October 1, 2025 • 49 mins
This week we’re diving into a conversation about personality disorders with psychiatrist Dr. Tracey Marks. Dr. Marks breaks down what personality disorders are, how they differ from other mental health conditions, and some of the common misconceptions people have about them. We also talk about how personality disorders can impact relationships, what treatment can look like, and ways to show compassion for yourself or a loved one who may be navigating one.
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The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or
(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much
(00:57):
for joining me for session four thirty one of the
Therapy for Black Girls Podcast. We'll get right into our
conversation after a word from our sponsors. This week, we're
diving into a conversation about personality disorders with psychiatrists doctor
(01:20):
Tracy Marx. Doctor Marx breaks down what personality disorders are,
how they differ from other mental health conditions, and some
of the common misconceptions people have about them. We also
talk about how personality disorders can impact relationships, what treatment
can look like in ways to show compassion for yourself
or a loved one who may be navigating one. If
(01:40):
something resonates with you while enjoying our conversation, please share
with us on social media using the hashtag tpg in session,
or join us over in our patreons and talk more
about the episode. You can join us at community dot
therapy for Blackgirls dot com. Here's our conversation. Thank you
so much for joining us today, doctor Wax.
Speaker 2 (02:03):
Thanks for inviting me on.
Speaker 1 (02:05):
So I would love for you to stop by telling
us a little bit about your journey into psychiatry. What
made you pick that specialty.
Speaker 2 (02:12):
It's actually a little bit of an indirect route into psychiatry.
So I was initially interested in becoming an internal medicine doctor. Actually,
in college, I was interested in being an engineer, electrical engineer.
And this is so immature of me, but I don't
want to be a doctor because I'm like, they wear
white coats, that's boring. Who wants to do that? So
(02:35):
I did engineering, but then I started having second doubts
and decided after I graduated, to then go to medical
school because I really did want to help people. So
in medical school, though I grew up in the South,
we're both in the South, well in Atlanta, but I
grew up in Florida and in my environment, I had
(02:59):
never talk to anyone who'd ever been to a psychiatrist before,
and really didn't see the value of it, the need
for it, So it just was not even on my
radar going into medical school, And in fact, I deferred
the rotations. In medical school in your third year, there's
all these required rotations that you have to do, with
the basic specialty psychiatry being one of them. You're allowed
(03:22):
to defer one for your fourth year. So I deferred
psychiatry so that I could do research in internal medicine,
which is what I was interested in. You know, looks
good for your applications to do research. Then in my
fourth year, when I got around to doing my psychiatry rotations,
I was already in the thick of applying for residency
(03:43):
in internal medicine, and I did the psychiatry rotation just
to kind of get it out of the way, and
I was super surprised at how interesting it was and
how much satisfaction I got out of helping people with
their emotional pain over tweaking someone's blood pressure medications. But
I was too far down the road of applying for residency,
(04:08):
which is kind of like a draft process. They call
it the match, but you pick where you want to go,
places pick you and then you just get assigned somewhere.
So I was too deep into that, So I matched
an internal medicine and I changed after the match the
place where I matched it in New York, a psychiatry
resident couldn't start because of an illness in the family,
(04:30):
so they had an open spot, so they just switched
me from one roster to the next, and so I
was able to then start in psychiatry.
Speaker 1 (04:38):
Wow, and it is almost as if this is where
you were meant to be. It sounds like it really was.
Speaker 2 (04:44):
It really was where I meant to be. I mean,
I've always been one who, probably to my detriment, have
a little too much empathy. Sometimes I'm one of those
people who feels for people and things like that. And
I've known that about my myself, but still didn't equate
that too. I need to be a psychiatrist. But my
(05:05):
mom said something that was very enlightening to me. She said,
I was telling her about this guy who looked in retrospect.
He was probably on the spectrum, but you know, he
was socially awkward in things and I was talking about
how he needed a friend, and my mom was like,
you need to leave these people with problems alone. They
need professional help, they don't need friends, which sounds very harsh,
(05:28):
but she was right in the sense of what I
was tapping into is my desire to want to help
people professionally.
Speaker 1 (05:37):
Thank you so much for sharing that. And you have
done so many different things in your career, but most
recently you are doing a lot of mental health YouTube
videos about psychiatry and mental health concerns. What led you
down that specific career path.
Speaker 2 (05:53):
I started my own private practice in two thousand and six,
and what I noticed was I had been a part
of someone else's practice before that after residency, but when
I was kind of seeing my own patients and whatnot,
I would I spent so much time teaching them things,
And I thought, well, if they don't know these things,
(06:14):
how many other people don't know these things. And also
I was trained to do therapy as well, not just
prescribe medications, so I found that the kind of teaching
them about their disorders took up too much time from
talking about the real stuff, if you will, of their lives.
And so the initially it was about creating a library
of information that I could refer my patients to. Hey,
(06:37):
you know you want to know more about this, go
look at this. But then I thought, well, but there's
so many other people who could benefit from this. So
it became about educating the world, if you will, more
people than just the people I could see in my
practice about basic mental health things.
Speaker 1 (06:55):
And what has been the balance in terms of you
doing the videos on YouTube and yourtice. Are you still practicing?
I am still practicing.
Speaker 2 (07:03):
Okay. I have patients who I think fear that I'm
going to let them go, and I mean there's some
of them I've been seeing for twenty years, so it's
a relationship. At this point, I can't just let go
of them. But I've stopped taking new patients, so I'm
still managing. It's still a lot of patients. It doesn't
take up my whole week anymore. I get lots of
(07:26):
inquiries about can you just one more patient, one more
can you just take me? And the answer to that is, well,
if I did, it would be goodbye YouTube, because you know,
I really wouldn't have time to do anything else other
than see patients all day long, and at this stage,
of my career. I want to do more than that,
even though I still love seeing my patients, but I
(07:47):
just want more.
Speaker 1 (07:50):
So you talked about a variety of different things on
your channel, but one thing that we're going to talk
more about today are personality disorder is so I think
that you know the big ones that it feels like
get a lot of attention, or borderline personality disorder and
narcissistic personality disorder, but we know that there are lots
of other personality disorders. Can you talk about like personality
(08:10):
disorders as like a sit of diagnoses and what does
it mean to have a personality disorder?
Speaker 2 (08:19):
Sure? So, yes, there are so many more personality disorders
I think you know, maybe like ten I think is
the number in total. And they're grouped into clusters. So
there's the dramatic or erratic cluster, and that would be
the ones that we hear most about, narcissistic personality disorder,
(08:40):
borderline personality disorder, and then antisocial personality disorder fits into that.
Then there's odd eccentric and that would be skeezoid, skeizotypal,
and paranoid. And then the third category would be anxious
or fearful, and that would be avoidant personality disorder dependent
(09:03):
and obsessive compulsive personality disorder, which is different from obsessive
compulsive disorder. So the thing about personality disorders is I
think this is kind of one thing that's generally misunderstood
and the proliferation of information online about personality disorders, and
that is we all have personality traits, but we don't
(09:25):
all have disorders. So when you look at the Diagnostic
and Statistical Manual of mental disorders and look at the
criteria for the various disorders, anyone can have any of
those single traits. So let's say, let's say with borderline
personality disorder, if one of them is difficulty with your
(09:48):
self identity or you know, emotional dysregulation, anyone can have those,
but it doesn't have to mean you have that disorder.
So with the disorders, you have a collection of the
traits that also cause dysfunction or problems in all aspects
of your life, relationships, your work, and it may even
(10:10):
affect you personally as well. So there's a threshold of
these traits that pile on that then cause problems for you.
One of the problems, unfortunately with personality disorders is that
often people don't have enough self awareness to see themselves
as having a disorder. There's a tendency to do what
(10:32):
we call externalized blame, so you see the problem as
your environment other people, and it's not you. You probably
can't just diagnose yourself with a personality disorder. And in fact,
there's another thing, a little pet peeve I have about
hearing things online and then wanting to diagnose other people
(10:53):
as being a certain disorder. We learned in my training
when that we usually don't diagnose a personality disorder with
the first evaluation because you're looking for longitudinal information, which
is information that stretches a span of time. So how
(11:14):
are you acting or what was going on in your
late childhood and in adulthood, you know, over years, and
not just this kind of one slice in time as
far as how do you have a personality or how
it develops. Going back to this kind of diagnostic question here,
there's no one thing that causes personality disorders. It's a
(11:35):
combination of the classic terminology that people will say nature
versus nurture. So the nature part would be what you
come into this world with genetics, your temperament. And then
nurture would be your environment and the effect it had
on you. So early experiences, how well you bonded in
(11:59):
attached growing up, or as you were being raised as
a child, any trauma experiences, like all of those things
can intervene and lead you down the road of a
disordered personality, because we all have personality. And then last
bit about personality disorders and how they come about when
(12:21):
they develop, They typically show themselves in late adolescence to
early adulthood. That's when things start coming together enough to
be able to see is this someone with a personality
disorder or just various aspects of different personality traits.
