Reconceptualizing Personality Disorders as Interpersonal Reactions to Childhood Relational Wound

This session is available for 1.5 APA and ASWB credits.

Abstract
Childhood experiences of trauma are pervasive and exceedingly common. Childhood trauma, which often occurs during imperative developmental periods, provides an ongoing dysregulation of the biological stress system, and continues to impact development (De Bellis & Zisk, 2014). The developmental impacts of this exposure increase in severity and complexity over time and often becoming chronic and debilitating in adulthood (Ford, 2018). Chronic exposure to interpersonal trauma during key developmental periods has long lasting impacts, such as increased rates of PTSD, depression, anxiety, antisocial behaviors, dissociation, and substance use disorders. Some researchers have advocated for the recognition of complex developmental disorder as an explanation for these symptoms (De Bellis & Zisk, 2014). In the current context, personality disorders are characterized by enduring and inflexible patterns of cognition, affect regulation, interpersonal and self-functioning, and impulse control issues seen across multiple environments and domains (Voestermans et al., 2020). While research suggests an association between personality disorders and interpersonal dynamics (Benjamin, 1996, 2010), few studies have proposed childhood trauma as a primary catalyst in personality disorders.

The current proposal conceptualizes personality disorders as ongoing and sophisticated interpersonal defense reactions to perceived relational threats, which are informed primarily by childhood relational wounds. Our stress response system, the autonomic nervous system, is designed to keep us safe from harm. For individuals who experienced ongoing childhood trauma, the autonomic nervous system may begin to perceive aspects of the interpersonal process as a threat. To establish safety, this heightened stress activation causes an interpersonal push and pull, moving the individual either away from or toward the threat. When experienced in childhood, well-meaning supportive others may misinterpret this reaction as “misbehavior,” which can result in punishment of the child, thereby eliciting shame and further heightening the child’s stress response within a relational context. This experienced relational dynamic becomes inherently self-reinforcing and can generalize to other interpersonal relationships. As adults, these children tend to recapitulate this pattern in their current relationships, generating interpersonal conflict across contexts. This process is also maintained in psychotherapy, often garnering a personality disorder diagnosis.

Although clinicians are trained to identify and treat relational patterns, they tend to conceptualize clients with personality disorders as difficult, rigid, and untreatable. Without the awareness of these sophisticated traumatic reactions, clinicians may struggle to meet their clients with compassion, due to finding themselves in shared trauma-driven interpersonal reenactments. As a result, therapists may inadvertently reinforce the individual's safety-seeking relational patterns. By developing an understanding of the trauma-informed relational dynamics occurring for individuals diagnosed with personality disorders, clinicians may develop greater empathy and confidence in the treatment of personality disorders. This proposal aims to reconceptualize personality disorders as interpersonal reactions to childhood relational trauma and to emphasize the importance of relational healing in the treatment of personality disorders.