Hold up. Personality Disorders and any other conditions (such as PTSD) that are thought to have origins in trauma are all still mental illnesses, full stop. These are mental health conditions that inhibit a person's ability to function. You can't just say that it's not an illness (and therefore can't be treated through medications) if there's not physical component of it. First of all, you'd be 100% Dead-On-Arrival wrong.
Traumatic stress is well documented to have physical impacts on the brain. These physical changes create the biological imbalances that lead to these behaviors. This is why
pharmacological therapy can have benefits for some people. In fact, SSRIs and SNRIs have shown
significant benefit in treating those with PTSD.
Some personality disorders can be treated through medications,
particularly through mood stabilizers and anti psychotics with BPD. Some don't respond to medications very well, but that doesn't mean there aren't biological causes for the disorder. In fact, ASPD is a notoriously treatment resistant disorder, but those diagnosed with it share very interesting
brain abnormalities in structures responsible for generating empathy, or in their case, lack thereof. Two other good examples are that NPD patients show a
neural disconnect between self and reward, and
OCPD patients show spontaneous activity compared to normal brains that indicate potential neurobiological causes for their disorder. My point is that you're completely wrong about these illnesses because they don't have biological changes. They do, very much so, so much so that some can be treated through medications (which completely contradicts what you said). Others are resistant to medications but still exhibit physical structures that may be indicative of a neurological cause that in the future might help us find treatments.
TLDR: PDs are mental illnesses. It's well documented within peer reviewed scientific literature. What else would they be if not mental illnesses?
Many — perhaps most — contemporary British psychiatrists seem not to regard personality disorders as illnesses. Certainly, it is commonplace for a diagnosis of personality disorder to be used to justify a decision not to admit someone to a psychiatric ward, or even to accept them for treatment — a practice that understandably puzzles and irritates the staff of accident and emergency departments, general practitioners and probation officers, who find themselves left to cope as best they can with extremely difficult, frustrating people without any psychiatric assistance. The reasons for this attitude were explored by Lewis & Appleby (
1988). Using ratings of case vignettes by 240 experienced psychiatrists, they showed that suicide attempts and other behaviours by patients previously diagnosed as having personality disorders were commonly regarded as manipulative and under voluntary control rather than the result of illness, and that the patients themselves were generally regarded as irritating, attention-seeking, difficult to manage and unlikely to comply with advice or treatment.
Personality disorders are described in the International Classification of Mental and Behavioural Disorders (ICD-10) as ‘deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations’; they represent ‘either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels, and particularly relates to others’ and are ‘developmental conditions, which appear in childhood or adolescence and continue into adulthood’ (
World Health Organization, 1992a ). They are distinguished from mental illness by their enduring, potentially lifelong nature and by the assumption that they represent extremes of normal variation rather than a morbid process of some kind. Whether or not these assumptions are justified, there is broad agreement that personality disorders are important to psychiatrists because they impinge on clinical practice in so many different ways. People with personality disorders are at increased risk of several different mental disorders, including depressions and anxiety disorders, suicide and parasuicide, and misuse of and dependence on alcohol and other drugs. In addition, people with schizotypal personalities are at increased risk of schizophrenia and those with anancastic personalities are at increased risk of obsessive—compulsive disorders. The presence of a personality disorder also complicates the treatment of most other mental disorders, most obviously because the individuals concerned do not easily form stable relationships with their therapists or take prescribed medication regularly. Indeed, in group settings they often disrupt the treatment of other patients as well. Finally, with or without treatment, the prognosis of most mental disorders is worsened by coexistent personality disorder. Because of these important, complex relationships, it is taken for granted that psychiatrists need to be alert to the presence of personality disorder, even if, as is often the case, the disorder does not correspond to any of the distinct types described in textbooks and listed in glossaries. The contentious issues are whether personality disorders are amenable to treatment, and whether people displaying these habitual abnormalities of behaviour deserve to be accorded the privileges of the ‘invalid role’.
If personality disorders are not to be regarded as mental illnesses despite their undisputed relevance to psychiatric practice, the obvious alternative is to regard them as risk factors and complicating factors for a wide range of mental disorders, in much the same way that obesity is a risk factor for diabetes, myocardial infarction, breast cancer, gallstones and osteoarthritis, and complicates the management of an even wider range of conditions. Like personality disorder, obesity is listed as a disease in the ICD-10: it is coded E66 as an endocrine, nutritional or metabolic disease (
World Health Organization, 1992b
