The New Elephant in the Room: Why All Professionals Need to Learn About Personality Disorders ©2023 Bill Eddy, LCSW, Esq. In 1994, a best-selling children’s book was published titled An Elephant in the Living Room, to help children learn about alcoholism—a topic that had been taboo to discuss or even acknowledge even though “at least 7 percent of the U.S. adult population is estimated to suffer from alcoholism.”[1] It wasn’t just children who weren’t discussing it, most adults hesitated to talk about it for fear of upsetting the person with alcoholism, their family, their workplace, or their community. Yet over the past few decades, our society has learned a great deal about alcoholism, including how to recognize it, set limits on it, and treat it. We are now at a similar point in history in regard to personality disorders—a topic that has been taboo to talk about or even acknowledge up to the present, even though as of 2022 the diagnostic manual of mental health professionals estimates that over 10 percent of the adult population would meet the criteria for a personality disorder, even though most have never been formally diagnosed.[2] This has become a public health problem comparable to alcoholism in its ability to ruin the lives of those who have it, those close to them, those professionals working with them, and society at large. The time has come for all professionals, especially those involved in legal disputes, workplace conflicts, and child and family problems, to learn about personality disorders, talk about them openly, and take their significant issues into account in their work. This article provides a background on: 1. Why personality disorders are interpersonal disorders. 2. The growing societal impact of personality disorders. 3. Concerns about stigmatization and discrimination. 4. Training available from High Conflict Institute. 1. Interpersonal Disorders There are several fundamental differences between personality disorders (hereafter “PDs”) and other mental disorders. PDs are primarily interpersonal disorders marked by interpersonal dysfunction, which means that their most difficult behavior comes out in relationship to other people, so that many more people are impacted than just the individual who has the disorder. As a major review of over 120 studies on this subject has noted: Personality disorders are defined in the current psychiatric diagnostic system as characterized by pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others that cause significant distress or impaired functioning in interpersonal or professional domains. The importance of interpersonal dysfunction in defining personality disorders is clearly evident in their descriptive features and diagnostic criteria—each personality disorder, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders [currently DSM-5-TR], is described by a problematic approach to interpersonal interactions, or by characteristics that are likely to interfere with adaptive interactions and relationships.[3] Lack of Self-Awareness Another way in which PDs are different from other forms of mental illness is that most people with PDs do not know they have a disorder or even a problem. This has been noted by mental health professionals for decades, as Aaron Beck, Arthur Freeman and Associates wrote over thirty years ago: Personality-disordered patients will often see the difficulties they encounter in dealing with other people or tasks as external to them, and generally independent of their behavior or input. They often describe being victimized by others or, more globally, by ‘the system.’ Such patients often have little idea about how they got to be the way they are, how they contribute to their own problems, or how to change.[4] The result of this lack of self-awareness and feeling like a victim in life can contribute to significant conflicts in families, in the workplace, and in legal disputes. They frequently claim that others mistreat them when they are not being treated badly, but simply perceive that they are. They may over-react to mild rejections or actually be rejected because of their own behavior. Of course, there are many people with personality disorders who are also victims of crimes, targets of domestic violence, those who suffer personal injuries, those who are swindled in business deals, and so forth. Therefore, handling their conflicts with knowledge and skill matters, both for the person with a PD and their targets of blame. Lack of Behavior Change The definition of a PD in the diagnostic manual begins with this sentence: “An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.”[5] The fact that this pattern of behavior is enduring is one of the biggest misunderstandings that most people, including professionals, have about PDs. Victims of domestic violence keep wishing and hoping for a change that doesn’t come. Workplace managers figure that the person knows their behavior is inappropriate and will stop themselves, while giving second and third and fourth chances with little or no change. Civil judges and family law judges often don’t recognize the individual’s dysfunctional interpersonal patterns and accept their stories at face value, which may be significantly distorted or knowingly false. Ironically, judges and juries are supposed to determine the credibility of a witness, without realizing that many people with PDs in legal disputes thoroughly believe the distorted statements they are making, that they are skilled at blaming others, and therefore appear very credible—sometimes even more than the true victims of their hostile behavior. For this reason, many courts get these cases backward. Legal decisions would be vastly more appropriate by understanding the true dynamics and needs of people with PDs and those around them. Not a Traditional “Mental Illness” Personality disorders are usually not obvious at first. Not only do people with this disorder not realize they have it, but those around them often are also unaware—until there is a crisis or they get into conflicts in a close relationship. They can be very successful in life, although many are not. They generally are considered to know right from wrong (especially under the law), but they often put a spin on their perceptions,