What is Personality Disorder?

What is Personality Disorder?

We are often asked this question by both patients and clinicians. Our definition most certainly goes beyond what you’d find in the DSM, because at Nysa Therapy, our focus is on WHY personality disorder makes sense, and why mental health practitioners should EXPECT patients to act the way they do.

At its simplest, personality disorder is a developmental arrest in the attachment and/or separation stage of development.

Infants and toddlers who had childhood trauma developed maladaptive ways to remain attached to or separate from their primary attachment figure (PAF).  The infants are trying to avoid abandonment, and the toddlers are trying to avoid engulfment.

We define trauma as the lack of attunement in any form: overt abuse or neglect, or a temperamental mismatch between the child and PAF.

The maladaptive ways the infant and toddler remain attached to or separate from their PAF evolve into defensive structures in the personality that persist into adulthood.  A defensive structure is a pattern of relationship between the child’s primitive internal image of themselves and their primitive internal image of the PAF who hurt them.  For example, many patients say, “I beat myself up.” We believe it is the hurtful PAF that is beating up the image of the self, and approach both therapy with patients and consultation with practitioners from this lens.

These defensive structures are stable, predictable patterns of reaction and behavior.  Their characteristics are descriptors of specific personality disorder presentations as detailed in the DSM.

It can be difficult to understand and accept that an individual with adult cognitive ability behaves as an infant or toddler. This is why most treatment for personality disorder fails. The reality is this: when threatened with abandonment or engulfment (either actual or imagined), the personality disordered patient reacts with a fight or flight response.  The individual simply has no control over this reflex.

The particular response is determined by the individual’s temperament and generally aligns with a specific personality disorder:

  • Active and extroverted temperament = fight response = borderline
  • Active and introverted temperament = flight or freeze response = avoidant
  • Passive and extroverted temperament = fawn response = masochistic
  • Passive and introverted temperament = feign response = schizoid

Nysa therapists expect our traumatized patients to regress to infant and toddler states. It is in those moments that we assume the archetypal role of the “good enough mother” in order to form a reparative secure attachment and heal their attachment wounds. Then, our patients are able to activate their true selves.

We believe that everyone already has within them all the potential to live a happy, authentic life. 

Our job as therapists is to remove the defensive structure that blocks activation of the true self.


If you are a mental health professional who needs support in treating personality disorder, we are here to help. Contact us about scheduling a free  case consultation and moving forward in therapy.