Personality Disorders and Marriage

by

Rabbi Simcha Feuerman, LCSW and Chaya Feuerman, LCSW

Psychotherapists

According to the soon-to-be-published DSM V (Diagnostic and Statistical Manual for Mental Disorders), a personality disorder is defined by an impaired sense of self-identity or failure to develop effective interpersonal functioning. Personality Disorders and marital difficulties go hand in hand. This is because persons with Personality Disorders have difficulty relating well and understanding other people, often are stuck in rigid and unhealthy thinking patterns, and have difficulty managing the way their inner emotional states and needs moderate in relationship with others’ emotional states and needs.

It is crucial for parents, shadchanim and rabbanim to understand that Personality Disorders can go undetected until marriage, especially with bright and motivated people. This is because when a person is single, he or she can compensate for poor relationship skills by dazzling others with his or her charm, intellect or beauty to the point where the need for control or insecurity is not overtly detectable.

For example, a young man or woman can be highly perfectionistic, controlling and rigid. However, if he or she is at the top of the class or shiur, may be perceived as ambitious and scrupulous. The negative aspects of these traits are only noticed after the marriage begins to fail under the stress of narcissism and inflexibility. Or, a person may be outgoing, attractive and vivacious. Since he or she is very charming and always the center of attention, no one notices the terrible insecurity and hunger for attention until it interferes with a stable relationship.

The DSM-IV lists ten Personality Disorders. While the newest DSM uses only 5 Personality Disorders and measure various traits, we find the DSM IV definitions to be very understandable for the layperson so we will stick with them.

In this series of articles, we will discuss in detail the correlation between each Personality Disorder and various marriage difficulties.

Narcissistic Personality Disorder

The DSM IV criteria for NPD is as follows:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) has a grandiose sense of self-importance

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people

(4) requires excessive admiration

(5) has a sense of entitlement

(6) is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends)

(7) lacks empathy (is unwilling to recognize or identify with the feelings and needs of others)

(8) is often envious of others or believes others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes

Keep in mind that many of us have some of these traits some of the time, but a person with NPD has at least five of these traits as part of a pervasive pattern of relating.

It is possible to imagine that a particularly gifted young man or woman can rise to the top of the class or shiur, and show enough basic relationship skills to appear normal. However, once this person is in a close relationship such as a marriage which requires flexibility, sacrifice, emotional openness and empathy, the cracks in the armor begin to show. The person may insist that his or her spouse is not loyal enough and does not listen enough. Or the person with NPD may be selfish and uncaring about his or her spouse and children, making it a nightmare for the other spouse. What’s worse is that a more submissive and unassertive person may be attracted to the power and charm of the narcissist leaving him or her trapped in a relationship without the skills to make any countermoves.

Treatment for couples where one spouse has NPD will involve simultaneously building up the ability of the other spouse to set boundaries and develop healthy assertiveness skills, and working with the NPD spouse to become more aware and attuned to the impact of his or her behavior by correcting distorted beliefs about the world. This has to be done without overwhelming either party, having them feel overly criticized, or destabilizing the relationship.

Obsessive-Compulsive Personality Disorder .

This disorder is characterized by a preoccupation with orderliness, perfectionism, and control. People with OCPD are rigid and feel they are always right. They criticize others who are less “perfect” and can be extremely demanding, arrogant, irritable and controlling.

This is not to be confused with Obsessive-Compulsive Disorder (OCD) which is a syndrome in which the person experiences troubling and intrusive thoughts and therefore feels compelled to behave in certain ways to thwart or ward off the thoughts. For example, a person may have an irrational fear of germs, and to ward off this fear, constantly wash his hands, even hundreds of times a day. But OCPD is very different. The person with OCPD is not troubled by his thoughts nor does he find them intrusive. Quite the contrary, he completely agrees with his thoughts and does not find them irrational or bothersome. His only bother is, “Why isn’t everyone else up to his standards?” For example, he may be extremely scrupulous about saving water and get upset at people in the family who run the shower for too long, or have extreme requirements for neatness. Some people with OCPD who are learned and religious can end up torturing their family members with obscure chumros and halachic requirements that are not typically followed by even very devout people, yet are technically still on the rule books. Often it is hard to tell on the surface what is the difference between piety, yiras shamayim and OCPD. However, in the end, your gut knows. Even great and pious tzadikkim were patient, flexible, and loving in how they treated their family members. A person with OCPD will be demanding, arrogant, inflexible and impatient.

One can easily imagine how OCPD can make a marriage into a living Hell. The spouse can feel constantly criticized, belittled and attacked for every infraction and quite bewildered why nothing is ever good enough. On the other side, the person suffering from OCPD will genuinely feel frustrated, disappointed and betrayed by the inability of his spouse to “just do it the right way.”

