Personality Disorder

What Is a Personality Disorder?

Personality disorders describe a type of mental disorder characterized by firm, unhealthy patterns of thinking and behaving. People with personality disorders often have trouble understanding and relating to others or social situations, and symptoms may cause significant issues or limitations with work, school, and interpersonal relationships.

For many people with a personality disorder, their way of thinking seems natural, and they will not realize they have the condition. Symptoms typically manifest in someone’s teenage years or early adulthood, although some types become less noticeable during middle age.

Psychiatry separates personality disorders into three clusters based on their symptoms and characteristics. It is not uncommon for a person with one personality disorder to have signs of an additional personality disorder. Someone doesn’t need to exhibit all the symptoms listed to receive a diagnosis.

Causes and Risk Factors of Personality Disorders

A personality is a combination of thoughts, emotions, and behaviors that make a person an individual. It usually develops during childhood. Unlike mood disorders, which affect a person’s ability to regulate their mood, personality disorders affect a person’s identity and how they understand and relate to the world.

As an individual’s personality forms, the interaction of certain genetic traits and the environment they’re raised in can cause a personality disorder to manifest. Some personality traits are inherited through a parent’s genes, increasing the likelihood of the disorder.

While genetics can make a person vulnerable to developing a personality disorder, a traumatic event or relationship encountered in childhood can trigger the development of a disorder.

Medical professionals have not yet identified the exact cause of personality disorders but note that certain factors seem to increase the risk of having a personality disorder.

These factors include:

• Abusive or unstable family life throughout adolescence
• Family members with a history of personality disorders or other mental health conditions
• Variations in brain chemistry and structure
• Diagnosis of childhood conduct disorder

Types of Personality Disorders

Ten different types of personality disorders are separated into clusters based on similar traits and features.

The three groups include:

• Cluster A (odd, eccentric thinking or behavior)
• Cluster B (dramatic or unpredictable thinking or behavior)
• Cluster C (anxious, fearful thinking or behavior)

Cluster A Personality Disorders

Cluster A disorders include types that have unusual thinking and behavior. These disorder types often experience paranoia, strange thinking patterns, and perceptual disturbances like hearing voices or seeing things that aren’t there.

This cluster includes:

• Paranoid personality disorder: People with this personality disorder can seem cold, overly suspicious, and have trouble seeing their role in conflicts. They are always on guard, believing others are constantly trying to demean, harm, or threaten them.
• Schizoid personality disorder: Individuals with this type of personality disorder are often described as extreme introverts who seem cold and distant, self-absorbed, and fear closeness with others. Often perceived as loners or dismissive of others, people with this type may lack the desire or skill to form close interpersonal relationships.
• Schizotypal personality disorder: This personality disorder commonly manifests as distorted views of reality and superstitions, causing unusual behaviors and discomfort with close relationships. Some people with schizotypal personality disorder later develop schizophrenia.

Cluster B Personality Disorders

Cluster B disorders are typically characterized by overly emotional, dramatic, and unpredictable thought patterns and behavior.

Cluster B types include:

• Antisocial personality disorder: Contrary to popular belief, the word “antisocial” in this context doesn’t mean people with this disorder avoid talking to others. Instead, it describes how they often break social and legal rules to get what they want. They also tend to ignore the feelings and even rights of others, focusing only on themselves and their goals.
• Borderline personality disorder: Perhaps the most well-known personality disorder, people with borderline personality disorder often have a fragile sense of self-worth and rely on others to help them feel stable. Their inconsistent moods can flip from very positive to negative without a clear cause, putting strain on their relationships.
• Histrionic personality disorder: The word “histrionic” means “dramatic or theatrical,” People with this disorder often experience intense and unstable emotions and a distorted self-image. Because their self-esteem depends on the approval of others, they have an overwhelming desire to get noticed and behave dramatically or inappropriately to get attention.
• Narcissistic personality disorder: People with this disorder generally believe they are better and more important than others and often expect special treatment. As a result, they often react badly to criticism or events they dislike and manipulate others or overreact if they don’t receive the attention they feel they deserve.

Cluster C Personality Disorders

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. Some types will cling to others due to this fear, while others will avoid people.

Cluster C disorders include: 

• Avoidant personality disorder: Individuals with this disorder typically avoid being around others out of fear of rejection or criticism. Feelings of nervousness and fear cause a chronic sense of inadequacy and sensitivity to judgment.
• Dependent personality disorder: People with this disorder usually cling to a few key people in their lives and lose their sense of self-confidence. They often feel helpless, submissive, or incapable of caring for themselves.
• Obsessive-compulsive personality disorder: Not to be confused with obsessive-compulsive disorder (OCD), an anxiety disorder, people with this personality disorder often focus on details, order, and rules. The need to achieve perfection, order, and control can impede their ability to finish tasks, collaborate with others, and treat social activities or hobbies as purely recreational.

Symptoms of Personality Disorders

Some personality disorders overlap with others, especially for types in the same cluster. It is not uncommon for someone with one personality disorder to have symptoms of a few others.

Remember that this is not an exhaustive list for each disorder and that some traits can overlap with other mental illnesses.

