Personality is the set of habits in how a person reacts to others, themselves and situations, and it is the one thing every patient brings. It is best understood through themes and stories rather than trait scores, and clinicians who leave it out of the formulation mistake it for treatment resistance.
What it is
Personality is a collection of habits and responses in how we react to other people, ourselves and situations: how you do things, and how you relate, think and feel about yourself and others. It is informed both by the characteristics we are born with and by our development.
“a personality, in as brief as I can say it, is a collection of habits and responses that in terms of how we react to other people, ourselves, and situations, that is both informed by the characteristics we're born with and by our development”
6:09Assessment of Personality: Practical Assessment in a Short TimeframeMay 2025 Also said in 1 more episode
“Personality is just personality. the habits of who you are how you do things how you relate think and feel about yourself and others that are present from early on in development but are also developed in development”
3:06What Psychiatrists Get Wrong About Personality DisordersOct 2024 What really organizes personality is themes and stories: the person's primary narrative, or what some cognitive clinicians call schemas.
“What really organizes personality is something more like themes and stories. What's the primary narrative of the person, or what some of the cognitive folks call schemas”
40:31Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode Each style holds its opposite. The arrogant sense of being better than other people compensates for feeling worse than them, and you see both sides in every narcissistic person.
“There's the arrogant version of feeling better than other people, which is a compensation for the fact that you feel worse than other people. And you see both sides of that in every narcissistic person I've ever met”
43:05Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
Why it matters
Personality is the one thing every single patient who walks through your door is going to have, unlike every other diagnostic category.
“personality is the one thing that every single patient that walks through your door is going to have, as opposed to all the other diagnostic and pathological categories”
21:31Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025 Many clinicians cannot formulate how personality shapes a presentation, so they think everything that does not respond to meds is some form of treatment resistance.
“A lot of clinicians can't formulate how personality shapes a presentation. And then that clinician thinks everything that doesn't respond to meds is some form of treatment resistance”
19:03Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025 The old Axis I and Axis II split was simplistic, but it pushed us to think about personality alongside symptoms. Today many people stop at depression or bipolar, when personality runs through all of it.
“I do miss the old axis one and axis two split. It was simplistic, but it pushed us to think about personality alongside symptoms. Today, like we, a lot of people just stop at depression or bipolar, whereas personality is going to run through all of it”
48:01Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025 Many supervisors purposefully ignore personality, formulation and diagnosis, likely because of stigma.
“many, many supervisors purposefully ignore personality and formulation and diagnosis. They purposefully ignore it. I think there's stigma”
21:13Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025
Traits versus stories
Two people can have perfectly overlapping OCEAN (Big Five) traits and totally different life stories.
“you can have two people with perfectly overlapped ocean traits and they'll have totally different life stories”
9:43What Psychiatrists Get Wrong About Personality DisordersOct 2024 The DSM alternative personality model is a big improvement on the regular categories because it is dimensional, but it was built on traits.
“The DSM alternative personality classification is a big improvement on the regular DSM personality categories. But unfortunately, from my perspective, it's dimensional. That's why it's a big improvement. But they tried to do it based on traits”
43:53Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
How we use it
To really get a feel for a person, let their story affect you, feel what it stirs up in you, and hear the themes: the music behind the notes.
“to really get a feel for a person, you have to Let their story impact you, feel what it stirs up in you, hear the themes, the music behind, just the notes”
46:35Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode A diagnosis is just a small slice of who someone is, meant to guide a specific type of treatment. It does not encompass who they are.
“The diagnosis is just a small slice of who you are meant to guide a specific type of treatment. It doesn't encompass who you are”
48:37Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025
It also comes up on
- Alternative model for personality disordersLooking at criterion A and level of personality functioning, we have hardly made a borderline personality disorder diagnosis in two years. Most of the time we point to maladaptive personality traits or problems of personality functioning instead.
- ADHDMany social media descriptions of ADHD are describing a personality disorder. Older DSM editions named personality disorders as an ADHD mimic, and DSM-5 notes ADHD can be hard to tell from borderline, narcissistic and other personality disorders in adolescents and adults.
- Borderline personality disorderThe affective temperaments are easily mistaken for personality disorders: cyclothymia for borderline personality, as hyperthymia is for narcissistic personality. The misdiagnosis can go both ways.
- DSM-5Few clinicians have read the Section III alternative model for personality disorders or the general personality disorder text. Most people are better described by specific traits and general personality dysfunction, and that is in the DSM.
- Narcissistic personality disorderThe affective temperaments are easily mistaken for personality disorders: hyperthymia for narcissistic personality, as cyclothymia is for borderline personality. The misdiagnosis can go both ways.
- Personality disordersPeople rarely fit into one of ten personality styles. Most are better described by specific traits and general personality dysfunction, and for most the most appropriate diagnosis is probably other specified personality disorder, with traits of several disorders reflecting core problems in self and interpersonal functioning.
- Affective temperamentsHyperthymia can be mistaken for narcissistic personality and cyclothymia for borderline personality, and the misdiagnosis can go both ways.
- Alternative model for personality disordersIt centers personality pathology on personality functioning, how we relate to ourselves and others. That splits into self-functioning (identity and self-direction) and interpersonal functioning (empathy and intimacy), four elements in all.
From these episodes
- Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025 · 5 points
- Assessment of Personality: Practical Assessment in a Short TimeframeMay 2025 · 1 point
- Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024 · 4 points
- What Psychiatrists Get Wrong About Personality DisordersOct 2024 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.