While people with OCD can respond very well to medication, OCPD is more difficult because it is rooted in the personality. In general, personality disorders do not respond well to medication, despite family members desperately seeking any way out, and any way to get this problematic person to change.

In situations such as this, the treatment begins when the spouse is fed up and cannot take it anymore. The person with OCPD will be dragged into couples counseling convinced that his or spouse is crazy and hope that the therapist will see this and set the record straight. The treatment process will often be long and slow in the beginning, requiring the therapist to deftly use logic and other practical considerations to persuade the person with OCPD that although he or she may be “One Hundred Percent Correct”, his or her spouse cannot tolerate living at that level of perfection. Another aspect of the treatment involves building the ability of the person with OCPD to develop empathy and regard for multiple perspectives. It can be a long process because personality issues are deep down and can only be modified very slowly. Nevertheless, improvements come along the way and that can provide enough emotional satisfaction, connection and improvement that can allow the marriage to be relatively pleasant and stable.

Avoidant Personality Disorder and Dependent Personality Disorder

We choose to discuss these disorders together because their similarity and that in particular, the marriage dynamics are analogous. In each case, the other spouse is left “holding the bag”, having to partially manage the responsibilities and life concerns of the less functional spouse.

Persons with Avoidant Personality Disorder may be overly fearful of the possibility of criticism and rejection. This may manifest itself in a lack of appropriate assertiveness and social and occupational timidity. For example, they will have difficulty taking jobs that involve any form of confrontation, or even have hard time disciplining children.

Persons with Dependent Personality Disorder may have difficulty making decisions, be passive and rely heavily on others for personal and professional assistance.

Keep in mind, ALL of us have SOME of the traits mentioned in any of the personality disorders. It is the intensity and prevalence of the symptoms, as well as the degree of social or occupational dysfunction that makes it into a diagnosable condition.

These personality disorders would not be hidden during courtship, so if they come as a surprise later in married life, it is due to having seen these behaviors in a different light. Perhaps in the case of a younger person marrying an older person, these aspects of dependency were seen as endearing and a sign of youthful naiveté. Or, in general these behaviors were attributed to youthfulness and lack of maturity. However, as the honeymoon ends and real life takes over, those same endearing characteristics can become highly frustrating.

Further complicating matters is that since these symptoms and behaviors are evident during courtship, chances are those who choose to marry such individuals found the ability to be superior, more knowledgeable and having control to be attractive. In short, they liked telling someone what to do, and the other person enjoyed feeling secure in having someone who seemed to always know what to do. Yet, as the years go on, the person who is dependent or avoidant might resent all the control, while at the same time still in some ways be dependent or passive.

Treatment for this involves couples therapy that first allows for each party to explore their original expectations and understanding of their respective roles, how that was once a basis for attraction and mutuality. The next phase involves exploring what has changes and what each party needs to feel safe, loved and successful in life. Some individual therapy may be necessary for either party to make the required changes in attitudes and beliefs to adapt to the next stage. All in all, the prognosis can be quite good so long as there is a strong motivation on both sides to make it work and an open-minded attitude.

Borderline Personality Disorder

About two years ago we wrote a series specifically on Borderline Personality Disorder, and anyone interested in them can send us an email requesting a copy.

Borderline Personality Disorder is an emotionally painful and debilitating mental illness that wreaks havoc on marriages and families. Its main symptoms are extreme emotional states, stormy interpersonal relationships and self-destructive or violent behavior. However, these same individuals can be charming, passionate and highly intelligent with compartmentalized areas of super functionality, so it can be confusing for both the person suffering from the disorder and their loved ones. Persons with Borderline Personality Disorder are adept at inducing strong feelings of guilt and anger in the people they know.

According to the DSM-IV Borderline Personality Disorder involves an instability in relationships, problems with self-image, emotions, and impulsivity such as: (1) Frantic efforts to avoid real or imagined abandonment, meaning feeling alone or cut off from other people; (2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of feeling the person is wonderful and can do no wrong to intense hatred; (3) Unstable or poor self-image or sense of self and chronic feelings of emptiness or feelings of disassociation, meaning feeling disconnected from people and the world around them; (4) Impulsivity in at least two areas that are potentially self-damaging (e.g., spending money, promiscuity, drug/alcohol abuse, reckless driving, binge eating); (5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior; and (6) Intense anger or difficulty controlling anger or paranoid thoughts.

Typically, persons with Borderline Personality Disorder will be needy in relationships, make unrealistic demands and interpret normal limitations as unfair and cruel abandonment.

Because persons with BPD can be also highly competent and intelligent, as well as extremely exciting to be around when they are feeling okay about themselves, it is very possible to notice any serious problems during courtship. Typically, there will be feelings of intense passion and connection. While in hindsight, some of intensity might later be understood as part of the syndrome, at the time it all can feel like good fun. This is especially true for a young man or woman who is not so experienced in dating and relationships.

