Personality Disorders in New York City
A diagnosis should clarify the narrative, not reduce someone to a label.
Personality disorders involve enduring mental models and automatic patterns in identity, self-esteem, emotional regulation, relationships, coping, and behavior that become inflexible or cause significant distress and impairment. At The Sheppe Group, evaluation considers development, trauma, mood, anxiety, attention, substance use, medical factors, family context, risk, strengths, and prior treatment before deciding whether a personality disorder diagnosis or a broader formulation about personality functioning is most useful. Often, considering personality functioning helps address the root causes of symptoms.
We can help when patterns limit flourishing.
Everyone has a personality, personality traits, and recurring ways of responding to stress. A personality disorder is considered when patterns in thinking, feeling, relating, or behaving are persistent, difficult to adapt, and associated with meaningful distress or impairment across important areas of life.
These difficulties may appear through unstable or rigid self-esteem, uncertainty about identity, intense emotional shifts, impulsive behavior, chronic shame, distrust, perfectionism, avoidance, dependence, conflict, fear of abandonment, sensitivity to criticism, or repeated maladaptive relationship patterns. The same outward behavior can have different meanings in different people.
At The Sheppe Group, assessment is developmental and longitudinal. The goal is to understand the person’s strengths, vulnerabilities, identity, relationships, coping styles, emotional regulation, life context, and prior treatment response so the diagnosis and formulation lead to a precise treatment direction.
Personality patterns can take different forms.
Diagnostic categories can be useful, but treatment also depends on the person’s level of personality functioning, strengths, safety, relationships, emotional regulation, capacity for reflection, and ability to participate in a structured treatment.
Borderline personality patterns
These may involve instability in identity, relationships, emotions, self-esteem, behavior, and the experience of oneself and other people. Fear of abandonment, impulsivity, intense anger, emptiness, self-harm, or rapid shifts in closeness and conflict may be present, though no single feature establishes the diagnosis.
Narcissistic personality patterns
The terms narcissism is often misunderstood. Difficulties may center on self-esteem regulation, up-down experiences of self and others, shame, sensitivity to criticism, comparison, difficulties with cooperation, or relationships organized around admiration and disappointment. Presentations can appear outwardly confident, inwardly fragile, or move between both.
Other enduring personality patterns
Avoidant, dependent, obsessive-compulsive, paranoid, schizoid, antisocial, and other personality patterns involve different combinations of fear, rigidity, distance, control, dependence, distrust, impulsivity, or difficulty sustaining mutual relationships. Expert differential diagnosis matters.
The pattern matters more than one isolated symptom.
Evaluation considers how consistently the pattern appears, when it began, whether it changes across relationships or settings, how it affects functioning, and whether another psychiatric, developmental, medical, or substance-related explanation better accounts for the difficulty.
Identity and emotional features
Relational and behavioral features
The diagnosis depends on the pattern across time.
A careful evaluation does not rely on a checklist or a difficult relationship alone. It asks how the person experiences the self and other people, how patterns developed, what changes across situations, and what may be explained by mood, trauma, anxiety, attention, substances, medical factors, or developmental context.
Pattern over time
Early relationships, temperament, attachment, trauma, family context, adolescence, adult transitions, major losses, and whether the pattern is enduring or primarily tied to a particular episode or environment.
Experience of the self
Identity, self-esteem, values, goals, continuity of self, responsibility, agency, capacity for reflection, and the ability to maintain direction when emotions or relationships become difficult.
Experience of other people
Trust, empathy, mutuality, boundaries, closeness, conflict, dependence, abandonment fears, sensitivity to criticism, and recurring expectations that shape relationships.
Overlapping explanations
Depression, bipolar-spectrum symptoms, anxiety, trauma, OCD, ADHD, psychosis, autism-related concerns, substance use, eating disorders, medical factors, and environmental stress may overlap with personality-related difficulties.
