A few years ago, a long term relationship I was in ended, suddenly and painfully. Nearly a year later, I’d found out that my former partner had cheated on me for at least the last five months of our relationship, relying on me for emotional support as his mother was dying while simultaneously lovebombing and creating an entire new fantasy world to disappear into with somebody new. At the same time as he was texting me that it felt like there was a “hole in his heart where I should be,” he was also going on fabulous international vacations with her, convincing her to move entire countries so that they could be together. The revelation shocked me. I spent almost that entire year afterwards going over and over the relationship in my mind, talking to my friends, and also talking to my therapist. Both of us were stunned about the way the relationship ended, the betrayal of my trust, and the flagrant disregard for my sexual health.

While processing the end of the relationship, a friend of mine suggested idly that my ex sounded like a narcissist, and when I talked to my therapist about this, he confirmed that some of the behavior sounded more to him like it could potentially land somewhere on the spectrum of anti-social personality. This was jarring to me, and I quickly fell down the rabbit hole of seemingly well-meaning Instagram graphics and Quora posts about mental health, personality disorders, and relationships.

As all of this was happening, I was also finishing up my last semester of grad school, getting my Masters in clinical social work. I was interning in a psychotherapy clinic, studying cognitive behavioral therapy, and being supervised weekly. Almost everyone who surrounded me was a therapist, or in training to become one. It became clear to me that the ways in which we talk about personality disorders in grad school and as professional therapists, and the types of information I was encountering online, were vastly different.

Personality disorders, perhaps more than any other diagnosis, are captivating to pop culture. You see it in the popularity of movies like Sybil (which is supposedly about what is now known as dissociative identity disorder) and the fervor they generate in the public mind. In pop culture, personality disorders tend to be highly dramatized, almost fantastical in nature. Anti-social personality disorder, borderline personality disorder and narcissistic personality disorder (three of the four Cluster B personality disorders) are perhaps the most well-known among them, and the communities that pop up online tend to reflect this cinematic pop psychology understanding of them, which is damaging and stigmatizing to folks who actually live with these diagnoses. In self-help books aimed at assisting laypeople in recognizing these characteristics, people with personality disorders are often lumped into the sensational category of emotional, psychological, or energetic “vampires,” though Healthline is quick to point out that this framework of personality disorders as “inherently evil and incapable of change…don’t do justice [to their] complexity.”

It’s not hard to see why characterizing personality disorders in this way is compelling: Often, these spaces seem to be curated by folks who have survived abuse from “narcs.” The narratives tend to be extremely polarizing – an us vs. them approach that reiterates, again and again, that if you suspect you are in a relationship with someone with a personality disorder, you should run. These narratives are replete with the black-and-white, all-or-nothing thinking that, ironically, often presents in folks with diagnoses like borderline personality disorder; the world is divided into the narcs/abusers and the empaths, who are positioned as perfect angels haplessly taken advantage of, time and time again.

I’ll admit that, in the most painful moments of trying to reconcile the end of this relationship and the betrayal for which I was afforded no opportunity for closure, this positioning was appealing. It made my ex all bad, and allowed me to remain blameless. Yet for the most part, it still didn’t sit right with me. Instead I turned to books, and learned that characteristics like narcissism and empathy – like most qualities we contain – exist along a spectrum. In fact, in Rethinking Narcissism, Dr. Craig Malkin explains the nuance in this spectrum – some narcissism is healthy and protective, and too much empathy (and lack of boundaries) can actually be quite problematic, codependent, and also lead to toxic patterns in relationships, something I learned the hard way, again, when the relationship that followed this one contained similar dynamics.

These patterns prompted me to shift my focus toward my own healing, and to prioritize a compassionate and non-judgmental but incisive look at the role I played in relationships: my willingness to look past the red flags that showed themselves early on, my commitment to ignoring my intuition and the somatic cues from my body that were trying to let me know that, regardless of whether or not these partners met whatever criteria in the DSM-5, there was something off in the relationships that required my attention.

Here are some of the things I learned:

It’s Not Your Job to Diagnose Your Partner

Unless you’re a trained clinician, it’s not your job to diagnose your partner. Even if you are a trained clinician, you’re not equipped to diagnose someone with whom you’re in a personal relationship. It’s not only unethical, but it also can’t be done: Diagnosis is a tricky art form, and even now, after two years of school, and two years of clinical practice, it’s still something that makes me vaguely uncomfortable when I try to do it.

Instead of focusing on whether or not someone your dating might fit the criteria for some kind of diagnosis, pay attention to your experience of the relationship. Some helpful questions might include:

• Does this person treat you with respect? Do you share similar values?
• Do you feel safe with them? (Do you know what safety feels like in your own body?)
• Is there reciprocity in your relationship – are you curious about each other, supportive of each other? Do you make each other laugh?
• Are they someone you can trust when you’re feeling low, or when you’re in a crisis?
• Are you comfortable with them, or do you feel like you have to perform in some way? What type of performance do you find yourself taking on?
• Do they respect your boundaries, or do you find yourself having to assert them again and again? Can you speak openly with them, or do you hold yourself back, afraid to speak your mind fully?
• How do you handle disagreements and arguments in your relationship? What shape does anger take between you?
• How do you each apologize, and what does accountability look like between you? Do apologies result in changed behavior?
• What processes do you each have for repairing a rupture and comforting each other after difficult conversations? Do you feel as though you can return to previous disagreements even after some time has passed, if you still have things you need to communicate with them?

