Personality Disorders: The First Steps Before Anything Else

A personality disorder is not a "bad character" or a whim. As the doctor puts it, "personality" here means a brain that, for various reasons, "grew up and works non-functionally." First the character responds the same way to stimuli; then neuroplasticity distorts further — and a brain state forms that we call a personality disorder. So the first steps are not "techniques against a narcissist," but calm assessment and understanding the mechanism.

Understand First, Don't Label

The main task of the first step is to see exactly how the brain works wrong. A narcissist, for example, carries psychotrauma, fear, insecurity, and a constant need for others' approval. All incoming information passes through one filter: "how can this hurt me." Looking at roses, he sees thorns; looking at mushrooms, he wonders if they're poisoned. This isn't ill will but a "battered brain, structurally working wrong." Grasping this mechanism removes blame and gives you a foothold.

Don't Start With Medication

The doctor warns plainly: with psychosomatic and similar complaints, don't grab for drugs right away. First try to set the brain's work and rhythm in order. Medication is not the first step but a possible later one.

Get Tested and Rule Out Other Causes

Before drawing conclusions, the doctor advises an examination: simple blood tests, liver panels (ALT, AST and other enzymes), urinalysis, biochemistry. This is to rule out somatic pathology — thyroid, liver, pancreas and other disorders that can themselves secondarily drive the experiences. For assessing the brain he names the EEG, and for imaging only MRI on a 3-tesla machine; the rest, in his words, has no informative basis.

Separate the "Everyday" From the Clinical

The doctor stresses a huge confusion: the same word means different things to laypeople and psychiatrists. For an ordinary person "depression" is fatigue and low mood as a symptom — a "basket" into which various bad feelings are dumped. For a psychiatrist it's already a mental disorder of a different register, treated completely differently. So the first step in sorting out complaints is to separate the mental register (severe disorders) from the somatic, and only then understand what you're facing.

Why This Matters for Personality Disorders

The same principle of recognizing the mechanism applies here. In a person with a distorted "character"-turned-"personality," information always runs through the sore points, through the thought "where will the blow come from." The task is not to treat with talk what talk can't treat, but first to understand the mechanism and rule out other causes. The doctor warns: trying to "talk away" what belongs to the severe registers simply cannot be done.

Practice

A first-steps checklist (strictly per the doctor's logic):

1. Don't start with medication — first try to set the brain's work and rhythm in order.
2. Get simple tests: blood, liver panels (ALT, AST, enzymes), urine, biochemistry.
3. Rule out somatics — thyroid, liver, pancreas and other disorders that may secondarily produce symptoms.
4. If brain assessment is needed — EEG; for imaging, only 3-tesla MRI.
5. Separate the everyday sense of a complaint from the clinical register — and only with this in hand go to a specialist.