Risk and daily life
Self-harm, suicidal thinking, aggression, impulsivity, substance use, dissociation, treatment participation, relationships, school, work, housing, finances, and the appropriate level of care.
What prior care reveals
Psychotherapy relationships, ruptures, dropouts, medication response, hospitalizations, programs, testing, family involvement, strengths, motivation, and which treatment structures have or have not been usable.
Treatment must address the root causes.
Structured psychotherapy is central to treatment. Psychiatric evaluation, medication consultation, personality assessment, family consultation, and coordination may support the plan when they answer a defined clinical question or address co-occurring conditions, safety, and functioning.
Psychodynamic psychotherapy and TFP
Psychodynamic psychotherapy and Transference-Focused Psychotherapy may examine identity, emotional regulation, coping styles, and automatic relationship patterns, including relationship patterns that become visible within the treatment relationship with the therapist. The treatment frame, goals, frequency, and fit should follow careful assessment.
Explore Transference-Focused Psychotherapy →Formulation and medication consultation
Personality assessment can clarify strengths, vulnerabilities, personality organization and level of functioning, diagnosis, and treatment fit. Medication does not replace personality-focused psychotherapy, but psychiatric care may address co-occurring depression, anxiety, ADHD, sleep, trauma-related symptoms, or other defined targets.
Explore Personality Assessment & Development →A consistent treatment structure
Families and clinicians may need clearer roles around safety, boundaries, communication, crisis responses, medication, treatment participation, and level of care. Coordination is most useful when it supports one formulation rather than creating competing treatment directions.
Explore family consultation and coordinated care →A partial response may mean the treatment needs a personality-informed formulation focused on root causes.
Limited improvement does not mean that personality-related difficulties cannot change. Treatment may have focused mainly on symptoms, the diagnosis may be incomplete, the structure may not fit the person, recurring patterns may be disrupting the therapy itself, or medication may be carrying expectations that psychotherapy and development need to address.
You do not need to know whether a formal personality-disorder diagnosis applies before reaching out. The first step can be a conversation about the recurring patterns, treatment history, relationships, risks, and goals that need a clearer formulation.
How The Sheppe Group treats personality disorders.
The practice brings psychiatrist-led evaluation together with personality assessment, psychodynamic psychotherapy, TFP, MBT-informed perspectives, medication consultation for co-occurring conditions, developmental context, family context, risk assessment, and coordinated treatment planning.
Alexander H. Sheppe, MD, FAPA, DFAACAP
Dr. Sheppe provides complex clinical evaluation, psychodynamic psychotherapy, psychoanalysis, TFP, medication consultation, personality-focused formulation, family consultation, and coordinated treatment planning for adolescents, emerging adults, and adults.
Aliza Spruch-Feiner, PhD
Dr. Spruch-Feiner provides comprehensive personality assessment, feedback designed to translate findings into a clear, practical treatment recommendations, and structured, personality-focused treatment.
The Sheppe Group Testimonials
“His guidance is much appreciated.”
MM · Zocdoc review · Read source“Very helpful! Great experience!”
Amy A. · Zocdoc review · Read source“His responses to my questions were so thorough, accurate, and reassuring…”
NS · Zocdoc review · Read source“Dr. Sheppe is honest and down-to-earth…”
RM · Zocdoc review · Read source“He is clear, coherent, and thorough.”
CB · Zocdoc review · Read source“Warm and comprehensive consult.”
YH · Healthgrades review · Read source“He was really patient with me and was so thorough.”
TP · Healthgrades review · Read source“His guidance is much appreciated.”
MM · Zocdoc review · Read source“Very helpful! Great experience!”
Amy A. · Zocdoc review · Read source“His responses to my questions were so thorough, accurate, and reassuring…”
NS · Zocdoc review · Read source“Dr. Sheppe is honest and down-to-earth…”
RM · Zocdoc review · Read source“He is clear, coherent, and thorough.”
CB · Zocdoc review · Read source“Warm and comprehensive consult.”
