Personality disorders (PD) diagnoses normally overshadow Complex trauma diagnosis. Most clinicians don’t even believe that pwPD (person with a personality disorder) suffered from trauma. Even if the clinician is trauma oriented, s[h]e may see the symptoms of trauma, but more often, the clinician will spot the PD presentation and may forget to assess for C-PTSD (complex trauma).
Clinicians may assume that the person suffered from traumatization early in life, but the symptoms and emotional difficulties that a personality disorder like NPD present may be so debilitating that treatment may focus on that, and neglect the trauma.
Since I use the trauma lens in general, and leverage in neurobiology to set my treatment plans, I see individuals that suffer from a personality disorder as individuals that need to regulate the activation of their autonomic nervous system, recover the capacity to have an observing ego, fix the distortions of their perception, and work on integrating the parts of the personality that dissociated from the core as part of the dysregulation (or the traumatization) and the maladaptation that the personality (or personalities) suffered. Those steps are basically identical to the treatment of C-PTSD. That’s why I think that we should care more about treatment than diagnoses, and that PD should be considered trauma based in order o modify their treatment.
Personality disorder symptoms normally present on top of the complex trauma ones. It’s as if a person with a PD has a set of symptoms that reflect on their personality, and a set of symptoms that reflect in all other aspects. As a clinician, if the personality disorder is evident, I may not spend too much time trying to find out about the way they were traumatized since many people with PD will deny (or don’t remember) a traumatic upbringing. Most people with NPD for example, praise their families as the strategy to feel superior. If they (or others) perceive their families as “defective,” that makes them defective, and that’s inadmissible for survival. On the contrary, if the trauma is evident, then I may not focus too much on trying to figure out what personality disorder presentation they have, even when ideally, you’ll see eventually notice it.
I treat PD, including NPD (narcissistic personality disorder) as trauma clients with an extra emphasis on correcting the alterations in the personality that they suffer from but after treating the complex trauma ones.
Personality disorders are different aspects of the same phenomena: the child needed to adapt to an environment that was not inviting, safe, nurturing, comforting, validating, etc., and that caused them to lose the connection with their Self.
Depending on the circumstances, starting in childhood and going on for many years, each person develops a set of “strategies” to belong, adapt, survive, and/or thrive adverse circumstances, which have consequences in their personality. These strategies are based on a distorted perception of reality and the fact that there is always a missing integration of a sense of self, and a difficulty managing interpersonal dynamics. That’s why they are called PERSONALITY disorders. Because of the way they perceive, define, identify, and present themselves is affected by the dysregulation of their emotional brain and the confusion and lack of acceptance when compared with other’s responses.
In PD there is also the issue of having more emotional needs than “others” which push them to focus on having those needs met and disregard the needs of others. The integration of “the other” is part of the treatment, whether their presentation similes NPD or any other.
Once treatment focuses on correcting the deficiencies or alterations that mirror those with C-PTSD, then the personality disorder traits are less evident and significant, and will eventually become a ‘non-issue.’