How long does your personality last?
The Oxford English Dictionary defines personality as “The quality, character, or fact of being a person as distinct from a thing”, a usage dating from at least the 14th century. Personhood implies some sort of persistence or continuity of character: we expect who we are to be relatively enduring, perhaps changing only in response to overwhelming “life-changing” experiences. So, if your personality is disordered, then we should expect to see the same picture – if you are a personality-disordered person then you stay one under normal circumstances.
Indeed, through much of the history of psychiatry this has been the predominant way of thinking: personality disorder, with its synonyms such as the psychopathic state, has been taken to be a long-term problem, evident in early life and persistent throughout most of adult life. Thus DSM 5 says: “The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.” While ICD 11 has it that “Personality disorder is characterised by problems in functioning of aspects of the self … and/or interpersonal dysfunction … that have persisted over an extended period of time…”.
Unfortunately (for those who like the diagnosis, that is) the assumption of stability doesn’t stand up to scrutiny.
The persistence of “personality disorder” can be studied by following up and repeatedly re-assessing a group of people given the diagnosis, a so-called cohort study. Much the same sort of study involves following up people in treatment trials who have been allocated to the comparison arm rather than the active treatment arm – which typically means they don’t get an intervention likely to influence the natural course of what happens to them.
A number of studies* have now shown that people with the diagnosis of personality disorder “get better” – sometimes very quickly after diagnosis, about a half within 1-2 years, and the great majority within 10 years. This is a well-known phenomenon – in fact the ICD-11 definition of an extended period of time is only “2 years or more”.
How to explain this finding? In medical practice it is not uncommon to encounter conditions that improve, sometimes only to come back later – for example multiple sclerosis, tuberculosis, bipolar disorder. There are two views of what is going on here. The condition may not really have gone away but simply be in a dormant or non-aggressive phase (quiescence) or it may have gone away, but the disposition to get it again (perhaps genetic) has not.
The first of these explanations doesn’t work for our purposes: the diagnosis of personality disorder is a description of how somebody is living in the world, not of a bodily state that fluctuates to become be more-or-less easily observable. If the individual doesn’t meet the diagnostic criteria then they haven’t got the condition. It can’t be thought of as lying dormant somewhere any more than somebody who diets their BMI down from 35 to 28 can be thought of as having quiescent obesity.
There are several reasons why somebody might change from meeting to no longer meeting the criteria for diagnosis of personality disorder – adversities resolve, relationships improve, and that means that distress settles and it is these symptoms that now decline enough to take the individual out of the diagnostic range. By the same token a change for the worse may be provoked by a worsening of these same experiences. Seen like this, personality traits are simply names for the individual vulnerabilities or resiliencies that modify how we respond to circumstances.
So the answer to the question “How long does your personality last?” is “If your personality has been diagnosed as disordered, on average about 2 years”. If that doesn’t match your idea of what the word “personality” means, then you’re on the way to understanding why there are so many critics of a term that is widely seen as conceptually flawed as well as pejorative in its routine usage.
*One or two references…
Shea MT, Stout R, Gunderson J, Morey LC, Grilo CM, McGlashan T, Skodol AE, Dolan-Sewell R, Dyck I, Zanarini MC, Keller MB. Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. American Journal of Psychiatry. 2002 Dec 1;159(12):2036-41.
McGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC, Gunderson JG, Skodol AE, Shea MT, Zanarini MC, Bender D, Stout RL. Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. American Journal of Psychiatry. 2005 May 1;162(5):883-9.
Zanarini MC, Frankenburg FR, Hennen J, Silk KR. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. American Journal of Psychiatry. 2003 Feb 1;160(2):274-83.
Gunderson JG, Bender D, Sanislow C, Yen S, Rettew JB, Dolan-Sewell R, Dyck I, Morey LC, McGlashan TH, Shea MT, Skodol AE. Plausibility and possible determinants of sudden “remissions” in borderline patients. Psychiatry: Interpersonal and Biological Processes. 2003 Jun 1;66(2):111-9.