The first article I wrote on the Dangers of Diagnosis brought out strong responses. Some agreed wholeheartedly, others felt I minimized the pain of living with a spouse who struggles with serious mental illness. My goal here is to clarify, especially when the issue involves a suspected personality disorder.
What to do when you think your spouse has a personality disorder
Mental illness
There are many people out there, including some of our readers who are living with a spouse who is suffering with mental illness. It was in no way my intention to minimize this reality or the difficulties of such a situation.
Depression exists. Obsessive Compulsive Disorder is a reality. Mental illness can be debilitating and can have a negative effect on a relationship. Medication can be effective in alleviating many of these symptoms and making life more livable.
Many times, it is advisable to treat these issues before going to couples counseling as many of the external stressors can be eliminated by treating the illness.
Misdiagnosis
With that being said, one goal of my article was to point out that it is not very useful for non-clinicians to diagnose their spouse. Unless one is trained and experienced in using the DSM-IV, the diagnosis may not only be incorrect, it may be harmful to the relationship as it labels one spouse as mentally ill.
This sets up an unlevel playing field.
Furthermore, all because someone is a therapist does not mean that they are making the correct diagnosis. It is a skill that comes trough consulting with experts and colleagues. It is not a right conferred when you receive your college degree.
Personality Disorders
This is especially important when it comes to more subjective diagnoses such as personality disorders. It is important to note that these abnormal behaviors need to generalize themselves to a range of personal and social interactions, not just in your marriage where there might be some type of trigger.
They also need to impair your day-to-day functioning. While your spouse may be very sensitive to criticism and have a poor self-image, it does not mean that your spouse has borderline personality disorder.
Many of us may identify with some of the symptoms listed and we may somewhere along the continuum but unless it is getting in the way of our daily functioning, then it may not be pathological.
(This is also the case with mood disorders such as depression. You may be unhappy and if your marriage is lousy, you have good reason to be. Does this make you clinically depressed? Can you get out of bed in the morning? Are you holding down your job? Did you lose twenty pounds? The point being that all because one’s mood is depressed if it does not interfere with your daily life, it may not be worthy of diagnosis. If the marriage were repaired, the mood may very well improve.)
Working on your marriage
Creating safety in your relationship can only help deal with the stress and anxiety that often triggers these personality disorders.
Sometimes the symptoms go away when the relationship is in a good space.
Furthermore, even people who are suffering with mood disorders can have a successful marriage. Mental illness can interfere but it does not have to interfere and ruin a relationship if you work together.
My article’s goal was to caution about the sometimes irresponsible labeling that goes on and how it can do a disservice to a marriage where in many cases working on the relationship may be all that is needed.
Of course, this does not mean that there are not cases where there is mental illness, and sometimes serious mental illness, that need be addressed first.
Should You Diagnose Your Spouse?
If you think your spouse may have a personality disorder, it’s natural to want answers. But here’s the danger:
- You are not objective. Even if you are a therapist, diagnosing your own spouse puts you in a conflicted position.
- Misdiagnosis can be damaging. Incorrectly labeling your spouse with a disorder sets up an uneven playing field, where one partner is “sick” and the other is “healthy.”¹
- Not every difficult trait equals a disorder. Many people identify with traits of borderline, narcissistic, or obsessive personalities. Unless these patterns are consistent across different areas of life and interfere with daily functioning, they do not necessarily qualify as a disorder.²
Questions People Ask in This Situation
1. “What if my spouse really does have a personality disorder?”
- If a qualified professional evaluates your spouse and confirms the diagnosis, treatment (therapy, medication, or both) may help.³
- Even then, focusing on building relational safety can reduce symptoms that show up most strongly in marriage.⁴
2. “Should I go to couples counseling if my spouse has mental illness?”
- Sometimes individual treatment should come first (for depression, OCD, bipolar disorder, etc.) if symptoms make daily functioning impossible.³
- In other cases, couples counseling provides a safe space that reduces triggers, helping the relationship and mental health at the same time.²
3. “Does mental illness mean my marriage can’t work?”
- Not necessarily. Many people with mental health struggles have long, successful marriages when both partners commit to growth, safety, and teamwork.⁴
- The key is distinguishing between what is truly illness-driven and what is relationship-driven.
When It’s Not a Diagnosis
- Feeling depressed because your marriage is unhappy doesn’t always mean you meet the criteria for clinical depression.¹
- Being highly sensitive in marriage doesn’t automatically mean you have borderline personality disorder.²
- Struggling with control or order doesn’t necessarily equal OCD.
Often, when the marriage improves, the emotional symptoms improve as well.⁴ That’s why labeling your spouse too quickly can backfire—it may prevent you from working on the very relationship patterns that could bring healing.
Working on the Marriage First
My main caution is this: diagnosing your spouse—especially with something as loaded as a personality disorder—may block progress instead of fostering it.
Instead:
- Focus on building relational safety.
- Reduce criticism and increase curiosity.
- Create the conditions where both of you feel secure enough to grow.
When safety is present, some of the symptoms that felt overwhelming may diminish, giving both of you more breathing room.³
Key Takeaways
- Don’t self-diagnose your spouse. Even trained therapists can mislabel when emotionally involved.
- Personality traits ≠ personality disorder. Diagnosis requires symptoms to be pervasive and disruptive across life—not just marriage.
- Treatment can help—but so can safety. Sometimes symptoms decrease when the relationship environment improves.
- Marriage is still possible. Even with mental illness present, couples who work together can build strong, lasting bonds.
Sources
¹ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Association; 2013.
² South, S. C., Turkheimer, E., & Oltmanns, T. F. (2008). Personality disorder symptoms and marital functioning. Journal of Consulting and Clinical Psychology, 76(5), 769–780.
³ Whisman, M. A., Uebelacker, L. A., & Weinstock, L. M. (2004). Psychopathology and marital satisfaction: The importance of evaluating both partners. Journal of Consulting and Clinical Psychology, 72(5), 830–838.
⁴ Johnson, S. L., & Whisman, M. A. (2013). Personality disorders and divorce. Journal of Personality Disorders, 27(4), 467–478.
More inspiration on being married to a spouse with a personality disorder:
