Perimenopause as Personality Collapse: A Psychoanalytic Deep Dive with McWilliams

Most people treat perimenopause like it's just hot flashes and hormones. But through the lens of Nancy McWilliams’ psychoanalytic theory, we see something far more structural: a full-blown stress test of personality. In this episode, Enrique, Ash, and Danni unpack how borderline, narcissistic, depressive, obsessive, and masochistic personalities react when the ego starts to crack under hormonal, relational, and existential pressure. This isn’t about blame—it’s about recalibration. elevate.epo

Transcript

Perimenopause as Personality Collapse: A Psychoanalytic Deep Dive with McWilliams
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[00:00:00] Most people talk about perimenopause, like it's just hot flashes and hormones, as if it's just a part of life that relationships manage to somehow survive given zero social context. But if you look through a psychoanalytic lens, you see something deeper. Perimenopause is a structural event. It doesn't just change the body.

It shakes the ego, tests, defenses, and cracks. The communication field wide open. This session isn't about symptoms. It's about what happens when long held relational patterns collide with biological change and how those old defenses either adapt or collapse. This episode uses Nancy MCMs psychoanalytic personality framework to decode how perimenopause stress tests five core structures 

Narcissistic, depressive, obsessive and masochistic. Each personality type [00:01:00] reacts to hormonal, relational, and identity upheaval in unique but patterned ways, often leading to regress defenses, amplified vulnerability, and dysregulated communication. Key insights from this episode Borderlines. heightened reactivity splitting.

Fear of abandonment, needs consistency, and firm, yet validating boundaries. narcissistic shame from loss of control, exaggerated need for praise, devaluation needs gentle framing, not confrontation. Depressive positions, intensify self blame, hopelessness, self withdrawal needs, patient presence, not toxic positivity.

We'll also learn about obsessive traits while going through menopause. Anxiety from unpredictability, rigid routines, emotional detachment, and this signifies a need of a structured [00:02:00] support, emotional permission to be present and masochistic elements, internalized suffering, passive resistance to help guilt from self-care needs boundaries and compassionate truth 

Ultimately, perimenopause is framed as a crucible for personality structure, and it's just what elevate that EPO is. Is understanding how your personality is structured and changes in real time, not just a hormonal event, but a psychological stressor that exposes the limits of one's ego.

Organization support isn't about fixing symptoms, but understanding and recalibrating the relational field as we'll go through this analysis by Ash and Danny, Nancy McWilliams does lay out. A pretty compelling case for how a lot of the clinical symptoms present are usually their impairment, perimenopausal phases as [00:03:00] well.

But again, this isn't to cast blame or make people feel worse than they already do. This is so that we can begin to have a conversation about how we begin to change the way we communicate about. perimenopause because dangerous.

Situation when we don't have any education about, this particular very real change, that structurally changes the relationship. as we introduce Nats Mick Williams, we'll take this week to understand how we can change the way that we communicate, and understand how that relationship is itself a model for.

A lot of the, dysfunctions that we bring from our own unresolved experiences. But for today, let's focus on Nancy McWilliams and look at the frameworks and structures, 

per her work.

As we take a look at Nancy mc Williams's Psychoanalytic Diagnosis, thank you for joining us here on a Monday. 

I'm Enrique. This is [00:04:00] Elevate dot epo. Let's open it up. 

Ash: Welcome to the deep 

Dive. Today we're looking at personality, um, through a psychoanalytic lens, 

right? Which means it comes more from, you know, clinical experience, not so much academic labs. McWilliams work is really key here. 

Ash: Exactly. And for you, the learner listening in, you want that deep understanding, those aha moments, but.

Well without getting totally swamped by jargon. 

Yeah, we get it quick, but thorough. 

Ash: So today we're doing something pretty specific. We're [00:05:00] taking a specific life phase, cardio, menopause, and seeing how it might, uh, stress test certain personality types 

using McQuillans framework. Yeah, it's a time of huge upheaval, hormones, identity relationships.

It all gets shaken up. 

Ash: Mm-hmm. So our mission, if you will, is to explore how some of mc Williams's main personality types were focusing on borderline narcissistic, depressive, obsessive and masochistic, how they might react when things get destabilized by perimenopause. And we'll 

look at like which defenses might start to crack under that pressure.

