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Karen's Blogs

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Neurotic versus Personality Disordered

I remember being fascinated in my social work psychopathology class as my professor described two types of clients we’d be treating. One type would seek us out and the other likely would need to be dragged, kicking and screaming, into our offices. Although I’m not sure after 30-plus years in practice that I’d draw such a sharp distinction between the two types, I do think back to my professor’s description when I meet clients for the first time or listen to them talk about the folks who populate their lives.

The first type has what we call a neurotic disorder. To paraphrase my professor, they think that all their problems are their fault. No matter what has happened to them, they brought it on. They made the wrong choice, didn’t see something coming, and berate themselves for staying too long in bad situations. They are mercilessly hard on themselves and shockingly easy on other people, many of whom don’t deserve their understanding or mercy. They feel defective, not good enough, broken, less than, and have—no surprise—low self-esteem. Their self-regard is conditional, based on achievement or being loved by others.

The second type has what is called a personality or character disorder. My professor described them as believing that their problems are everyone else’s fault and never theirs. No matter what has happened, other people are to blame. Those who are character disordered will go so far as to insist that others actually made them do something and that they, themselves, couldn’t possibly be responsible. They feel superior to others and carry an unwarranted sense of entitlement. Their self-regard is unconditional because they couldn’t possibly imagine (or, more precisely, tolerate the distress of thinking) that something might be wrong with them.

Take a wild guess which type of people generally seek out therapy to change or better themselves? Those with a neurotic disorder, of course, who are constantly trying to fix themselves. They may not be all that mentally unhealthy but want to cover all the bases just in case. These people work incredibly hard in therapy and most do extremely well— as opposed to character disordered clients who have a rough time unless they’re there to complain about someone else and want help in getting others to change.

Truly, my heart goes out to character disordered people who find it too painful to see themselves as humanly flawed, and my heart goes out equally to those who can’t stop wishing to be perfect so that they can begin to love themselves as is. By the way, since you’re reading this self-help blog, I think I know which type you are.

Best,

Karen

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