Relationships and Personality Disorders: Understanding Both Sides

What happens when mental health challenges become part of a romantic relationship?

For some couples, the answer may involve intense emotions, misunderstandings, difficulty trusting, fear of rejection, conflict, or periods of emotional distance. For others, the challenges may be much less visible. A partner may struggle privately with shame, insecurity, or a fear of being hurt, while the other partner is left wondering why it feels so difficult to get close.

When a personality disorder is part of a relationship, both people may find themselves asking the same question in different ways:

“Why do we keep getting stuck in the same patterns?”

Personality disorders are not all the same. They involve different patterns of thinking, feeling, relating, and responding to the world, and those patterns can affect relationships in different ways. Research has found an association between personality pathology and difficulties in interpersonal functioning, including romantic relationships, but it is important not to assume that everyone with a personality disorder will experience relationships in the same way (Wilson et al., 2017).

Understanding both partners' experiences can reduce blame and create more opportunities for change.

What Can It Feel Like to Be in a Relationship With Someone Who Has a Personality Disorder?

Being close to someone who struggles with a personality disorder can sometimes be confusing or emotionally exhausting.

A partner may experience periods of intense closeness followed by conflict or withdrawal. Communication may become difficult when one person feels rejected, criticized, misunderstood, or overwhelmed. In some relationships, disagreements may escalate quickly. In others, one partner may withdraw or avoid difficult conversations, leaving the other feeling shut out.

The particular pattern depends on the individual and the personality disorder involved.

For example, someone experiencing borderline personality disorder may struggle with intense emotions, fears of abandonment, or rapidly changing perceptions of themselves and their relationships. Someone with avoidant personality disorder may strongly desire connection while also being highly sensitive to criticism or rejection, making vulnerability difficult.

These patterns can affect both people in the relationship. Research involving couples with elevated personality disorder severity has found that attachment insecurity and behaviours such as withdrawal can help explain some of the relationship difficulties associated with personality pathology.

For the partner, the experience can involve genuine love and commitment alongside frustration, uncertainty, or emotional fatigue. A systematic review of partners of people with BPD found that partners commonly described emotional challenges, feeling pulled into roles beyond that of romantic partner, and a sense of having limited control over the situation (Greer & Cohen, 2018).

That does not make either person the villain.

It means the relationship may need support.

What Is It Like to Have a Personality Disorder and Be in a Relationship?

It is equally important to consider the experience of the person living with the diagnosis.

Wanting a close relationship does not disappear because someone has a personality disorder. In fact, relationships may be deeply important to them while also activating some of their most difficult emotions.

Depending on the individual, there may be fears of rejection, difficulty trusting others, sensitivity to criticism, uncertainty about self-worth, difficulty regulating emotions, or a tendency to withdraw when feeling vulnerable.

For someone with BPD, for example, a perceived change in a partner's tone, availability, or affection may trigger intense emotional distress. What looks confusing from the outside may feel very real and frightening to the person experiencing it.

At the same time, having a personality disorder does not mean someone is incapable of insight, empathy, commitment, or change.

This is an important distinction because stigma surrounding personality disorders can be incredibly damaging. A diagnosis should help us understand patterns that are causing difficulty. It should not become a label that defines someone's character or determines what kind of relationship they can have.

Why Couples Can Get Caught in Difficult Patterns

Relationship difficulties often become self-reinforcing.

Imagine one partner becomes afraid that the other is pulling away. They seek reassurance repeatedly or become angry. The other partner feels overwhelmed and withdraws. The withdrawal then increases the first partner's fear, leading them to pursue even more strongly.

Neither person may be consciously choosing this cycle.

Yet both people can become increasingly frustrated by it.

Research with couples has found that relationship satisfaction is associated with patterns involving attachment anxiety, attachment avoidance, and withdrawal, suggesting that the interaction between partners matters rather than looking at one person's diagnosis in isolation.

This is why simply telling one partner to “stop being so emotional” or the other to “try harder” rarely addresses the underlying pattern.

The more useful question is often:

“What happens between us when we both feel threatened, rejected, overwhelmed, or misunderstood?”

Relationships Can Change

A personality disorder can create significant challenges, but it does not determine the future of a relationship.

Research on long-term married couples has found that higher levels of personality disorder pathology are associated with lower relationship satisfaction for both individuals and their spouses. At the same time, the researchers found considerable individual variation, reminding us that personality pathology does not produce one inevitable relationship outcome (South et al., 2020).

People can learn new ways of managing emotions, communicating, responding to conflict, and understanding themselves and one another.

For people with BPD in particular, psychotherapy has a substantial evidence base. Recent systematic reviews have found that psychological treatments can improve BPD symptoms and functioning, although there is not strong evidence that one particular therapy is universally superior to all others (Crotty et al., 2024; Setkowski et al., 2023).

That matters for relationships because individual change can affect the relationship as a whole.

Supporting Both People in the Relationship

The person with the diagnosis is not the only one who may need support.

