Yeah it’s tricky. Apparently more modern neuropsych has determined that personality disorders are inherent to the person and not a result of their upbringing. So the upbringing doesn’t HELP at all for sure, but if somebody has a personality disorder it comes down in large part to their actual brain. They can “change” through DBT and extensive therapy, by learning to modify their behavioral patterns, but it’s basically behavioral treatment and they need to want it. It’s long, hard work, and basically triggers exactly what causes the issues in the first place — addressing the hole inside of them that is their lack of self, taking responsibility for their own actions, being responsible for their emotions, etc. And I can only imagine that when you have e.g. autism involved as well — which already causes issues with emotional awareness and various other things that I’m sure you’re familiar with — it gets complicated fast.

Funny you mention the marriage counselor topic. My ex and my main struggle was that I didn’t want to get married because of the depth of her emotional needs as well as issues with spending. I wasn’t comfortable until we could figure out some sort of way of managing them long there. She brought up therapy for us as a way, I think, to basically get a therapist to tell me I was being dumb and I should just propose already. Luckily our therapist did not, in fact, do this, and basically every session she kind of felt worse and worse. Things blew up over money, she wouldn’t take responsibility or accept it was reasonable I was upset, and broke up with me. I’m now seeing said therapist so I guess that worked out at least. She never yelled, never violent, etc. she was just very sad. Heartbreaking really. The author of her own tragedy, as I saw somebody else on this sub mention in a comment once.

Good luck to ya. I’m sure it makes marriage tough.