphasizing curiosity and empathy over labeling and judgment.
🧩 Major Themes and Discussion Points:
The DSM Definition and Its Limits
Ken reads the DSM-5-TR criteria for personality disorders—enduring, inflexible patterns of thinking, feeling, and relating that cause distress or impairment. Eliza notes how broad and impersonal these categories can feel, often obscuring the relational nature of personality. The DSM lists traits, but IRT asks what relationships taught these traits and what purposes they serve.
Reframing “Disorder” as Learned Relational Pattern
IRT, rooted in Lorna Smith Benjamin’s SASB model, interprets each so-called disorder as a learned configuration of behaviors, emotions, and expectations in relationships. Rather than “broken personalities,” clients express enduring attachment strategies—ways of staying safe or loyal to early caregivers.
Moving from Labels to Compassion
We discuss how diagnostic terms such as narcissistic, avoidant, or borderline often carry stigma, even among clinicians. IRT replaces judgment with curiosity: these patterns are behavioral footprints of love and survival, not moral failings.
Using the Therapeutic Relationship as Data
Eliza describes how a therapist’s emotional responses to clients (e.g., feeling distant, anxious, or frustrated) become tools for understanding the client’s interpersonal world. This “use of self” helps therapists sense the relational pull of the client’s patterns in vivo.
Personality Patterns in SASB Terms
Lorna Benjamin’s 1993 work mapped DSM categories onto SASB dimensions—offering specific, researchable hypotheses about how interpersonal behaviors (e.g., control vs. submission, closeness vs. distance) reflect early learning histories. This transforms static labels into dynamic relational maps that can guide empathy and treatment planning.
Clinician Self-Awareness and Complementarity
Ken and Eliza illustrate how client patterns “pull” for complementary responses. For instance, an avoidant stance invites distance from the therapist—yet therapeutic progress requires leaning in gently instead. Recognizing these pulls helps prevent reenactments of clients’ old attachment patterns.
Toward a Compassionate, Functional View
Personality, in IRT terms, includes how people relate both to others and to themselves. Problematic patterns are functional but outdated—they once kept the person safe. Understanding their origin allows both therapist and client to approach change without shame.
📚 Key Takeaways:
• Personality disorders reflect relational learning, not intrinsic defects.
• The DSM provides descriptive labels; IRT provides relational explanations.
• Therapists’ emotional responses can be diagnostic tools for understanding interpersonal patterns.
• SASB translates categorical diagnoses into measurable relational positions.
• Compassion, not labeling, fosters understanding and growth.