Ash: Right? And what kind of, uh, communication patterns may be the less helpful ones pop up more often. 

Finally, what kinds of responses from other people or even from themselves are actually helpful versus well harmful during this phase, all through that McWilliams lens. 

Ash: Okay. Sounds like a plan. Let's, uh, let's dive in, starting with borderline personality structure in perimenopause.

Okay. So what's really interesting here is that the hormonal chaos of car menopause. It [00:06:00] can almost well mirror the baseline emotional state for someone with a borderline organization. 

Ash: You mean that effective ability, the ups and downs. 

Exactly. So you might see that baseline reactivity get even more intense, heightened emotional responses 

Ash: and the instability of it all, physical changes, relationship shifts, that must hit those core borderline fears.

Right? Like abandonment. 

Absolutely. Fears of abandonment could definitely spike. You might see more reliance, maybe even regression, um, becoming more dependent on partners or key figures. 

Ash: And you mentioned something interesting earlier, drawing from M Williams. Yeah. About hope being scary. 

Yes. That's a crucial clinical point.

Sometimes when real hope for improvement appears, like, say, finding ways to manage perimenopause symptoms. Borderline clients can paradoxically panic. Why is that? It's often seen as a defense against potential future disappointment. Like if I hope too much, the crash will be even worse. So weirdly, getting better can trigger anxiety or even, you know, [00:07:00] self-sabotage.

Ash: Wow. Okay. So what are other typical defenses like splitting? 

Ah, splitting? Yes, that could become much more pronounced, really rapid shifts, you know, between seeing someone, a partner, a doctor, is absolutely perfect, then suddenly totally awful 

Ash: black and white thinking on overdrive. 

Pretty much, and projective identification could ramp up too.

That feeling of being controlled by others' emotions or intensely influencing them. And of course, maybe denial about how much the symptoms are actually affecting them. 

Ash: So how does this translate into how they communicate, how they interact with people? 

While you might see more demanding behavior may be a sense of entitlement stemming from those deeper dependency needs being start up.

Angry outbursts could be more frequent. Or difficulty managing emotions in conversations and that classic pattern, idealizing someone intensely, then bam, devaluing them sharply if they feel let down, 

Ash: because nuance is hard when you're in that state. 

Very hard. It often comes out in extremes. 

Ash: So thinking about support.

What [00:08:00] actually helps someone navigating this and what really doesn't? 

Consistency is huge, predictable support, validating their emotional experience. Like, wow, that sounds incredibly intense, without necessarily agreeing with the extreme conclusions. That's key. 

Ash: So acknowledging the feeling without feeding the distortion.

Exactly. Clear boundaries are also essential, just like in therapy for borderline patterns and really. Patience. Understanding that regulating these intense feelings is genuinely difficult for them 

Ash: and the harmful responses. Mm-hmm. What should people avoid? 

Oh, definitely dismissing it as just hormones.

That's incredibly invalidating, right? Inconsistent responses. Rejection. Those directly hit the abandonment fears, getting sucked into the splitting, taking sides that's not helpful, 

Ash: and making interpretations about their past. 

Generally McWilliams suggests focusing on the present experience. Historical interpretations, especially when someone's feeling overwhelmed, often aren't that useful in the moment.

They need help with the now. 

Ash: Okay. That paints a clear picture for borderline. Let's [00:09:00] shift gears now to, uh, the narcissistic personality structure during perimenopause. How might that play out? 

Well, for someone whose self-worth is really tied up in feeling superior, special in control, perimenopause can feel like a direct assault 

Ash: because it's something they can't fully control.

I. The physical changes, the emotional shifts 

precisely. It threatens that carefully constructed sense of self-sufficiency and their ideal self-image. This can stir up a lot of vulnerability underneath 

Ash: vulnerability. Like what? Shame, 

definitely shame. Shame about aging. Maybe shame about not coping perfectly, maybe envy towards others who seem unaffected, and that can lead to feelings of emptiness or inadequacy.

It's like a narcissistic injury as the term goes. 

Ash: So how do they typically cope with those uncomfortable feelings? 