Personality Disorders Are Often Related to Trauma

In my practice, I’m hesitant to diagnose, unless it’s something that a client specifically asks of me. Even then, it’s something that I work on collaboratively with my clients – I ask them what their views are on diagnosis, and what diagnoses they’ve learned about that resonate with them. I let them know, if they aren’t already aware, about the stigma associated with personality disorders, and we work out what that means for our work together in terms of paperwork. Some people are uncomfortable with the idea of having a paper trail that includes a stigmatized diagnosis in their medical record, because even among therapists and other mental health professionals – as well as some doctors – folks with a diagnosis of borderline personality disorder, for example, experience discrimination, often compounded by other axes of marginalization such as race, gender, class, and disability.

What I find most often is that the symptoms of borderline personality are also highly reminiscent of the markers of trauma – intense mood swings, all-or-nothing thinking, patterns of self-harm or suicidal ideations, struggles around substance use and food, highly unstable relationships, difficulty controlling anger and anxiety, grandiose thinking, and deep, deep self-loathing. From a strengths-based perspective, I often explore with clients the ways in which these patterns emerged, primarily, as an attempt to keep clients safe in childhood while they tried to navigate unpredictable, chaotic, or violent environments. Even behaviors in relationships that could be manipulative or emotionally abusive are often made in response to frightening out-of-control feelings and an intense, desperate desire for safety. When I work with clients, we work on understanding the feelings, the context and history of the feelings, and the ways in which they relate to clients’ behaviors – as well as how these behaviors impact clients’ friends, family members and partners. Particularly useful is the DBT Skills Workbook. DBT is a form of therapy that was created by Marsha Linehan specifically to work with clients with borderline personality disorder, to help them tolerate and regulate their intense and scary feelings. The beautiful thing about the DBT Skills Workbook, though, is that anyone can use it – and it can be helpful for pretty much anyone.

I think it’s a good idea for everyone to take a trauma informed approach to their relationships. If you’re dating, and you’re in therapy, and you consider yourself pretty on top of your shit emotionally, it’s a good idea to ask yourself what it means to be trauma informed both for yourself, and also in terms of your partners.

Some questions to consider:

• How much do you know about trauma and the body?
• How comfortable are you talking about things like recognizing a partner’s triggers, and having conversations around how you can be supportive of them if they’re activated?
• Do you feel okay hearing that what someone might need in that situation is to be left alone – or would you receive that as a rejection?
• What do your boundaries – both interpersonally, but also your own internal boundaries and self-regulation – look like, and how does your prior history (in terms of romantic relationships, but also in terms of your upbringing and attachment history) get poked in current romantic relationships?
• How might you grow into a more trauma informed partner?

I am not the type to believe that we need to be completely healed before we enter into loving relationships – in fact, I think that when we work towards building healthy, reciprocal, and respectful relationships, we are simultaneously actively healing. Still, there are some patterns of behavior that – all diagnoses aside – can make relationships difficult if not harmful. If, for example, your partner is constantly checking in on you, doesn’t trust you to the point of you feeling as though you need to alter your own behavior (not seeing friends, not wearing what you want to wear), or if you find that threats of self-harm or suicide being used as a means of controlling the outcome of disagreements and conflict, I would recommend taking some time to pause and consider how these patterns impact your own mental health, and what you want your boundaries to be around such behavior.

These patterns, I also want to note, have less to do with a personality disorder diagnosis (they can show up in extreme anxious attachment styles or in folks who struggle deeply with codependency, for example). More important is to consider your partner’s awareness around these behaviors, what efforts they are making to communicate more healthily, and whether or not it is sustainable for you to be in a relationship where these patterns are present.

It’s Not Your Job To Heal Your Partner

People with personality disorders – especially borderline personality disorder – get an extremely bad rap online. It’s dangerous to conflate harm in relationships with personality disorders – so many other factors contribute to how we experience relationships, both as people who experience harm, and as people who harm others. None of us is perfect, and all of us deserve kindness, compassion, and patience. After all, no one teaches us how to be in relationship with each other, and we have very few models of what healthy relationships look like. We’re all living in the same toxic stew of cissexist, white supremacist, heteronormative patriarchy, and these systems have shaped the way we relate to each other – even those of us who have put in a lot of work for years trying to unlearn them.

That said, you deserve to feel safe and be treated with dignity, respect, and kindness in your relationships. Regardless of who you’re with, if you notice yourself feeling anxious, nervous, afraid, consistently confused; if you’re afraid to speak up, afraid to disagree; if you’re not telling your friends about your relationship because you want to protect the image they (and you) have about your partner – all of these are red flags. They happen in relationships with folks who have personality disorder diagnoses, and they happen in relationships with folks who don’t. They happen in relationships with folks who have trauma histories, and they happen in relationships with folks who don’t.

You are not responsible for your partner’s healing.

The only person’s healing you have control over… is your own.

Regardless of who you’re dating, one thing is clear: Relationships require us to know ourselves, deeply and well. To know what our values are, and how to stick to them. To know what our boundaries are, and practice speaking and holding them, firmly and with compassion. If you feel like a relationship is taking you away from yourself, if it’s making you sad and anxious, if it makes you doubt yourself… that information is more important than any diagnosis ever could be. Your first and most important relationship is the one you have with yourself, and your diagnostic criteria for staying or going is whether you are acting in integrity with yourself. Let that be your guide.

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