What Are Personality Disorders?

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Personality disorders include 10 diagnosable psychiatric conditions that are recognized and described in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Each is a distinct mental illness defined by personality traits that can be troubling enough to create problems with relating to other people in healthy ways and can lead to significant distress or impairment in important areas of functioning.

Woman depressed and alone

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It is estimated that about 8% of the world’s population suffer from a personality disorder.

What Are Personality Disorders?

Personality is the way of thinking, feeling, and behaving that makes a person different from other people. An individual's personality typically stays the same over time.

A personality disorder is a way of thinking, feeling, and behaving that:

  • Deviates from the expectations of the culture
  • Causes distress or problems functioning
  • Lasts over time

Types

The DSM-5 organizes personality disorders into three groups, or clusters, based on shared key features and symptoms. Some people may have signs and symptoms of multiple personality disorder types.

Cluster A

These personality disorders are characterized by odd or eccentric behavior. People with cluster A personality disorders tend to experience major disruptions in relationships because their behavior may be perceived as peculiar, suspicious, or detached.

Cluster A personality disorders include:

  • Paranoid personality disorder: Someone with this disorder has a constant mistrust and suspicion of others. They believe that others are trying to demean, harm, or threaten.
  • Schizoid personality disorder: People with this disorder are distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion.
  • Schizotypal personality disorder: This features odd speech, behavior, and appearance, as well as strange beliefs and difficulty forming relationships. A person with schizotypal personality disorder is often described as odd or eccentric and usually have few, if any, close relationships or may have excessive social anxiety.

Cluster B

Cluster B personality disorders are characterized by dramatic or erratic behavior. People who have a personality disorder from this cluster tend to either experience very intense emotions or engage in extremely impulsive, theatrical, promiscuous, or law-breaking behaviors.

Cluster B personality disorders include:

  • Antisocial personality disorder: Symptoms include a pattern of disregarding or violating the rights of others. A person with an antisocial personality disorder who may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively.
  • Borderline personality disorder: This is characterized by instability in interpersonal relationships, emotions, self-image, and impulsive behaviors. A person with borderline personality disorder may have repeated suicide attempts, display inappropriate intense anger, or have ongoing feelings of emptiness.
  • Histrionic personality disorder: People with histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves, or have rapidly shifting or exaggerated emotions.
  • Narcissistic personality disorder: A person with narcissistic personality disorder may have grandiose fantasies or behaviors, a sense of entitlement, take advantage of others, or lack empathy which is often driven by an underlying fragility in the sense of self.

Cluster C 

Cluster C personality disorders are characterized by anxiety. People with personality disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.

Cluster C personality disorders include:

  • Avoidant personality disorder: People with avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept.
  • Dependent personality disorder: Individuals with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.
  • Obsessive-compulsive personality disorder: A person with obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively, not allowing time for leisure or friends, or may be inflexible in their morality and values. Though similarly named, it is not the same as obsessive-compulsive disorder (OCD).

Seek Help

If you or a loved one are struggling with a personality disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Symptoms

Symptoms vary depending on the type of personality disorder and can range from mild to severe. All personality disorders affect how someone thinks, feels, and behaves. They can potentially cause huge conflict with other people, impacting relationships, social situations, and life goals.

People with personality disorders often don't recognize that they have problems and can be confusing and frustrating to people around them.

Certain symptoms of personality disorders can fall into two categories: self-identity and interpersonal functioning.

Self-identity problems include:

  • Unstable self-image
  • Inconsistencies in values, goals, and appearance

Interpersonal problems include:

  • Being insensitive to others (unable to empathize)
  • Difficulty knowing boundaries between themselves and others
  • Inconsistent, detached, overemotional, abusive, or irresponsible styles of relating

Overall, there are no clear distinctions in terms of sex, socioeconomic class, and race. However, in antisocial personality disorder, men can outnumber women 6:1. In borderline personality disorder, women outnumber men 3:1 (but only in clinical settings, not in the general population).