Speaker 1 (12:41):
So, doctor Marks, would you say that a personality disorder
is something that could develop after like one singular traumatic
event or is it typically like a longer standing pattern
of behavior and circumstances that would lead to a personality disorder.
Speaker 2 (12:58):
That's such a perfect second part of that question. It's
the latter. It's not just one hit and then now
you're impaired for life with this personality disorder. It's a
series of things and experiences and reactions that you have
that come together to form to result in a personality disorder. Again,
(13:20):
I keep emphasizing that disordered part, because we all have personalities.
The presence of aspects of different personalities does not mean
you are disordered, and disordered equals pathology, So not everything
is pathology. That said, with something like complex PTSD versus
(13:41):
regular PTSD, if you will, is first of all, complex
PTSD is a construct. It's not a diagnosis or official
diagnosis like PTSD. But complex PTSD is thought to develop
from multiple traumatic events like hits. No, not necessarily little,
(14:02):
but thousand stabs over time that start in your younger
developmental years, such that the experience itself and your reaction
to it infuses itself into your personality makeup, therefore potentially
leading to a personality or a disordered personality as you
(14:25):
get older.
Speaker 1 (14:27):
And what would you say You've already kind of talked
about like one of the hallmark characteristics of personality disorders,
is this like lack of insight and ability to see
yourself maybe as others do. Can you talk about why
that is kind of a homework of this cluster of disorders?
Speaker 2 (14:44):
Sure? So, okay, I get a little bit heavy here
with the kind of ego psychology Here a minute, I'm sure,
you're fine with this, but I just want to we're
in the audience a minute. So there's a concept called
something that is ego sentonic, is ego dystonic. Ego syenttonic
would be something or things that go along with how
(15:08):
you see yourself, how you feel, how you view yourself,
such that you don't see it as a problem. Ego
dystonic would be something or behaviors or experiences that are
go against how you see yourself. So an example of
this would be the psychiatric disorders like depression and anxiety.
(15:29):
The experiences that you have are different from how you
see yourself. You know you have a problem because you
are different versus with personalities tend to be ego sentonic.
You don't see that you have a problem because it's
built in to your nature or it's built into how
you view the world. So for you, this is how
(15:50):
things should be, and other people who don't like it,
they're the ones with a problem. So another way to
phrase that or to see that is having lack of
insight that you don't see that you have a problem.
And one of the results of this or what can
happen is that often people with personality disorders don't come
(16:10):
to treatment because of their personality disorder. They come to
treatment either because they have something else like depression, anxiety,
something that's ego dystonic that's causing problems for them that
they see as a problem. Or they come because a
partner says, you either do this or I'm gone. But
(16:31):
they normally don't just kind of walk into therapy saying
I've got histrionic personality disorder and I want you to
help me with that. It takes a lot of self awareness,
and chances are if they did say that, they've already
had therapy to see that that's what their problem is.
Speaker 1 (16:48):
And I know this is different across disorders, different probably
across the clusters. Well, what does treatment planning in a
treatment process typically look like to help somebody who does
have a personality disorder?
Speaker 2 (17:01):
Yes, so I know that at this point there are
lots of different therapy modalities, many of which I'm not
familiar with. When I trained, I trained in New York City,
it was very psychoanalytical. A lot of my supervisor were analysts,
and so it was very heavy into psychoanalysis and psychodynamic psychotherapy.
(17:23):
So the approach to personality disorders was helping someone have insight,
and that is my orientation when trying to help someone
with this. That's not necessarily analysis, by the way, but
just kind of insight oriented psychotherapy, and the approach with
(17:45):
that would be from a high level view, would be
helping someone see what they don't see, so we all
have blind spots and seeing patterns and trying to understand
why you have certain reactions. Take an extreme example, if
I believe that people who are stupid deserve to be
(18:06):
punished or deserve to be criticized because they're stupid, Okay,
I can live believing that, But if I go out
into the world and have a job or have relationships
somewhere along the line, there's going to be a big
old rub with me with that bad attitude. But I
don't see it as a bad attitude. I just see
it as it just makes sense. If I had a
patient who believed that, I would try and help them
(18:30):
see how that belief causes problems for the people that
they're around, as well as for themselves. Because in that scenario,
if I'm the person who believes that, I may not
care that other people are insulted, there has to be
something in it for me to feel like I need
to change because of that. So what could that be?
(18:52):
That could be mean not getting not seeming to get
promoted and I can't understand why, or never being made
a manager, or my partner being mad at me all
the time, like why. So I, as a therapist would
help try and bring those examples in and then try
and help deconstruct what causes people to have these kinds
(19:15):
of reactions. Oh, what do you know? It's because this
is what you think, helping them try and discover their
flawed thinking. Essentially, there are other approaches. There's things like
schem of therapy, and you know, there's lots of different
therapies today. I mean I trained, I finished training in
(19:36):
two thousand and one. There's lots of therapies that came
out since the two thousands that also can address personality disorders.
But I will say no, I think my bias is
no matter what the modality, it still takes time and
patience and a lot of investment that some people aren't
willing to make or just can't make money wise, But
(19:59):
it's not something that changes overnight. Dialectical behavior therapy that's
another therapy that was designed originally for borderline personality disorder,
but it can also help with coping skills and things
like that for other people as well. So that's more
of a cognitive behavioral format for helping a personality disorder.
(20:22):
But typical programs with the way that it's set up,
last a year at least, and then often people will
still need to repeat the year because there's certain segments
that they go over. Long story short to that is
is that there's different ways you can approach addressing treating
a personality disorder. I think the two biggest hurdles are
(20:45):
the person being seeing the need for it in the
first place, and then having the patience and the resources
to be able to hang in there for an extended
period of time. Because if you think about it, if
you're thinking about going to therapy and you're even if
you're twenty five years old, you're looking at least a
good decade or more of well ingrained reactions to life behaviors,
(21:12):
knee jerk responses, attitudes that you're trying to undo or
at least modify, and that takes time.
Speaker 1 (21:25):
More from our conversation after the break, I want to
ask you a question around what feels like empathy and
like other people's reactions to people who have been diagnosed
with a personality disorder. And we know it's because this
(21:47):
cluster of disorders, like it mostly impacts other people, right,
Like it shows up a lot in your relationships. And
so there's a lot of burn bridges, a lot of
just a lot of hurt that has typically been caused
because maybe this person either doesn't recogniz they have a
personality disorder or because that is the way the disorder
itself presents. So can you talk about, like what does
the support system look like and maybe like what does
(22:09):
it mean to have empathy towards people who have been
diagnosed with personality disorders?
Speaker 2 (22:15):
That is a real tough one because I think it
takes a certain amount of It takes a lot of
patience for people close to a person with a personality
disorder to hang in there and not want to reject them.
And on the one hand, there's the issue of well,
what about the needs of the loved one. I'll just
(22:37):
use a personal example. I dated someone years ago and
that person did have insight because that person he had
been in therapy, and so me, being the empathic person,
I was like, oh, he just needs to be loved.
I can love him enough that'll help him heal. Well, okay,
(23:00):
that's nice, but what's that doing for me? Like I'm
sacrificing my own self while I kind of put up
with being beat up on by this person. So I've
got to have my own boundaries as the person who
cares about the person with the personality disorder. I've got
to have boundaries around how much of myself I'm willing
(23:24):
and my own wishes and needs I'm willing to put
aside for the sake of just tolerating bad behavior, if
you will, from this other person while still trying to
be understanding that they're working through something. Now, I think
the difference is if the person really is working through
(23:48):
they're at that stage of having very little awareness or
very little They may be aware because they've watched a
bunch of TikTok videos, but they're still not wanting to
get into any kind of treatment because it's not that bad.
They won't need to go pay somebody for this. They
can work on this. Well, the working that they're doing
is attacking you every day and trying not to attack you.
(24:09):
I mean so, and that's not really going to help
very much. The call to be patient and make the
sacrifice of putting up with the stuff comes if the
person is actively working toward change, because you need to
give them credit for that. But it's not a good
(24:31):
situation if the person hardly recognizes that they need to change.