YH · Healthgrades review · Read source“He was really patient with me and was so thorough.”
TP · Healthgrades review · Read sourcePersonality disorder care in Midtown Manhattan, near Grand Central.
The Sheppe Group sees patients at 122 East 42nd Street, 32nd Floor in New York, NY 10168, near Grand Central. In-person psychiatric evaluation, personality assessment, psychodynamic psychotherapy, TFP, medication consultation, and family consultation may be part of care, with telehealth considered when clinically appropriate and legally permitted.
122 East 42nd Street, 32nd Floor
New York, NY 10168
(646) 859-8585
Midtown Manhattan near Grand Central
Psychiatry, personality assessment, psychodynamic psychotherapy, TFP, medication consultation, family work, and coordinated care.
Telehealth for New York and Other Licensed States
Telehealth may be available for patients located in New York, New Jersey, Connecticut, Florida, and California, depending on clinical need, licensure, privacy, safety, treatment structure, and whether remote care is the right setting.
Common questions about evaluation and treatment.
These answers provide general information. A consultation is needed to evaluate an individual diagnosis, risk, treatment structure, medication question, family role, or level of care.
Further reading from national mental-health organizations.
What are personality disorders?
Personality disorders involve enduring patterns in thinking, feeling, relating, or behaving that become inflexible and cause significant distress or impairment. Diagnosis depends on the pattern across time and settings, its effect on functioning, developmental context, and whether another psychiatric, medical, substance-related, or situational explanation better accounts for the difficulty.
Does having strong personality traits mean I have a personality disorder?
No. Everyone has personality traits, strengths, vulnerabilities, and recurring coping styles. A disorder is considered only when patterns are persistent, difficult to adapt, and associated with meaningful distress or impairment. Personality functioning concerns can still benefit from treatment even when a formal diagnosis does not apply.
How are personality disorders evaluated?
Evaluation considers development, identity, self-esteem, emotional regulation, relationships, empathy, intimacy, coping, behavior, risk, functioning, trauma, mood, anxiety, attention, substance use, medical factors, culture, family context, and prior treatment. Records, psychological or personality assessment, and collateral information may be useful when they answer a defined clinical question.
Can personality disorders be diagnosed in adolescents?
Yes. Adolescents can have clinically important and persistent difficulties involving identity, relationships, emotional regulation, behavior, and personality development. Assessment should be especially careful about developmental stage, duration, context, trauma, family systems, mood, anxiety, ADHD, and other explanations. Expertise is critical; a formal diagnosis should not be rushed or used simply to describe a difficult period.
What treatments can help with personality disorders?
Structured psychotherapy is central to treatment. Depending on the formulation, treatment may include psychodynamic psychotherapy, Transference-Focused Psychotherapy, mentalization-based approaches, dialectical behavior therapy, cognitive therapies, supportive psychotherapy, family consultation, and coordinated care. The appropriate treatment depends on diagnosis, risk, goals, strengths, treatment history, and capacity to make use of the treatment structure.
Is medication used to treat personality disorders?
Evidence-based psychotherapy is the gold-standard treatment for personality disorders. Medication is not a substitute for personality-focused psychotherapy and may not directly treat the core personality pattern. Psychiatric medication may be considered for specific symptoms or co-occurring conditions such as depression, anxiety, ADHD, sleep disturbance, trauma-related symptoms, or mood instability after careful evaluation of benefits, risks, prior response, and the overall treatment plan.
Can family members or existing clinicians be involved?
Yes, when involvement adds clinical value and appropriate permission is in place. Family consultation and care coordination may clarify safety, boundaries, communication, crisis responses, medication, treatment roles, and level of care. Coordination works best when each participant understands the formulation and has a defined responsibility.
Ready to take the next step?
A consultation can help determine whether the right starting point is complex clinical evaluation, personality assessment, psychodynamic psychotherapy, TFP, medication review for co-occurring concerns, family consultation, or collaboration with an existing treatment team.
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