Diagnosis

According to the DMS-5, a person must meet the following criteria to be diagnosed with a personality disorder:

  • Chronic and pervasive patterns of behavior that affect social functioning, work, school, and close relationships
  • Symptoms that affect two or more of the following four areas: thoughts, emotions, interpersonal functioning, impulse control
  • The onset of patterns of behavior that can be traced back to adolescence or early adulthood
  • Patterns of behaviors that cannot be explained by any other mental disorders, substance use, or medical conditions

Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness as the cause of the symptoms.

A correct diagnosis is very important but can be difficult since personality disorders also commonly co-occur with other mental illnesses.

A person who meets the criteria for one personality disorder will often also meet the criteria for one or more additional personality disorders.

Causes

Personality disorders are among the least understood and recognized mental disorders. It is thought that a combination of genetic factors and life experiences—particularly adverse childhood experiences—contribute to personality disorder development.

In addition to biological factors, personality disorders might develop as a way of coping with a troubling developmental environment. There is also a significant association between a history of childhood trauma as well as verbal abuse.

One study found that children who experience verbal abuse were three times more likely to have borderline, narcissistic, obsessive-compulsive, or paranoid personality disorders in adulthood.

High reactivity in children has also been linked to certain personality disorders, including sensitivity to:

  • Light
  • Noise
  • Texture
  • Other stimuli

Treatment

Compared to mood disorders such as clinical depression and bipolar disorder, there are relatively few studies on how to effectively treat personality disorders. However, there is an increasing number of evidence-based treatments that are being found effective for personality disorders.

In general, the goal of personality disorder treatment includes the following:

  • Reducing subjective distress and symptoms such as anxiety and depression
  • Helping people to understand the aspect of their problems that are internal to themselves
  • Changing maladaptive and socially undesirable behaviors, including recklessness, social isolation, lack of assertiveness, and temper outbursts
  • Modifying problematic personality traits like dependency, distrust, arrogance, and manipulativeness

Psychotherapy

The National Alliance on Mental Illness (NAMI) lists several types of psychotherapy that may be useful in the treatment of personality disorders:

  • Dialectical behavior therapy (DBT), which teaches coping skills and strategies for dealing with urges related to self-harm and suicide, regulating emotions, and improving relationships.
  • Cognitive behavior therapy (CBT), the goal of CBT is to help reduce symptoms by changing the way someone thinks about or interpret situations, as well as the actions that they take in their daily life.
  • Psychodynamic therapy, which places a large emphasis on the unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for someone to directly look at are housed.
  • Family therapy, during which family members learn to change unhealthy reactions to each other and learn effective communication skills.

Medication

Typically, personality disorders are not very responsive to drugs, although some medications can effectively target associated or co-morbid depression or anxiety. Depending on someone's symptoms, a healthcare provider may prescribe one or more of the following:

  • Anti-anxiety medication: This helps relieve anxiety, agitation, and insomnia.
  • Antidepressants: These help improve a depressed mood, anger, or impulsivity.
  • Antipsychotics: These may be beneficial for people who often lose touch with reality.
  • Mood stabilizers: These prevent mood swings and reduce irritability and aggression.

Complications

People with untreated personality disorders are at risk for substance use disorder, violent or self-destructive behavior, and even suicide. One research study found a 20-fold increase in suicide risk for patients with personality disorder versus no recorded psychiatric disorder, and a four-fold increase versus all other psychiatric illnesses combined.

Coping

Learning how to cope with a personality disorder is key. In addition to seeking professional support, it's important to reach out to a supportive friend or family member who can help when someone is struggling with strong emotions. If there is no one to reach out to, call a helpline.

  • Know the triggers: No matter which type of personality disorder someone has, one of the keys to coping is to recognize the emotional patterns and triggers. In conjunction with a therapist, they should be able to identify strategies that help them deal with strong emotions.
  • Engage fully with treatment: Even if someone is not feeling well, they should not skip therapy sessions or stop taking medications without talking to a healthcare professional. Similarly, they should be sure to stick with regular appointments.
  • Practice self-care strategies: Regular exercise and consistent eating and sleeping schedules can help prevent mood swings and manage anxiety, stress, and depression. It’s also important to avoid drugs and alcohol, which can exacerbate symptoms and interact with medications.
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