Another part about this too, is well, what about you
in retrospect, I can see I mean, I was much
younger than but I could see where I was part
of the problem of even allowing myself to be in
that kind of relationship. It may not have stemmed from
(24:53):
a personality disordered, but it stemmed from some vulnerabilities I
had that allowed me to just deal with whatever I
was getting. All that to say, be careful not to
judge the other person too much, because you're probably not
one hundred percent yourself, and so they're probably putting up
with some stuff from you. So that's another kind of
(25:16):
concession you can give them that if they're working toward change,
they're going to need a long runway to be able
to make those changes. But you also got to have
to look at yourself too, and not just be standing
on a high horse saying you've got a personality disorder.
Nothing's wrong with me. You need to fix yourself or
am gone that marks.
Speaker 1 (25:39):
Are there any racial or cultural nuances that are related
to you, like the diagnosis of personality disorders that you
feel like are important to call attention to.
Speaker 2 (25:50):
That's a really difficult question for me to pinpoint, like
give a specific answer. The way that we have defined
personality disorders already has a lot of criticism associated with it.
In fact, in the DSM there's a whole like appendix
area of a whole nother way to look at personality disorders.
(26:15):
And because it's you know, this is thought that this
is this old fashion and it doesn't really take into
account nuances. And I think the nuances come with the
cultural differences. So I think it's very easy for say
a black male to be considered antisocial if he's the
(26:37):
least bit I don't even say aggressive, because I think
that's another bias, but the least bit assertive, loud talking,
arguing for the sake of argument. I mean things that
you're used to in your family. Someone looking from the
outside could say, oh, all these people have personality disorders.
And I think it's easy to peg people as if
(27:00):
you're the least bit disagreeable, if you will then you're angry.
That's not necessarily calling someone personality disordered, but it still
speaks to that easily pathologizing behavior because it's something that
you're not used to. But another kind of cultural bias
(27:21):
is the one of our stereotype is the Italians living
next to you a arguing all the time. Well, people
can say that about black people too, but that idea
of people talking loud or having disagreements, that's pathology, whereas
that actually may be adaptive for that group of people.
Like being able to just be frank about what you're feeling,
(27:45):
that's a good thing, rather than stuffing your feelings because
we're going to look a certain way and growing up
believing that it's not okay to express yourself that causes problems.
Speaker 1 (27:57):
Thank you for that nuance. I think that's helpful. So,
you know, you made a couple of comments that I
definitely want to talk more about in terms of all
of the mental health information that we're seeing online, all
of the information that we see in YouTube, TikTok, like
all of the places, and I would imagine your training
was similar in that I was trained that the number
of people who actually meet criteria you're for personality disorders
(28:20):
is very small if you go online, Oh my gosh,
like it's one in three. Like there everybody has, oh
personality disorder. Can you talk a little bit about like
the proliferation of conversations around mental health, specifically around personality disorders,
and which you think is often missed in some of
these conversations.
Speaker 2 (28:39):
Yes, I'm trying to hold it together, not get not
go off of my soap box.
Speaker 1 (28:47):
But so bock and welcome here.
Speaker 2 (28:49):
Okay, so let me just let me just cut to
the chase. I cannot stand the way narcissism is portrayed online.
I can't stand it. Granted, there are people who put
out very accurate and helpful information, but somehow, because it's
(29:12):
become trending such that people have just latched onto it
and turned anything that they don't like about someone into
it's because of narcissism. You know, everybody's mother is a narcissist.
So I'm not actually sure why we've latched onto that
personality disorder. I'm not sure, but that has become the
(29:35):
scapegoat for any bad behaviors because you're a narcissist. And
this is a small antidote example, my son He was
in middle school at the time, and I was he's
got social anxiety, and I was trying to help him
with like how to have conversations with people, and so
I was saying, okay, so you know, and you need
to ask people questions and listen and then try and
(29:58):
follow up on some of those questions later of things
that they told you. And then you also want to
give a little of yourself too, So you don't want
to just be an interview. You want to talk about yourself,
give an example you had in your life. And he said, yeah,
but if I talk about myself, then I'm being a narcissist.
And I thought, oh, my goodness, really is that what
(30:19):
we've come to. And so I think narcissistic personality is
a lot more complicated or complex than we give it
credit for. Online there's different presentations of it, but narcissism
itself is a good thing. In fact, not having a
(30:43):
healthy love of yourself is what makes you susceptible to
narcissistic personality disorder, because you have either a fragile sense
of self or an overinflated sense of self stemming from
not enough self validation. So you're more sensitive to slights
(31:03):
and things, or needing to puff yourself up or tear
people down to build yourself up, and things like that.
All right, So that's my soapbox. Sorry on that particular disorder.
But I think that, just as I was saying earlier
that even in a diagnostic setting, we psychiatrists or psychologists
(31:24):
clinicians are trained to put the brakes on any tendency
to want to diagnose someone with a personality disorder. It's
on the first meeting, especially if it's in the context
of them having what we would call an access one disorder.
Those would be the things like depression, bipolar disorder, anxiety OCD,
(31:47):
things like that, because that's like the storm that can
cover up the personality that's underneath. You can't really see
what's underneath if you've got all this other stuff going on.
So if a clinician can't always know what an underlying
personality someone has doing a diagnostic evaluation, how can you
(32:12):
watch a TikTok video and know what someone's personality is.
And it's not useful too, because, unfortunately, I think it
ends up being used as weapons for name calling and
boxing people in and that's not the intent you know
of even having this construct of personality disorders. So on
(32:39):
the positive side, I am pleased with how far we've
come in talking about mental health in general. When I
started on YouTube, actually I started probably like twenty ten,
and I had several false starts because people didn't at
least from the comments I got, people don't want to
(32:59):
hear about this, and so I got a lot, a
lot of hate. So I just I put out a
few videos, then get scared and stop. So anyway, when
I started in twenty eighteen regularly even then, like part
of my purpose was to destigmatize the discussion, and a
(33:20):
goal was to make talking about mental health part of
regular conversation, not anything that we got a whisper about.
We're not all the way there, but we're pretty far along,
and I love that. I love that a gen Z
person can say out loud, well, my anxiety is getting
in the way of me doing XYZ, and it could
(33:41):
admit that and not feel ashamed. But with every good
thing comes downsides too, and this is just one of
those downsides of proliferation of misinformation, but also the trivialization
of some of these disorder or such that ADHD is
(34:01):
another one that not every trouble. You know, I couldn't
focus yesterday. Oh I've got ADHD. Not everyone who has
trouble focusing has ADHD. But you know, I think it's
just human nature to want to put people in categories,
name things, understand what things are, and so I can't
(34:24):
fault someone who has limited information to take the information
that they do have and try it and apply it.
And that's essentially what's.
Speaker 1 (34:32):
Happening more from our conversation after the break. Of course,
there's the youtubes, the tiktoks, all the things, but there's
also like bigger media productions like movies and TV shows
(34:53):
that often don't do the greatest job of actually displaying
what a personality disorder might look like. Are there any
instances of things in film or TV that you've seen
and you feel like they've done actually a really good
job talking about or displaying personality disorders?
Speaker 2 (35:08):
So this isn't personality disorder. But I did really like
the way they portrayed psychosis in a Beautiful Mind way
back in the day with Russell Crowe. That was like
my first experience with feeling like, wow, Okay, they did
a great job of showing this and how it can
be that was very creative of them. But since then,
(35:31):
there was a movie out that came out not too
long ago with Tom Holland and I forget the name
of it. They were trying to show multiple personality disorder,
which is a very complex disorder, and I just thought,
I mean, I don't know, I think there's more examples
(35:53):
of it just being this is what we need to
see on screen, this is what will excite people, So
let's make it look like this than true portrayals, because
true portrayals aren't necessarily all that interesting.
Speaker 1 (36:08):
Yeah, which I think is would make them sometimes difficult
to depict online right or infield?
Speaker 2 (36:14):
Yeah, yeah, exactly, And actually that's a good point back
to this, like why is there so much focus on say,
narcissistic personality disord and borderline They're in the cluster of dramatic,
and dramatic is more interesting than anxious, like a dependent
personality disorder that's not as interesting. So yeah, that the
(36:37):
presentation itself, I think does have something to do with
what's portrayed, how it's portrayed, and how much we focus
on it.
Speaker 1 (36:46):
Doctor Marks, what suggestions would you have for people for
wading through all of the information they might find online.