Often by doubling down on the defense. So you might see more grandiosity, not less as a way to push away those vulnerable feelings. 

Ash: Ah, interesting. Like overcompensating. 

Exactly. And a heightened need for external [00:10:00] validation.

What M Williams calls narcissistic supplies, they need more admiration. More reassurance from the outside to kind of prop up that shaky self-esteem. 

Ash: And their usual defenses, idealization and devaluation, for example. 

Yeah, those might become more erratic. They might idealize a doctor who seems powerful, hoping to sort of borrow that strength, but then quickly devalue them if they don't provide constant praise or solve everything immediately.

Ash: And that self-sufficiency image, 

it might crack. You could see a kind of resentful dependence emerge, needing help, but hating that they need it. And projection is common too, projecting their own fears about aging or inadequacy onto other people. 

Ash: So communication wise. What might we expect? 

Possibly more entitled demands for attention for reassurance.

More criticism directed outwards, especially if they feel their needs aren't being perfectly met, 

Ash: devaluing others to feel better themselves. 

That can be part of it, exaggerating their own importance, denying any difficulties they're having, and you know [00:11:00] that core difficulty with genuine empathy might become even more pronounced if they're feeling very self-absorbed due to their own vulnerability.

Ash: So interacting with someone like this during perimenopause. 

Enrique: Hmm. 

Ash: How can you be helpful without getting caught in those dynamics? 

It's tricky. Gently acknowledging their discomfort, maybe validating the reality of the changes without directly challenging the grandiosity itself. 

Ash: So focus on the situation I.

Not the personality flaw, 

Enrique: kind of respecting their need to maintain self-esteem, even if it seems inflated. Framing suggestions really sensitively to avoid triggering that underlying shame is crucial. Always remember the shame, even if they seem arrogant 

Ash: and the pitfalls. What should you definitely avoid?

Direct confrontations about the grandiosity or entitlement, usually backfire, big time. Leads to defensiveness, maybe rage 

Ash: don't mirror their devaluation either, I imagine. 

No, definitely not. Don't get drawn into criticizing others with them or criticizing them back in the same way, and don't [00:12:00] just focus on their flaws.

Try to see the vulnerability underneath. Failing to recognize that hidden shame is probably the biggest mistake. 

Ash: Right. Understanding the function of the defense. Okay. Let's move on to the depressive personality structure. How might perimenopause impact someone? Organized this way 

for someone already prone to sadness, guilt, self-blame, perimenopause can really amplify those feelings.

The hormonal shifts themselves can affect mood, plus the tangible losses, changes in body, maybe abilities. Shifting identity, 

Ash: it feeds into that existing narrative of loss or inadequacy. 

It can, yes, you might see increased feelings of sadness, more intense. Self-reproach, maybe more social withdrawal, isolating themselves and that common depressive fear of being a burden that can get much stronger.

Ash: How might their typical defenses shift under this stress? 

Interjection? Swallowing, critical voices might get harsher. So more intense self-criticism, 

Ash: beating themselves up more. 

Yeah, and idealizing the past. I used to be [00:13:00] so much better. Stronger. Happier can create a really painful contrast with the present and that turning of anger inward.

That can deepen feelings of worthlessness. 

Ash: So communication wise, what might that look like? 

You might hear a lot of apologies. Excessive self blame, even for things that aren't their fault, difficulty asking for what they need because they fear rejection or just feel they don't deserve it, or that they'll bother people.

A 

Ash: generally pessimistic vibe 

often, yes. Focusing on the negative aspects and McWilliams highlights this resistance to seeing external sources of frustration or anger. They tend to turn it back on themselves, assuming they must be the problem. 

Ash: Okay, so what kind of support really lands well with someone like this during perimenopause?

Consistent reassurance. Acceptance is huge. Just being there reliably, gently challenging that negative self-talk can be helpful, but it needs to be gentle, 

Ash: not just cheer up. 

Definitely not encouraging them to express all their feelings. Even anger, if it's accessible under the sadness can be really important and [00:14:00] patience.

Understanding that deep belief they have, that if people really knew them, they'd be rejected. You have to patiently counteract that. 

