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Dogra Magra
2,911 Posts
Most PDs impact your ability to function and/or cause problems for society. That seems to be the benchmark, since it's not like professionals can see into what you're actually thinking or feeling on the inside.

I've read a lot on Cluster B disorders, and my general understanding (or "bull**** theory" more like) is that PDs are largely caused by adverse environmental factors. Prolonged exposure to a bad environment causes our personalities to adapt to them, which in turn might make us less functional in the outside world/"normal" environment. Trauma seems to arrest development, and different PDs display predominant traits of different "stages of development" in that sense.

Cluster B would run the spectrum of histronic on the one end (~adolescent age) to malignant narcissist and antisocial on the other end (~preschool). The underlying "wounds" are the same, but their responses/adaptations are at different levels of sophistication. Otto Kernberg talks about this. Borderline PD is so-called because it was considered the "borderline" between psychosis and neurosis. Toddler age and below would tend to have trouble distinguishing reality (blending elements of fantasy/imagination). Those would be the Cluster A disorders, which themselves run along a spectrum from more psychotic (shizoaffective/schizophrenia) to less (schizoid). I don't know much about Cluster Cs, but those seem to be more "neurotic" in nature and more about cognitive distortions rather than delusions. But basically all the PDs seem to run along a spectrum by this theory - which I've probably done a poor job of explaining, but oh well.

Tldr, I think there are various milestones you have to hit in order to have a functional adult personality. And if you miss one at different points along the way, they manifest as the respective PDs.

Honestly I think psychotic disorders could receive better treatment if professionals stopped pushing pills so much and looked more into the underlying root causes instead. But that doesn't seem to be a popular view in contemporary psychology. I've read that people like genetic explanations for illnesses because they think it promotes compassion, but in practice it often does the opposite - it makes people see the mentally ill as "born defective" and such.

I've heard BPD improves through stable relationships sustained over years (which are probably hard for the sufferers to sustain in the first place), and NPD can potentially be improved by inducing an "existential crisis" and helping them rebuild their whole self from the ground up. Anecdotally, I see AvPD as a stepping stone or more treatable variation of (covert) NPD/BPD, but that may not be generalisable to all cases.
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