You just mentioned like, of course people want resources like
something's happening, I want some answers. What suggestions do you
have for people for how to make sense of what
they might find online.
Speaker 2 (37:01):
Yeah, so I guess first is getting clear on what
you're trying to accomplish. So there's watching for entertainment like
we do television, and then there is trying to get
inside about yourself, and then there's trying to get inside
about someone you know. I think if you really are
trying to understand yourself better, it's about looking at the
(37:24):
source and being aware of things being too generalized. So
I can think of an example a TikTok video. I
saw someone I can't remember exactly what she said. It
was something like signs of my ADHD and it was
I can't stop writing in my journal or something like that,
(37:44):
where it's like that's actually, I mean, people can do
that for any reason that's not that doesn't equate to well,
then you've got ADHD if you do these things, but
that's what people will take from that. So the viewer
then has to be aware that to keep in mind
that people talking about their personal experiences is their personal
(38:05):
experiences and it's not it's not necessarily something you can
draw from. You might be able to relate that, oh yeah,
I do that too, but that doesn't mean you now
have a disorder because of that. And so I think
if there's a lot of things you can get online,
and I think that the things to get to extract
(38:26):
out of all of the information online is feeling the
things that you're experiencing, well, that you're not alone, but
then that you're feeling heard like wow, she does this too,
or she has this too, this is what Okay, I
don't feel so bad anymore. Like those are some positive
outcomes that still has nothing to do with what your
(38:46):
diagnosis is. That's just experiences. And so this unification of
experiences and destigmatizing and all that, those are all good
things that I think are good to get from social
media information. Going deeper than that though, as far as
actually feeling like it's helping you understand yourself or even
(39:09):
come to a conclusion about something you may have looking
at the source. So YouTube has taken the step of
identifying clinicians and putting that label under their videos. So
we have to submit our licenses and things like that.
So all of my videos will say this is from
a licensed health provider, and they do that for this
(39:32):
purpose so that people can have a better way of
screening the source of their information, so that at least
you have a greater chance that this is accurate. So
looking for reliable sources, accurate sources, even on say TikTok
or Instagram if the person they don't have those labels
like YouTube, but you could still look at the person's credentials.
(39:56):
So pay attention to whether what you're watching is someone's
perersonal experience which may not apply to you and others,
or is it from a clinician talking about broad experiences
and talking more in specific terms. Then if you think
that you have a disorder, go get a second opinion
(40:20):
or an official opinion from a licensed clinician rather than
just going with that and trying to find a way
to treat yourself if it's something that requires some form
of treatment. Because let's just say we're talking about personality
disorders today, but let's say you watch a bunch of
(40:40):
videos and you believe that you have I don't know,
dependent personality disorder, which is in the anxious, fearful cluster
where you are very hesitant to the assertive. You feel
like you need people to take care of you a lot,
which can cause problems getting on people's nerves. Are just
(41:00):
not being able to have enough get up and go
and do your own thing because you've got to wait
for other people's approval. If you recognize that because of
some videos that you've seen, then it's still helpful for
you to have that insight. Going back to what I
was saying earlier about often with personality disorders, people lack
(41:20):
the insight to see what the problem is. So it's
still a win. If you never see a psychiatrist or therapist,
it's still a win to have insight. So if these
videos help you have insight, that's good, but still it's
good if then you can take it to the next
step and try and work on yourself. There's books, there's
(41:42):
lots of self help material out there that's written and
provided by authoritative sources, So you can go to that
next step, to an authoritative source to try and get
some self help rather than the self help being all
from TikTok videos from Jane Doe who's talking about her
personal experience because everything about her may not apply to you.
(42:04):
I appreciate you.
Speaker 1 (42:05):
Bringing up the idea of resources, and that was my
next question. Are there any particular resources like podcasts, books,
other things that you typically recommend for people who either
have been diagnosed with the personality disorder or are people
who may be in their support system who want to
learn more or get more information.
Speaker 2 (42:22):
I don't have any things specific, because there's so many
things out there now. Years ago, no, but now there's
lots of different podcasts. There's your podcast, I mean, which
you know, it didn't exist years ago. So I think
it's important though, for people to feel like whatever resources
(42:43):
they're using, whether it be a book, a podcast, a
YouTube channel, that it feel relatable to them, because there's
people who've produced some great stuff, but it's either just
too academic maybe and it's just not going to be helpful.
So okay, don't worry about that, don't stress over that.
There's so many other sources out there, But it really
(43:06):
boils down to just doing searches on whatever platform it
is that you like to consume, whether it be a podcast,
go to Spotify or Apple podcasts and search for the topic.
Amazon search for the topic. So yeah, I don't have
a specific recommendation because there's just so many resources out there.
(43:27):
Oh one other thing though, so getting more specific about resources.
So nammy National Association of Mentally Ill. Don't let that
ill word scare you away. But before there was so
much more information like podcasts and online information. They were
kind of a good place to go for resources, and
(43:51):
they still are. But personality disorder wise, I'm not so sure.
I don't know what they have to offer there, but
that is still another place you could look.
Speaker 1 (44:03):
With one thing that you hope people leave this conversation
kind of understanding better about personality disorders, Doctor Marx.
Speaker 2 (44:11):
I would love it if people just understood the basic
that we all have personalities and not all personality traits
are pathologic, like personality disorders is pathology, meaning it causes
problems in multiple areas of your life. So one bad day,
(44:36):
one bad month of you feeling insecure and yelling at
people does not mean you have a personality disorder. This
is a pattern of behavior that reaches or affects multiple
aspects of your life, your relationships, your work relationships as well,
(44:58):
or school if you're still a student. It affects even
how you feel about yourself. The second part of that
is personality disorders are. They're not rare, but they're not common.
So let's just say general prevalence rates may be around
let's just say on a high side, it would be
(45:19):
like five six percent. Depression is around ten to twelve percent.
Those are still small numbers in the big scheme of things,
But personality disorders is less common than depression. So don't
be so quick to believe that every person with bad
(45:40):
behavior or who gets on your nerves and you can't
stand has a personality disorder. They may be going through
some things that's making them act this way. They may
have emotional dysregulation, which is not the same as a
personality disorder. That's an aspect of your behavior that's controlled
by your brain prefrontal cortex, be specific, and so if
(46:03):
someone has trouble managing their emotions, it doesn't necessarily mean
they have a personality source. So not everything so big
picture here, Not everything's personality disorder. If you feel you
have one, or you've been identified to have one, you
can change, but you've got to temper your expectations that
(46:24):
it's going to be a little bit of change over time,
and you've got to be patient with yourself or patient
with the person in your life who is working on themselves.
Because just like your personality did not form from one thing,
the solution to it or the change doesn't happen from
a couple of things you do. It's going to be
(46:46):
a lifetime of change.
Speaker 1 (46:51):
And where can we stay connected with you, doctor walks way,
can we check out the YouTube channel and anything else
you have to offer?
Speaker 2 (46:57):
Sure? So, my main platform that I am active on
his YouTube and my channel is my name doctor Tracy Marx,
and that's d R and then t R a c
e Y and then m A r k s. The
same handle on Instagram and the same handle on on
TikTok as well. But I'm more active on YouTube and
(47:20):
then Instagram and then TikTok. Last my website where I
just I post articles and also my videos on that
site as well is marx Psychiatry dot com. Perfect.
Speaker 1 (47:35):
We'll be sure to include all of that in our
show notes. Thank you so much for joining us today,
doctor Marx. I appreciate it.
Speaker 2 (47:40):
You are so welcome. I enjoyed this and thanks for
having me. Thank you.