Ash: And conversely, what's really unhelpful 

dismissing their sadness is just menopause is terrible. Telling them to look on the bright side feels invalidating. Anything that reinforces guilt or inadequacy, even accidentally 

Ash: exercising their negativity.

Yeah, that just confirms their worst fears about themselves. It usually makes them shut down more. 

Ash: Okay. Let's pivot to the obsessive personality structure. Mm-hmm. Perimenopause seems like it would be uniquely challenging for someone who needs control in order. 

Oh, absolutely. The unpredictability is the core problem here.

Yeah. Hormonal swings, you can't predict bodily changes. You can't fully manage. 

Ash: Yeah. 

It directly threatens that fundamental need for control. 

Ash: So more anxiety, 

definitely increased anxiety. You might see a much tighter focus on details, maybe intense rumination. Lots of worrying about managing symptoms or future health stuff.

Ash: Trying to regain control through mental effort. 

Exactly. [00:15:00] And potentially more rigidity. Finding it harder to adapt to the changes. And maybe shame too. Shame about not being able to control their body or emotions as effectively as usual. 

Ash: What happens to the usual defenses? The isolation of affect, intellectualization.

Isolation of effect. Separating feelings from thoughts might start to fail them a bit. 

Ash: Wow. 

Because the physical and emotional sensations can become pretty intense. Harder to just wall off 

Ash: the feelings leak through. 

Right, so Intellectualization might ramp up even more trying to manage it all through logic, facts, research, distancing from the actual felt, experience and reaction formation, maybe acting overly controlled or rational, to combat underlying anxiety about losing control.

Ash: How might this show up in their communication? 

Lots of questions. Seeking tons of information, trying to pin everything down, regain that sense of control through knowledge, 

Ash: maybe becoming a bit of a health expert on themselves. 

Could be maybe more moralizing or rigidly sticking to rules and routines to [00:16:00] manage the anxiety, difficulty expressing emotions directly.

Focusing much more on facts, logistics, shoulds 

Ash: and projecting expectations. 

Yeah, projecting their own high standards onto others, and feeling frustrated or critical or ashamed themselves when things aren't perfect. 

Ash: So how can you support someone with this structure? Through perimenopause effectively 

providing clear, reliable information is often really appreciated.

Respecting their need for structure and predictability where you can, 

Ash: don't mess with their schedule unnecessarily. 

Basically. Yeah, gently helping them connect with the underlying feelings, the anxiety beneath the need for control can be useful, and just acknowledging that, yeah, this process is frustrating and unpredictable.

Validating that reality. 

Ash: What should be avoided, 

being dismissive of their need for information or their attempts to control things. That'll just ramp up the anxiety imposing sudden changes or being chaotic around them 

Ash: and getting impatient with the details. 

Right. Impatience or criticism about their focus on [00:17:00] details or rules will likely just make them feel misunderstood and more anxious.

Ash: Okay. Last one on our list, the masochistic or self-defeating personality structure. How might perimenopause interact with those patterns? 

This is complex. Someone with this structure might often unconsciously find ways to experience perimenopause as particularly difficult or fraught with suffering. 

Ash: How so?

Like making it worse somehow. 

It's less about intentionally making it worse and more about patterns where suffering feels familiar, necessary, or even virtuous. So they might unconsciously gravitate towards situations or interpretations that involve hardship, reinforcing that self-image of someone who endures.

Ash: So maybe downplaying their own needs during this time. 

Very likely prioritizing everyone else or the perceived demands of the situation to an extreme. Finding it really hard to set boundaries or ask for help directly may be fearing rejection if they seem selfish. 

Ash: But McWilliams also talks about evoking caretaking, right?

Yes. That paradoxical pattern. They might [00:18:00] appear helpless or overwhelmed, drawing people into help, but then subtly resist or undermine the help offered. It keeps them in the suffering role in a way, 

Ash: and their defenses during this time. Turning against the self 

that could manifest as self neglect, not seeking medical care, not prioritizing rest or wellbeing, almost like they don't deserve it.

Idealizing, the suffering itself might intensify and denial about the actual negative impact of their self-defeating choices. 

Ash: What communication patterns might stand out? 

Help rejecting complaining is a classic one. Oh, this is awful. Nothing works. And then shooting down every suggestion. 