What will begin to show after the honeymoon wears off will be an extreme sensitivity to rejection and abandonment, abnormal levels of impulsivity, rage and self-destructiveness, and an inability to be flexible and reasonable.

Often, there are other secondary problems in the relationship, possibly on both sides such as poor communication skills. Treatment for this involves some couples therapy focusing on communication, de-escalating conflict, and emotion modulation. However, the couples work is unlikely to be successful unless the individual with BPD acknowledges his or her problem, and gets specialized treatment for it. One of the most recognized and evidenced based treatment for BPD is called Dialectical Behavior Therapy (DBT), that allows the person to internalize certain relationship and self care skills which reduce emotional reactivity.

A fascinating sidebar that reveals the amazing intelligence and competency that persons with BPD may have, despite severe dysfunction, can be found in the biography of DBT’s world-famous founder Marsha Linehan, Ph.D. She herself in her youth suffered from BPD and was hospitalized for 26 months in her youth and deemed “one of the most disturbed patients in the hospital.”

The high intelligence and competency may make it very hard for persons with BPD to face that they need treatment. They also can resent that their spouse gets off “scot free” without being seen as having any problems, and “nebuch had to be married to this ill person.” This is why couples treatment and a careful therapeutic process is advantageous in helping the person with BPD to come to a state of awareness and recognition of the problem without feeling scapegoated and stigmatized.

Anti-Social Personality Disorder

Persons with Anti-Social Personality Disorder lack a sense of conscience or empathy for others. They can be cold, calculating and manipulative and often violate the law. If they are intelligent they can use charm and wit to flatter and prey on others. Con artists, thieves, white collar criminals of the “Madoff” variety all belong in this category.

If it is black and white clear that you are married to such a person, get out. Find a way to get out quickly and avoid power struggles and conflict. People like this will almost always win because they have no scruples or morals to hold them back. They will not fight fair. If there are custody or financial battles, prepare yourself for a terrible, expensive and long haul, or just find a way to settle with a minimum of antagonism even if it means making many concessions.

However, often times it may not be so clear that the person you are married to fully fits the diagnosis. In general, diagnoses are not that scientific. This is why the mental health diagnosis manual is called the “Diagnostic and Statistical Manual”. Statistics, that is, prevalence, frequency and societal norms play a role in the diagnosis and therefore are far less conclusive than a CT scan or a blood test. People often have features of various personality disorders and do not absolutely fit one category.

In addition, substance abuse addiction, while a severe problem in its own right, can certainly cause people to mimic many behaviors of various personality disorders. A junkie will act with little remorse or moral compunction because he is helpless to his compulsive need to get his fix. He or she can rob, lie, or sell body and soul, quite literally, in order to feed the addiction.

Severe psychological trauma can also contribute to cruel, selfish and hurtful behaviors for some persons. Once again, while trauma is a serious condition also requiring treatment it is not the same as Anti-Social Personality Disorder.

Furthermore, not every greedy and impulsive person who commits crimes is suffering from this disorder. Bad judgment, immaturity, impulsiveness and greed may not be great features of personality, but people can make mistakes as well and learn from them. If you find yourself married to someone who is committing criminal behavior, of course the behavior must be confronted and corrected, but it does not mean the person is suffering from Anti-Social Personality Disorder.

The major deciding factor is the lack of conscience, remorse, regret and feeling for the victims. If you discern a pattern of cruel or manipulative behaviors without any feelings of guilt or shame, then it is time to become concerned. Remember, a person with this disorder will never feel guilty or bad about what he does. If he does sometimes, and other times does not, the diagnosis does not fully apply. Get help from a professional who is knowledgeable and well-versed in the treatment of personality disorders so you can get a more objective perspective.

Concluding Thoughts

One final point about all personality disorders – don’t be quick to diagnose your loved ones. The Gemara (Bava Metzia 59a) speaks of how one must be more sensitive to a woman because “Her tears are accustomed to come”. The Gemara doesn’t blame or pathologize women for crying, rather it warns the men to be more careful in regard to their wives’ feelings. In addition, the Steipler Gaon ZT’L warns in his Iggeres Kodesh that a husband’s neglect of his wife’s emotions and wish to be loved can lead her “almost to the point of death, from the great distress she feels.” Clearly, the Steipler was not saying that extreme emotional pain be treated as histrionics and be ignored. Furthermore, at times, if the husband is unusually cold and remote, his wife’s behavior will appear bizarre and needy when actually it is he who is the ill one. Think of a person who hasn’t eaten for three days sitting down to a meal with a group of well-fed mannered individuals. He will appear to be gluttonous and uncivilized to those around him who have no idea what deprivations he went through.

Labeling your spouse as “ill” might be a way to avoid looking at the important role you play in the success or failure of your relationships.