Speaker 1 (47:49):
I'm so glad Doctor Marks was able to share her
expertise for this conversation to learn more about her and
her work. Visit the show notes at Therapy for Blackgirls
dot com slash Session four thirty one. Don't forget to
text this episode to two of your girls right now
and tell them to check it out. Did you know
that you could leave us a voicemail with your questions
or suggestions for the podcast. If you have movies or
(48:10):
books you'd like us to review, or have thoughts about
topics you'd like us to discuss, drop us a message
at Memo dot fm slash Therapy for Black Girls and
let us know what's on your mind. We just might
feature it on the podcast. If you're looking for a
therapist in your area, visit our therapist directory at Therapy
for Blackgirls dot com slash directory. Don't forget to follow
us on Instagram at Therapy for Black Girls or join
(48:33):
us over in our Patreon channel for exclusive updates and
behind the scenes content. You can join us at community
dot Therapy for Blackgirls dot com. This episode was produced
by Elise Ellis, Indytubu and Tyrie Rush. Editing was done
by Dennis and Bradford. Thank y'all so much for joining
me again this week. I look forward to continuing this
conversation with you all real soon Take good care
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or
(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much
(00:57):
for joining me for session four thirty one of the
Therapy for Black Girls Podcast. We'll get right into our
conversation after a word from our sponsors. This week, we're
diving into a conversation about personality disorders with psychiatrists doctor
(01:20):
Tracy Marx. Doctor Marx breaks down what personality disorders are,
how they differ from other mental health conditions, and some
of the common misconceptions people have about them. We also
talk about how personality disorders can impact relationships, what treatment
can look like in ways to show compassion for yourself
or a loved one who may be navigating one. If
(01:40):
something resonates with you while enjoying our conversation, please share
with us on social media using the hashtag tpg in session,
or join us over in our patreons and talk more
about the episode. You can join us at community dot
therapy for Blackgirls dot com. Here's our conversation. Thank you
so much for joining us today, doctor Wax.
Speaker 2 (02:03):
Thanks for inviting me on.
Speaker 1 (02:05):
So I would love for you to stop by telling
us a little bit about your journey into psychiatry. What
made you pick that specialty.
Speaker 2 (02:12):
It's actually a little bit of an indirect route into psychiatry.
So I was initially interested in becoming an internal medicine doctor. Actually,
in college, I was interested in being an engineer, electrical engineer.
And this is so immature of me, but I don't
want to be a doctor because I'm like, they wear
white coats, that's boring. Who wants to do that? So
(02:35):
I did engineering, but then I started having second doubts
and decided after I graduated, to then go to medical
school because I really did want to help people. So
in medical school, though I grew up in the South,
we're both in the South, well in Atlanta, but I
grew up in Florida and in my environment, I had
(02:59):
never talk to anyone who'd ever been to a psychiatrist before,
and really didn't see the value of it, the need
for it, So it just was not even on my
radar going into medical school, And in fact, I deferred
the rotations. In medical school in your third year, there's
all these required rotations that you have to do, with
the basic specialty psychiatry being one of them. You're allowed
(03:22):
to defer one for your fourth year. So I deferred
psychiatry so that I could do research in internal medicine,
which is what I was interested in. You know, looks
good for your applications to do research. Then in my
fourth year, when I got around to doing my psychiatry rotations,
I was already in the thick of applying for residency
(03:43):
in internal medicine, and I did the psychiatry rotation just
to kind of get it out of the way, and
I was super surprised at how interesting it was and
how much satisfaction I got out of helping people with
their emotional pain over tweaking someone's blood pressure medications. But
I was too far down the road of applying for residency,
(04:08):
which is kind of like a draft process. They call
it the match, but you pick where you want to go,
places pick you and then you just get assigned somewhere.
So I was too deep into that, So I matched
an internal medicine and I changed after the match the
place where I matched it in New York, a psychiatry
resident couldn't start because of an illness in the family,
(04:30):
so they had an open spot, so they just switched
me from one roster to the next, and so I
was able to then start in psychiatry.
Speaker 1 (04:38):
Wow, and it is almost as if this is where
you were meant to be. It sounds like it really was.
Speaker 2 (04:44):
It really was where I meant to be. I mean,
I've always been one who, probably to my detriment, have
a little too much empathy. Sometimes I'm one of those
people who feels for people and things like that. And
I've known that about my myself, but still didn't equate
that too. I need to be a psychiatrist. But my
(05:05):
mom said something that was very enlightening to me. She said,
I was telling her about this guy who looked in retrospect.
He was probably on the spectrum, but you know, he
was socially awkward in things and I was talking about
how he needed a friend, and my mom was like,
you need to leave these people with problems alone. They
need professional help, they don't need friends, which sounds very harsh,
(05:28):
but she was right in the sense of what I
was tapping into is my desire to want to help
people professionally.
Speaker 1 (05:37):
Thank you so much for sharing that. And you have
done so many different things in your career, but most
recently you are doing a lot of mental health YouTube
videos about psychiatry and mental health concerns. What led you
down that specific career path.
Speaker 2 (05:53):
I started my own private practice in two thousand and six,
and what I noticed was I had been a part
of someone else's practice before that after residency, but when
I was kind of seeing my own patients and whatnot,
I would I spent so much time teaching them things,
And I thought, well, if they don't know these things,
(06:14):
how many other people don't know these things. And also
I was trained to do therapy as well, not just
prescribe medications, so I found that the kind of teaching
them about their disorders took up too much time from
talking about the real stuff, if you will, of their lives.
And so the initially it was about creating a library
of information that I could refer my patients to. Hey,
(06:37):
you know you want to know more about this, go
look at this. But then I thought, well, but there's
so many other people who could benefit from this. So
it became about educating the world, if you will, more
people than just the people I could see in my
practice about basic mental health things.
Speaker 1 (06:55):
And what has been the balance in terms of you
doing the videos on YouTube and yourtice. Are you still practicing?
I am still practicing.
Speaker 2 (07:03):
Okay. I have patients who I think fear that I'm
going to let them go, and I mean there's some
of them I've been seeing for twenty years, so it's
a relationship. At this point, I can't just let go
of them. But I've stopped taking new patients, so I'm
still managing. It's still a lot of patients. It doesn't
take up my whole week anymore. I get lots of
(07:26):
inquiries about can you just one more patient, one more
can you just take me? And the answer to that is, well,
if I did, it would be goodbye YouTube, because you know,
I really wouldn't have time to do anything else other
than see patients all day long, and at this stage,
of my career. I want to do more than that,
even though I still love seeing my patients, but I
(07:47):
just want more.
Speaker 1 (07:50):
So you talked about a variety of different things on
your channel, but one thing that we're going to talk
more about today are personality disorder is so I think
that you know the big ones that it feels like
get a lot of attention, or borderline personality disorder and
narcissistic personality disorder, but we know that there are lots
of other personality disorders. Can you talk about like personality
(08:10):
disorders as like a sit of diagnoses and what does
it mean to have a personality disorder?
Speaker 2 (08:19):
Sure? So, yes, there are so many more personality disorders
I think you know, maybe like ten I think is
the number in total. And they're grouped into clusters. So
there's the dramatic or erratic cluster, and that would be
the ones that we hear most about, narcissistic personality disorder,
(08:40):
borderline personality disorder, and then antisocial personality disorder fits into that.
Then there's odd eccentric and that would be skeezoid, skeizotypal,
and paranoid. And then the third category would be anxious
or fearful, and that would be avoidant personality disorder dependent
(09:03):
and obsessive compulsive personality disorder, which is different from obsessive
compulsive disorder. So the thing about personality disorders is I
think this is kind of one thing that's generally misunderstood
and the proliferation of information online about personality disorders, and
that is we all have personality traits, but we don't
(09:25):
all have disorders. So when you look at the Diagnostic
and Statistical Manual of mental disorders and look at the
criteria for the various disorders, anyone can have any of
those single traits. So let's say, let's say with borderline
personality disorder, if one of them is difficulty with your
(09:48):
self identity or you know, emotional dysregulation, anyone can have those,
but it doesn't have to mean you have that disorder.
So with the disorders, you have a collection of the
traits that also cause dysfunction or problems in all aspects
of your life, relationships, your work, and it may even
(10:10):
affect you personally as well. So there's a threshold of
these traits that pile on that then cause problems for you.
One of the problems, unfortunately with personality disorders is that
often people don't have enough self awareness to see themselves
as having a disorder. There's a tendency to do what
(10:32):
we call externalized blame, so you see the problem as
your environment other people, and it's not you. You probably
can't just diagnose yourself with a personality disorder. And in fact,
there's another thing, a little pet peeve I have about
hearing things online and then wanting to diagnose other people
(10:53):
as being a certain disorder. We learned in my training
when that we usually don't diagnose a personality disorder with
the first evaluation because you're looking for longitudinal information, which
is information that stretches a span of time. So how
(11:14):
are you acting or what was going on in your
late childhood and in adulthood, you know, over years, and
not just this kind of one slice in time as
far as how do you have a personality or how
it develops. Going back to this kind of diagnostic question here,
there's no one thing that causes personality disorders. It's a
(11:35):
combination of the classic terminology that people will say nature
versus nurture. So the nature part would be what you
come into this world with genetics, your temperament. And then
nurture would be your environment and the effect it had
on you. So early experiences, how well you bonded in
(11:59):
attached growing up, or as you were being raised as
a child, any trauma experiences, like all of those things
can intervene and lead you down the road of a
disordered personality, because we all have personality. And then last
bit about personality disorders and how they come about when
(12:21):
they develop, They typically show themselves in late adolescence to
early adulthood. That's when things start coming together enough to
be able to see is this someone with a personality
disorder or just various aspects of different personality traits.
