Interpersonal Difficulties in Specific Personality DisordersSimone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.Let's consider someone with an Avoidant Personality Disorder. Their way of thinking about and interpreting the world revolves around the thought that they are not good enough, and that others don't like them. They think of themselves as unappealing and socially inept. These types of thoughts create feelings of intense anxiety in social situations, along with a fear of being ridiculed, criticized, and rejected. The intensity of this fearful anxiety, and the discomfort it creates, compels them to avoid interpersonal situations. They might avoid parties or social events, and may have difficulty giving presentations at work or speaking up in meetings. Others might perceive them as distant or shy. They likely come across as stiff and restricted. All this will likely interfere with their ability to make friends, or to move ahead professionally.
Alternatively, think of the example of someone with Narcissistic Personality Disorder who is preoccupied with fantasies of unlimited success and power, so much so that they might end up getting lost in their daydreams while they fantasize about their superior intelligence or stunning beauty. These people can get so caught up in their fantasies that they don't put any effort into their daily life and don't direct their energies toward accomplishing their goals. They may believe that they are special and deserve special treatment, and may display an attitude that is arrogant and haughty. This can create a lot of conflict with other people who feel exploited and who dislike being treated in a condescending fashion. People with Narcissistic Personality Disorder often feel devastated when they realize that they have normal, average human limitations; that they are not as special as they think, or that others don't admire them as much as they would like. These realizations are often accompanied by feelings of intense anger or shame that they sometimes take out on other people. Their need to be powerful, and their lack of empathy for others, makes for conflictual relationships that are often superficial and devoid of real intimacy and caring.
A person with Borderline Personality Disorder may have the tendency to view the world in terms of black-and-white, or all-or-nothing thinking. People with Borderline Personality Disorder tend to have stormy relationships, going back and forth between being deeply involved and worried about being abandoned, to feeling intensely sad or angry when their needs are not met. Their tendency to see the world in black-or-white (polarized) terms makes it easy for them to misinterpret the actions and motivations of others. These polarized thoughts about their relationships with others lead them to experience intense emotional reactions, which in turn interacts with their difficulties in regulating these intense emotions. The result is that they will characteristically experience great distress which they cannot easily control and may subsequently engage in self-destructive behaviors as they do their best to cope. The intensity of their emotions, coupled with their difficulty regulating these emotions, leads them to act impulsively.
To illustrate the way black-and-white thinking, emotional dys-regulation, and poor impulse regulation all merge and culminate to create interpersonal conflict and distress, let's return to our earlier example: The partner of a woman with Borderline Personality Disorder fails to remember their anniversary. Black-and-white thinking causes her to conclude, "He doesn't love me anymore" and all-or-nothing thinking leads her to (falsely) conclude, "If he does not love me, then he must hate me." Such thoughts would easily lead to some pretty intense emotions, such as feeling rejected, abandoned, sad, and angry. She has a hard time tolerating and dealing with these intense feelings and consequently becomes highly upset and overwhelmed. The intensity of her negative feelings seems unbearable. Next she has a powerful impulse to "do something" just so that these feelings will go away. She might angrily accuse her partner of having an affair and she might plead with her partner not to leave her. Meanwhile her partner is baffled by this extreme reaction, particularly since he is not having an affair, and he readily recalls all his other recent loving gestures. Her partner might also become angry at these wild accusations of infidelity and so the conflict escalates and things get more intense. Alone after the fight, the woman feels overwhelming self-loathing or numbness and goes on to intentionally injure herself (by cutting or burning herself) as a way to cope with her numbness. When her partner learns about this self-harm behavior he can't understand it and concludes he is being manipulated. He expresses his strong concern for her well-being but also his anger. In turn, she feels misunderstood. Clearly, the Borderline Personality Disorder with its combination of distorted thought patterns, intense and under-regulated emotions, and poor impulse control is practically designed to wreak havoc on any interpersonal relationship.
The above examples illustrate the way in which interactions between three core features of personality disorders (distorted thinking, problems with emotional regulation, and problems with impulse regulation) all work together to contribute to the fourth and most important core feature of personality disorders: interpersonal difficulties. When people have distorted ways of thinking about themselves and others, have difficulty regulating their emotions, and have trouble regulating their impulses, it only makes sense that these problems will go on to affect the way they enter into, and behave in relationships; the way they handle conflict with others; and the way other people will react to them.
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