Ash: Passive aggression 

could be as an indirect way to express anger or resentment.

They can't voice directly presenting as the victim needing rescue, but then sabotaging the rescue attempt. It's a way of maintaining control, ironically, through helplessness. So 

Ash: what does helpful interaction look like here? It sounds really challenging. 

It is gently, consistently confronting. The self-defeating behavior itself is important.[00:19:00] 

Not in a blaming way, but pointing out the pattern, helping them examine any underlying beliefs, linking suffering to being loved or worthy. 

Ash: Setting boundaries is key, I assume, 

crucial. Don't keep rescuing them from consequences they've created. Expect them to take responsibility, but at the same time, show consistent care without reinforcing the helplessness.

It's a fine line 

Ash: and was definitely not helpful. 

Jumping into rescue them all the time just perpetuates the cycle. Getting overly frustrated or contemptuous, which is easy to do, just confirms their negative self-view and colluding with their denial, pretending the consequences aren't happening, that prevents any real change.

So as we've kind of walked through these types, you can see how complex navigating perimenopause can be, understanding these underlying personality dynamics. Using that McWilliams framework, it really can offer some valuable insight. Yeah, 

Ash: insights for the person going through it, and also for the people around them, their support system.

But it's so important, as you said, to remember this is a framework. It's based on clinical [00:20:00] observation theory, 

Ash: not a predictive checklist for every single person. 

Exactly. Individual experiences will vary hugely, but having some awareness of these potential patterns, it can hopefully lead to more self-compassion, maybe better communication, 

Ash: making a challenging transition, potentially a bit smoother or at least more understandable, 

hopefully.

Ash: So maybe a final thought for you, the learner to chew on. Think about how broader societal messages about women aging menopause. How those might intersect with these personality dynamics we've discussed. 

Hmm. That's a big one. How does culture interact with these internal structures when someone's trying to get support or just prioritize their own wellbeing during perimenopause?

Ash: Yeah. What are the implications? Definitely something to think about. We really encourage you to look more into McWilliams work if this sparked your interest, and also seek out good, solid resources on perimenopause itself. 

Absolutely. 

Ash: Thanks for taking this deep dive with us today.

[00:21:00] What you just heard wasn't a diagnosis. It was a map. A map of what happens when internal structures break under pressure and what it takes to rebuild. Perimenopause isn't pathology, it's ego reorganization in real time. And if you know how to see it, you stop blaming the mood swings and start recalibrating the field.

That's what Elevate Dot EPO is built for. Not to soothe the storm, but to train the system that holds steady inside of it. Thank you very much for listening. Today has been a great opportunity to expand on Nancy McWilliams and her contributions to psychoanalytic theory, how it pertains to real relationships.

[00:22:00] And what we can learn as it pertains to perimenopause. How do we change the conversation so that we stop blaming relationships and start fixing and recalibrating in real time? Thank you very much. My name is Enrique.

You can reach me at enrique@elevateepo.com, elevate dot epo on Instagram and Facebook on Twitter as well. Be on the lookout for our drips Substack, more podcasts to come on Wednesday and Friday of this week. Thank you very much to everyone who has downloaded and supported this podcast. Can't do it without you.

We really appreciate your help. today's episode was to begin the conversation and put the real truth out on the table so we can start the process of fixing some of these dynamics, which are leading to extremely outta controlled divorce rates. Ultimately that's what we're seeing here is that.

[00:23:00] Relationships reach a point when they can no longer communicate effectively. and that's from both sides. because of somatic structural changes that happen and the requisite mental changes and structural changes don't come concurrently. we see where these communication breakdowns are, and we see where some of these problems and relationships lie.

this is a real issue for Gen X we see our parents who are divorcing at bigger rates and if we're gonna continue that trend, then we're gonna obviously be numb to the fact that, relationship dynamics suffer when we don't understand how relationships operate. we'll be going over that on Wednesday and then bringing it home on Friday as we talk to how can we change the conversation.

Save our relationships and ultimately get through this very difficult perimenopause state, which is not only critical for a woman but also for her partner. Thank you very [00:24:00] much. We'll be back on Wednesday. I'm Enrique. It was great talking to you. Take care.