Speaker 1 (12:41):
So, doctor Marks, would you say that a personality disorder
is something that could develop after like one singular traumatic
event or is it typically like a longer standing pattern
of behavior and circumstances that would lead to a personality disorder.
Speaker 2 (12:58):
That's such a perfect second part of that question. It's
the latter. It's not just one hit and then now
you're impaired for life with this personality disorder. It's a
series of things and experiences and reactions that you have
that come together to form to result in a personality disorder. Again,
(13:20):
I keep emphasizing that disordered part, because we all have personalities.
The presence of aspects of different personalities does not mean
you are disordered, and disordered equals pathology, So not everything
is pathology. That said, with something like complex PTSD versus
(13:41):
regular PTSD, if you will, is first of all, complex
PTSD is a construct. It's not a diagnosis or official
diagnosis like PTSD. But complex PTSD is thought to develop
from multiple traumatic events like hits. No, not necessarily little,
(14:02):
but thousand stabs over time that start in your younger
developmental years, such that the experience itself and your reaction
to it infuses itself into your personality makeup, therefore potentially
leading to a personality or a disordered personality as you
(14:25):
get older.
Speaker 1 (14:27):
And what would you say You've already kind of talked
about like one of the hallmark characteristics of personality disorders,
is this like lack of insight and ability to see
yourself maybe as others do. Can you talk about why
that is kind of a homework of this cluster of disorders?
Speaker 2 (14:44):
Sure? So, okay, I get a little bit heavy here
with the kind of ego psychology Here a minute, I'm sure,
you're fine with this, but I just want to we're
in the audience a minute. So there's a concept called
something that is ego sentonic, is ego dystonic. Ego syenttonic
would be something or things that go along with how
(15:08):
you see yourself, how you feel, how you view yourself,
such that you don't see it as a problem. Ego
dystonic would be something or behaviors or experiences that are
go against how you see yourself. So an example of
this would be the psychiatric disorders like depression and anxiety.
(15:29):
The experiences that you have are different from how you
see yourself. You know you have a problem because you
are different versus with personalities tend to be ego sentonic.
You don't see that you have a problem because it's
built in to your nature or it's built into how
you view the world. So for you, this is how
(15:50):
things should be, and other people who don't like it,
they're the ones with a problem. So another way to
phrase that or to see that is having lack of
insight that you don't see that you have a problem.
And one of the results of this or what can
happen is that often people with personality disorders don't come
(16:10):
to treatment because of their personality disorder. They come to
treatment either because they have something else like depression, anxiety,
something that's ego dystonic that's causing problems for them that
they see as a problem. Or they come because a
partner says, you either do this or I'm gone. But
(16:31):
they normally don't just kind of walk into therapy saying
I've got histrionic personality disorder and I want you to
help me with that. It takes a lot of self awareness,
and chances are if they did say that, they've already
had therapy to see that that's what their problem is.
Speaker 1 (16:48):
And I know this is different across disorders, different probably
across the clusters. Well, what does treatment planning in a
treatment process typically look like to help somebody who does
have a personality disorder?
Speaker 2 (17:01):
Yes, so I know that at this point there are
lots of different therapy modalities, many of which I'm not
familiar with. When I trained, I trained in New York City,
it was very psychoanalytical. A lot of my supervisor were analysts,
and so it was very heavy into psychoanalysis and psychodynamic psychotherapy.
(17:23):
So the approach to personality disorders was helping someone have insight,
and that is my orientation when trying to help someone
with this. That's not necessarily analysis, by the way, but
just kind of insight oriented psychotherapy, and the approach with
(17:45):
that would be from a high level view, would be
helping someone see what they don't see, so we all
have blind spots and seeing patterns and trying to understand
why you have certain reactions. Take an extreme example, if
I believe that people who are stupid deserve to be
(18:06):
punished or deserve to be criticized because they're stupid, Okay,
I can live believing that, But if I go out
into the world and have a job or have relationships
somewhere along the line, there's going to be a big
old rub with me with that bad attitude. But I
don't see it as a bad attitude. I just see
it as it just makes sense. If I had a
patient who believed that, I would try and help them
(18:30):
see how that belief causes problems for the people that
they're around, as well as for themselves. Because in that scenario,
if I'm the person who believes that, I may not
care that other people are insulted, there has to be
something in it for me to feel like I need
to change because of that. So what could that be?
(18:52):
That could be mean not getting not seeming to get
promoted and I can't understand why, or never being made
a manager, or my partner being mad at me all
the time, like why. So I, as a therapist would
help try and bring those examples in and then try
and help deconstruct what causes people to have these kinds
(19:15):
of reactions. Oh, what do you know? It's because this
is what you think, helping them try and discover their
flawed thinking. Essentially, there are other approaches. There's things like
schem of therapy, and you know, there's lots of different
therapies today. I mean I trained, I finished training in
(19:36):
two thousand and one. There's lots of therapies that came
out since the two thousands that also can address personality disorders.
But I will say no, I think my bias is
no matter what the modality, it still takes time and
patience and a lot of investment that some people aren't
willing to make or just can't make money wise, But
(19:59):
it's not something that changes overnight. Dialectical behavior therapy that's
another therapy that was designed originally for borderline personality disorder,
but it can also help with coping skills and things
like that for other people as well. So that's more
of a cognitive behavioral format for helping a personality disorder.
(20:22):
But typical programs with the way that it's set up,
last a year at least, and then often people will
still need to repeat the year because there's certain segments
that they go over. Long story short to that is
is that there's different ways you can approach addressing treating
a personality disorder. I think the two biggest hurdles are
(20:45):
the person being seeing the need for it in the
first place, and then having the patience and the resources
to be able to hang in there for an extended
period of time. Because if you think about it, if
you're thinking about going to therapy and you're even if
you're twenty five years old, you're looking at least a
good decade or more of well ingrained reactions to life behaviors,
(21:12):
knee jerk responses, attitudes that you're trying to undo or
at least modify, and that takes time.
Speaker 1 (21:25):
More from our conversation after the break, I want to
ask you a question around what feels like empathy and
like other people's reactions to people who have been diagnosed
with a personality disorder. And we know it's because this
(21:47):
cluster of disorders, like it mostly impacts other people, right,
Like it shows up a lot in your relationships. And
so there's a lot of burn bridges, a lot of
just a lot of hurt that has typically been caused
because maybe this person either doesn't recogniz they have a
personality disorder or because that is the way the disorder
itself presents. So can you talk about, like what does
the support system look like and maybe like what does
(22:09):
it mean to have empathy towards people who have been
diagnosed with personality disorders?
Speaker 2 (22:15):
That is a real tough one because I think it
takes a certain amount of It takes a lot of
patience for people close to a person with a personality
disorder to hang in there and not want to reject them.
And on the one hand, there's the issue of well,
what about the needs of the loved one. I'll just
(22:37):
use a personal example. I dated someone years ago and
that person did have insight because that person he had
been in therapy, and so me, being the empathic person,
I was like, oh, he just needs to be loved.
I can love him enough that'll help him heal. Well, okay,
(23:00):
that's nice, but what's that doing for me? Like I'm
sacrificing my own self while I kind of put up
with being beat up on by this person. So I've
got to have my own boundaries as the person who
cares about the person with the personality disorder. I've got
to have boundaries around how much of myself I'm willing
(23:24):
and my own wishes and needs I'm willing to put
aside for the sake of just tolerating bad behavior, if
you will, from this other person while still trying to
be understanding that they're working through something. Now, I think
the difference is if the person really is working through
(23:48):
they're at that stage of having very little awareness or
very little They may be aware because they've watched a
bunch of TikTok videos, but they're still not wanting to
get into any kind of treatment because it's not that bad.
They won't need to go pay somebody for this. They
can work on this. Well, the working that they're doing
is attacking you every day and trying not to attack you.
(24:09):
I mean so, and that's not really going to help
very much. The call to be patient and make the
sacrifice of putting up with the stuff comes if the
person is actively working toward change, because you need to
give them credit for that. But it's not a good
(24:31):
situation if the person hardly recognizes that they need to change.