Partners can experience considerable stress and may need a place where they can talk honestly about what they are experiencing without being judged for loving someone who is struggling.

Research on interventions for relatives of people with personality disorders suggests that psychoeducation and skills-based support can help family members develop greater confidence and improve aspects of their own well-being and family functioning. One study of the Family Connections program, for example, found improvements in family members' burden, emotional symptoms, family empowerment, and family functioning (Guillén et al., 2022). A subsequent randomized controlled trial also found benefits for relatives of people with BPD (Guillén et al., 2024).

Support does not have to mean taking responsibility for another person's emotions.

Healthy relationships still need boundaries, mutual respect, accountability, and room for both people to have their own needs.

Can Couples Therapy Help?

Sometimes the most helpful place to begin is individual therapy.

A person living with a personality disorder may benefit from learning more about their emotional patterns, developing coping strategies, strengthening their sense of self, and finding different ways to respond during moments of distress.

Partners may also benefit from individual counselling. It can provide space to understand their own reactions, clarify boundaries, work through exhaustion or resentment, and consider what they need from the relationship.

Couples therapy may also be appropriate when both people are willing to participate and the relationship is safe enough for conjoint work. Therapy can help couples identify recurring cycles, communicate more effectively, understand each other's experiences, and practice different ways of responding to conflict.

Couples therapy is not about deciding who is right.

It is about understanding what keeps happening between two people and determining whether those patterns can change.

When Safety Needs to Come First

There is one important exception.

Not every relationship problem should be addressed through couples therapy.

If there is intimidation, coercive control, threats, violence, or fear of retaliation, safety needs to be assessed before considering conjoint therapy. A diagnosis of a personality disorder does not excuse abusive behaviour, and having a personality disorder does not mean someone is abusive.

The focus should remain on behaviour, safety, accountability, and the well-being of everyone involved.

A Diagnosis Does Not Tell the Whole Story

A personality disorder can influence how someone experiences themselves, other people, and close relationships. But a diagnosis is only one part of a person.

There is also the individual who loves deeply, wants to feel understood, has strengths and values, has experienced pain, and may genuinely want their relationships to be different.

And there is the partner who may love someone very much while also feeling tired, confused, hurt, or unsure of what to do next.

Both experiences deserve to be taken seriously.

With appropriate support, people can develop greater awareness of their patterns and learn new ways of responding. Relationships can change too.

At Authentic Living London, Sandra Graham, BSc, MACP works with individuals and couples navigating the challenges that can arise when personality disorders affect relationships. Therapy can provide a compassionate, non-judgmental space to understand what is happening, strengthen communication, establish healthy boundaries, and explore what a healthier relationship could look like.

If your relationship has begun to feel stuck in the same painful patterns, you do not have to understand everything before reaching out for support. Sometimes the first step is simply having a place to talk openly about what has been happening.

CLICK HERE to book a free 15 minute consultation today.

References

Crotty, K., Viswanathan, M., Kennedy, S., Edlund, M. J., Ali, R., Siddiqui, M., Wines, R., Ratajczak, P., & Gartlehner, G. (2024). Psychotherapies for the treatment of borderline personality disorder: A systematic review. Journal of Consulting and Clinical Psychology, 92(5), 275–295. https://doi.org/10.1037/ccp0000833

Greer, H., & Cohen, J. N. (2018). Partners of individuals with borderline personality disorder: A systematic review of the literature examining their experiences and the supports available to them. Harvard Review of Psychiatry, 26(4), 185–200. https://doi.org/10.1097/HRP.0000000000000164

Guillén, V., Fonseca-Baeza, S., Fernández-Felipe, I., Botella, C., Baños, R., García-Palacios, A., & Marco, J. H. (2022). Effectiveness of Family Connections intervention for family members of persons with personality disorders in two different formats: Online vs face-to-face. Internet Interventions, 28, 100532. https://doi.org/10.1016/j.invent.2022.100532

Guillén, V., Fernández-Felipe, I., Marco, J. H., Grau, A., Botella, C., & García-Palacios, A. (2024). Family Connections, a program for relatives of people with borderline personality disorder: A randomized controlled trial. Family Process. https://doi.org/10.1111/famp.13089

Setkowski, K., Palantza, C., van Ballegooijen, W., Gilissen, R., Oud, M., Cristea, I. A., Noma, H., Furukawa, T. A., Arntz, A., van Balkom, A. J. L. M., & Cuijpers, P. (2023). Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychological Medicine, 53(8), 3261–3280. https://doi.org/10.1017/S0033291723000685

South, S. C., Boudreaux, M. J., & Oltmanns, T. F. (2020). The impact of personality disorders on longitudinal change in relationship satisfaction in long-term married couples. Journal of Personality Disorders, 34(4), 439–458. https://doi.org/10.1521/pedi_2019_33_392

Wilson, S., Stroud, C. B., & Durbin, C. E. (2017). Interpersonal dysfunction in personality disorders: A meta-analytic review. Psychological Bulletin, 143(7), 677–734. https://doi.org/10.1037/bul0000101