Another part about this too, is well, what about you
in retrospect, I can see I mean, I was much
younger than but I could see where I was part
of the problem of even allowing myself to be in
that kind of relationship. It may not have stemmed from
(24:53):
a personality disordered, but it stemmed from some vulnerabilities I
had that allowed me to just deal with whatever I
was getting. All that to say, be careful not to
judge the other person too much, because you're probably not
one hundred percent yourself, and so they're probably putting up
with some stuff from you. So that's another kind of
(25:16):
concession you can give them that if they're working toward change,
they're going to need a long runway to be able
to make those changes. But you also got to have
to look at yourself too, and not just be standing
on a high horse saying you've got a personality disorder.
Nothing's wrong with me. You need to fix yourself or
am gone that marks.
Speaker 1 (25:39):
Are there any racial or cultural nuances that are related
to you, like the diagnosis of personality disorders that you
feel like are important to call attention to.
Speaker 2 (25:50):
That's a really difficult question for me to pinpoint, like
give a specific answer. The way that we have defined
personality disorders already has a lot of criticism associated with it.
In fact, in the DSM there's a whole like appendix
area of a whole nother way to look at personality disorders.
(26:15):
And because it's you know, this is thought that this
is this old fashion and it doesn't really take into
account nuances. And I think the nuances come with the
cultural differences. So I think it's very easy for say
a black male to be considered antisocial if he's the
(26:37):
least bit I don't even say aggressive, because I think
that's another bias, but the least bit assertive, loud talking,
arguing for the sake of argument. I mean things that
you're used to in your family. Someone looking from the
outside could say, oh, all these people have personality disorders.
And I think it's easy to peg people as if
(27:00):
you're the least bit disagreeable, if you will then you're angry.
That's not necessarily calling someone personality disordered, but it still
speaks to that easily pathologizing behavior because it's something that
you're not used to. But another kind of cultural bias
(27:21):
is the one of our stereotype is the Italians living
next to you a arguing all the time. Well, people
can say that about black people too, but that idea
of people talking loud or having disagreements, that's pathology, whereas
that actually may be adaptive for that group of people.
Like being able to just be frank about what you're feeling,
(27:45):
that's a good thing, rather than stuffing your feelings because
we're going to look a certain way and growing up
believing that it's not okay to express yourself that causes problems.
Speaker 1 (27:57):
Thank you for that nuance. I think that's helpful. So,
you know, you made a couple of comments that I
definitely want to talk more about in terms of all
of the mental health information that we're seeing online, all
of the information that we see in YouTube, TikTok, like
all of the places, and I would imagine your training
was similar in that I was trained that the number
of people who actually meet criteria you're for personality disorders
(28:20):
is very small if you go online, Oh my gosh,
like it's one in three. Like there everybody has, oh
personality disorder. Can you talk a little bit about like
the proliferation of conversations around mental health, specifically around personality disorders,
and which you think is often missed in some of
these conversations.
Speaker 2 (28:39):
Yes, I'm trying to hold it together, not get not
go off of my soap box.
Speaker 1 (28:47):
But so bock and welcome here.
Speaker 2 (28:49):
Okay, so let me just let me just cut to
the chase. I cannot stand the way narcissism is portrayed online.
I can't stand it. Granted, there are people who put
out very accurate and helpful information, but somehow, because it's
(29:12):
become trending such that people have just latched onto it
and turned anything that they don't like about someone into
it's because of narcissism. You know, everybody's mother is a narcissist.
So I'm not actually sure why we've latched onto that
personality disorder. I'm not sure, but that has become the
(29:35):
scapegoat for any bad behaviors because you're a narcissist. And
this is a small antidote example, my son He was
in middle school at the time, and I was he's
got social anxiety, and I was trying to help him
with like how to have conversations with people, and so
I was saying, okay, so you know, and you need
to ask people questions and listen and then try and
(29:58):
follow up on some of those questions later of things
that they told you. And then you also want to
give a little of yourself too, So you don't want
to just be an interview. You want to talk about yourself,
give an example you had in your life. And he said, yeah,
but if I talk about myself, then I'm being a narcissist.
And I thought, oh, my goodness, really is that what
(30:19):
we've come to. And so I think narcissistic personality is
a lot more complicated or complex than we give it
credit for. Online there's different presentations of it, but narcissism
itself is a good thing. In fact, not having a
(30:43):
healthy love of yourself is what makes you susceptible to
narcissistic personality disorder, because you have either a fragile sense
of self or an overinflated sense of self stemming from
not enough self validation. So you're more sensitive to slights
(31:03):
and things, or needing to puff yourself up or tear
people down to build yourself up, and things like that.
All right, So that's my soapbox. Sorry on that particular disorder.
But I think that, just as I was saying earlier
that even in a diagnostic setting, we psychiatrists or psychologists
(31:24):
clinicians are trained to put the brakes on any tendency
to want to diagnose someone with a personality disorder. It's
on the first meeting, especially if it's in the context
of them having what we would call an access one disorder.
Those would be the things like depression, bipolar disorder, anxiety OCD,
(31:47):
things like that, because that's like the storm that can
cover up the personality that's underneath. You can't really see
what's underneath if you've got all this other stuff going on.
So if a clinician can't always know what an underlying
personality someone has doing a diagnostic evaluation, how can you
(32:12):
watch a TikTok video and know what someone's personality is.
And it's not useful too, because, unfortunately, I think it
ends up being used as weapons for name calling and
boxing people in and that's not the intent you know
of even having this construct of personality disorders. So on
(32:39):
the positive side, I am pleased with how far we've
come in talking about mental health in general. When I
started on YouTube, actually I started probably like twenty ten,
and I had several false starts because people didn't at
least from the comments I got, people don't want to
(32:59):
hear about this, and so I got a lot, a
lot of hate. So I just I put out a
few videos, then get scared and stop. So anyway, when
I started in twenty eighteen regularly even then, like part
of my purpose was to destigmatize the discussion, and a
(33:20):
goal was to make talking about mental health part of
regular conversation, not anything that we got a whisper about.
We're not all the way there, but we're pretty far along,
and I love that. I love that a gen Z
person can say out loud, well, my anxiety is getting
in the way of me doing XYZ, and it could
(33:41):
admit that and not feel ashamed. But with every good
thing comes downsides too, and this is just one of
those downsides of proliferation of misinformation, but also the trivialization
of some of these disorder or such that ADHD is
(34:01):
another one that not every trouble. You know, I couldn't
focus yesterday. Oh I've got ADHD. Not everyone who has
trouble focusing has ADHD. But you know, I think it's
just human nature to want to put people in categories,
name things, understand what things are, and so I can't
(34:24):
fault someone who has limited information to take the information
that they do have and try it and apply it.
And that's essentially what's.
Speaker 1 (34:32):
Happening more from our conversation after the break. Of course,
there's the youtubes, the tiktoks, all the things, but there's
also like bigger media productions like movies and TV shows
(34:53):
that often don't do the greatest job of actually displaying
what a personality disorder might look like. Are there any
instances of things in film or TV that you've seen
and you feel like they've done actually a really good
job talking about or displaying personality disorders?
Speaker 2 (35:08):
So this isn't personality disorder. But I did really like
the way they portrayed psychosis in a Beautiful Mind way
back in the day with Russell Crowe. That was like
my first experience with feeling like, wow, Okay, they did
a great job of showing this and how it can
be that was very creative of them. But since then,
(35:31):
there was a movie out that came out not too
long ago with Tom Holland and I forget the name
of it. They were trying to show multiple personality disorder,
which is a very complex disorder, and I just thought,
I mean, I don't know, I think there's more examples
(35:53):
of it just being this is what we need to
see on screen, this is what will excite people, So
let's make it look like this than true portrayals, because
true portrayals aren't necessarily all that interesting.
Speaker 1 (36:08):
Yeah, which I think is would make them sometimes difficult
to depict online right or infield?
Speaker 2 (36:14):
Yeah, yeah, exactly, And actually that's a good point back
to this, like why is there so much focus on say,
narcissistic personality disord and borderline They're in the cluster of dramatic,
and dramatic is more interesting than anxious, like a dependent
personality disorder that's not as interesting. So yeah, that the
(36:37):
presentation itself, I think does have something to do with
what's portrayed, how it's portrayed, and how much we focus
on it.
Speaker 1 (36:46):
Doctor Marks, what suggestions would you have for people for
wading through all of the information they might find online.
You just mentioned like, of course people want resources like
something's happening, I want some answers. What suggestions do you
have for people for how to make sense of what
they might find online.
Speaker 2 (37:01):
Yeah, so I guess first is getting clear on what
you're trying to accomplish. So there's watching for entertainment like
we do television, and then there is trying to get
inside about yourself, and then there's trying to get inside
about someone you know. I think if you really are
trying to understand yourself better, it's about looking at the
(37:24):
source and being aware of things being too generalized. So
I can think of an example a TikTok video. I
saw someone I can't remember exactly what she said. It
was something like signs of my ADHD and it was
I can't stop writing in my journal or something like that,
(37:44):
where it's like that's actually, I mean, people can do
that for any reason that's not that doesn't equate to well,
then you've got ADHD if you do these things, but
that's what people will take from that. So the viewer
then has to be aware that to keep in mind
that people talking about their personal experiences is their personal
(38:05):
experiences and it's not it's not necessarily something you can
draw from. You might be able to relate that, oh yeah,
I do that too, but that doesn't mean you now
have a disorder because of that. And so I think
if there's a lot of things you can get online,
and I think that the things to get to extract
(38:26):
out of all of the information online is feeling the
things that you're experiencing, well, that you're not alone, but
then that you're feeling heard like wow, she does this too,
or she has this too, this is what Okay, I
don't feel so bad anymore. Like those are some positive
outcomes that still has nothing to do with what your
(38:46):
diagnosis is. That's just experiences. And so this unification of
experiences and destigmatizing and all that, those are all good
things that I think are good to get from social
media information. Going deeper than that though, as far as
actually feeling like it's helping you understand yourself or even
(39:09):
come to a conclusion about something you may have looking
at the source. So YouTube has taken the step of
identifying clinicians and putting that label under their videos. So
we have to submit our licenses and things like that.
So all of my videos will say this is from
a licensed health provider, and they do that for this
(39:32):
purpose so that people can have a better way of
screening the source of their information, so that at least
you have a greater chance that this is accurate. So
looking for reliable sources, accurate sources, even on say TikTok
or Instagram if the person they don't have those labels
like YouTube, but you could still look at the person's credentials.
(39:56):
So pay attention to whether what you're watching is someone's
perersonal experience which may not apply to you and others,
or is it from a clinician talking about broad experiences
and talking more in specific terms. Then if you think
that you have a disorder, go get a second opinion
(40:20):
or an official opinion from a licensed clinician rather than
just going with that and trying to find a way
to treat yourself if it's something that requires some form
of treatment. Because let's just say we're talking about personality
disorders today, but let's say you watch a bunch of
(40:40):
videos and you believe that you have I don't know,
dependent personality disorder, which is in the anxious, fearful cluster
where you are very hesitant to the assertive. You feel
like you need people to take care of you a lot,
which can cause problems getting on people's nerves. Are just
(41:00):
not being able to have enough get up and go
and do your own thing because you've got to wait
for other people's approval. If you recognize that because of
some videos that you've seen, then it's still helpful for
you to have that insight. Going back to what I
was saying earlier about often with personality disorders, people lack
(41:20):
the insight to see what the problem is. So it's
still a win. If you never see a psychiatrist or therapist,
it's still a win to have insight. So if these
videos help you have insight, that's good, but still it's
good if then you can take it to the next
step and try and work on yourself. There's books, there's
(41:42):
lots of self help material out there that's written and
provided by authoritative sources, So you can go to that
next step, to an authoritative source to try and get
some self help rather than the self help being all
from TikTok videos from Jane Doe who's talking about her
personal experience because everything about her may not apply to you.
(42:04):
I appreciate you.
Speaker 1 (42:05):
Bringing up the idea of resources, and that was my
next question. Are there any particular resources like podcasts, books,
other things that you typically recommend for people who either
have been diagnosed with the personality disorder or are people
who may be in their support system who want to
learn more or get more information.
Speaker 2 (42:22):
I don't have any things specific, because there's so many
things out there now. Years ago, no, but now there's
lots of different podcasts. There's your podcast, I mean, which
you know, it didn't exist years ago. So I think
it's important though, for people to feel like whatever resources
(42:43):
they're using, whether it be a book, a podcast, a
YouTube channel, that it feel relatable to them, because there's
people who've produced some great stuff, but it's either just
too academic maybe and it's just not going to be helpful.
So okay, don't worry about that, don't stress over that.
There's so many other sources out there, But it really
(43:06):
boils down to just doing searches on whatever platform it
is that you like to consume, whether it be a podcast,
go to Spotify or Apple podcasts and search for the topic.
Amazon search for the topic. So yeah, I don't have
a specific recommendation because there's just so many resources out there.
(43:27):
Oh one other thing though, so getting more specific about resources.
So nammy National Association of Mentally Ill. Don't let that
ill word scare you away. But before there was so
much more information like podcasts and online information. They were
kind of a good place to go for resources, and
(43:51):
they still are. But personality disorder wise, I'm not so sure.
I don't know what they have to offer there, but
that is still another place you could look.
Speaker 1 (44:03):
With one thing that you hope people leave this conversation
kind of understanding better about personality disorders, Doctor Marx.
Speaker 2 (44:11):
I would love it if people just understood the basic
that we all have personalities and not all personality traits
are pathologic, like personality disorders is pathology, meaning it causes
problems in multiple areas of your life. So one bad day,
(44:36):
one bad month of you feeling insecure and yelling at
people does not mean you have a personality disorder. This
is a pattern of behavior that reaches or affects multiple
aspects of your life, your relationships, your work relationships as well,
(44:58):
or school if you're still a student. It affects even
how you feel about yourself. The second part of that
is personality disorders are. They're not rare, but they're not common.
So let's just say general prevalence rates may be around
let's just say on a high side, it would be
(45:19):
like five six percent. Depression is around ten to twelve percent.
Those are still small numbers in the big scheme of things,
But personality disorders is less common than depression. So don't
be so quick to believe that every person with bad
(45:40):
behavior or who gets on your nerves and you can't
stand has a personality disorder. They may be going through
some things that's making them act this way. They may
have emotional dysregulation, which is not the same as a
personality disorder. That's an aspect of your behavior that's controlled
by your brain prefrontal cortex, be specific, and so if
(46:03):
someone has trouble managing their emotions, it doesn't necessarily mean
they have a personality source. So not everything so big
picture here, Not everything's personality disorder. If you feel you
have one, or you've been identified to have one, you
can change, but you've got to temper your expectations that
(46:24):
it's going to be a little bit of change over time,
and you've got to be patient with yourself or patient
with the person in your life who is working on themselves.
Because just like your personality did not form from one thing,
the solution to it or the change doesn't happen from
a couple of things you do. It's going to be
(46:46):
a lifetime of change.
Speaker 1 (46:51):
And where can we stay connected with you, doctor walks way,
can we check out the YouTube channel and anything else
you have to offer?
Speaker 2 (46:57):
Sure? So, my main platform that I am active on
his YouTube and my channel is my name doctor Tracy Marx,
and that's d R and then t R a c
e Y and then m A r k s. The
same handle on Instagram and the same handle on on
TikTok as well. But I'm more active on YouTube and
(47:20):
then Instagram and then TikTok. Last my website where I
just I post articles and also my videos on that
site as well is marx Psychiatry dot com. Perfect.
Speaker 1 (47:35):
We'll be sure to include all of that in our
show notes. Thank you so much for joining us today,
doctor Marx. I appreciate it.
Speaker 2 (47:40):
You are so welcome. I enjoyed this and thanks for
having me. Thank you.
Speaker 1 (47:49):
I'm so glad Doctor Marks was able to share her
expertise for this conversation to learn more about her and
her work. Visit the show notes at Therapy for Blackgirls
dot com slash Session four thirty one. Don't forget to
text this episode to two of your girls right now
and tell them to check it out. Did you know
that you could leave us a voicemail with your questions
or suggestions for the podcast. If you have movies or
(48:10):
books you'd like us to review, or have thoughts about
topics you'd like us to discuss, drop us a message
at Memo dot fm slash Therapy for Black Girls and
let us know what's on your mind. We just might
feature it on the podcast. If you're looking for a
therapist in your area, visit our therapist directory at Therapy
for Blackgirls dot com slash directory. Don't forget to follow
us on Instagram at Therapy for Black Girls or join
(48:33):
us over in our Patreon channel for exclusive updates and
behind the scenes content. You can join us at community
dot Therapy for Blackgirls dot com. This episode was produced
by Elise Ellis, Indytubu and Tyrie Rush. Editing was done
by Dennis and Bradford. Thank y'all so much for joining
me again this week. I look forward to continuing this
conversation with you all real soon Take good care
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