Paranoid Personality Disorder

Symptoms of paranoid personality disorder include:

• Pervasive distrust and suspicion of others and their motives
• Belief that everyone is trying to harm or deceive them
• The belief that others lack loyalty and aren’t trustworthy
• Tendency to hold grudges
• Avoids sharing information for fear it will be used against them
• Seeing attacks or insults in harmless comments

Schizoid Personality Disorder

Symptoms of schizoid personality disorder include:

• Lack of or limited range of emotional expression
• Little interest in maintaining family relationships or friendships
• Unable to read typical social cues
• Prefers being alone rather than spending time with others
• Inability to take pleasure in most activities
• Appears cold or indifferent to others
• Little or no interest in having sex

Schizotypal Personality Disorder

Symptoms of schizotypal personality disorder include:

• Peculiar dress, thinking, beliefs, speech, or behavior
• Flat emotions or inappropriate emotional responses
• Social anxiety and discomfort with close relationships
• Odd perceptive experiences and magical beliefs, like thinking they have special paranormal powers
• Odd speech, such as using excessively abstract or concrete phrases or using phrases or words in unusual ways
• The belief that certain casual incidents or events have hidden messages meant only for them

Antisocial Personality Disorder

Symptoms of antisocial personality disorder include:

• Disregard for the needs or feelings of others
• Persistent lying, stealing, using aliases, conning others
• Repeated issues with the law
• Aggressive or violent behavior
• Disregard for the safety of self or others
• Impulsive behavior or other impulse control struggles
• Lack of empathy or remorse for behavior

Borderline Personality Disorder

Symptoms of borderline personality disorder include:

• Deep fear of loneliness and abandonment
• ‌Frequent outbursts of anger or feelings of emptiness
• A distorted and unstable self-image or sense of self
• Manipulate others to stay with them
• Unstable relationships
• ‌Impulsive, risk-seeking behavior like gambling or unsafe sex
• Feelings of dissociation
• ‌Suicidal threats and self-harm

Histrionic Personality Disorder

Symptoms of histrionic personality disorder include:

• Shallow, rapidly changing emotions
• Overreact to small events
• Easily influenced by others
• Speak dramatically and express strong opinions with few facts to support their opinions
• Excessive emotional, dramatic, or sexually provocative behavior to gain attention
• Think relationships with others are closer than they are
• Need instant gratification and become bored or frustrated very easily

Narcissistic Personality Disorder

Symptoms of narcissistic personality disorder include:

• The belief they’re special and more important than others
• Fixated on power, success, and attractiveness
• Failure to recognize the needs and feelings of others
• Exaggeration of achievements or talents
• Expectation of constant praise and admiration
• Taking advantage of others to get what they want
• Envy of others or belief that others envy them

Avoidant Personality Disorder

Symptoms of avoidant personality disorder include:

• Extreme sensitivity to criticism or rejection
• Feeling inadequate, inferior, or unattractive
• Exaggerating potential problems
• Avoidance of work activities requiring interpersonal contact
• Socially timid and isolated, avoiding new activities or strangers
• Intense fear of disapproval, embarrassment, or ridicule

Dependent Personality Disorder

Symptoms of dependent personality disorder include:

• Excessive dependence on others to be taken care of
• Submissive or clingy behavior toward others
• Fear of having to provide self-care
• Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
• Difficulty starting or completing projects due to lack of self-confidence
• Difficulty disagreeing with others and fearing disapproval
• Tolerance of poor or abusive treatment, even when other options are available
• Urgent need to start a new relationship when a close one has ended

Obsessive-Compulsive Personality Disorder

Symptoms of obsessive-compulsive personality disorder include:

• Preoccupation with details, orderliness, and rules
• Extreme perfectionism results in dysfunction and distress when perfection is not achieved
• Desire to control people, tasks, and situations
• Neglect of friends and enjoyable activities because of excessive commitment to perfection
• Inability to discard broken or worthless objects, even if they lack sentimental value
• Inflexible about morality, ethics, or values
• Tight, miserly control over budgeting and spending money

Diagnosis and Treatment

If you suspect that you or someone you love has a personality disorder, receiving a diagnosis and treatment can seem like a daunting task. Luckily, the treatment of personality disorders has many decades of research, and a mental health professional can guide you through the process.

Diagnosing a Personality Disorder

Determining if someone has a personality disorder requires the involvement of a licensed mental health care professional to make a formal diagnosis.

Because many personality disorders share symptoms with other illnesses, getting a professional diagnosis is important rather than relying on self-diagnosis.

A diagnosis usually involves a physical exam, psychiatric assessment, screening questionnaires, and a review of disorder criteria.

Some disorders have dedicated screening questionnaires, such as the McLean Screening Instrument for borderline personality disorder (BPD). These include a list of questions the patient will answer in writing.

According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), generally, the diagnosis of a personality disorder includes significant long-term deviation from cultural expectations.

Symptoms must also lead to significant distress or impairment in at least two of these areas:

• The way they perceive and interpret themselves, other people, and events
• The appropriateness of their emotional responses
• How well they function when dealing with other people and in relationships
• Whether they can control their impulses

Common Forms of Treatment

Treatment for a personality disorder depends on the person’s particular disorder, severity, and life situation. Patients often do well with a team approach of psychiatrists and therapists to ensure all psychiatric, medical, and social needs are met.

Typically, a combination of psychotherapy and medication works best for people with personality disorders. Psychotherapy or “talk therapy” can help the patient address past trauma and problem behaviors, while medication can help combat certain unwanted symptoms.

Standard psychotherapy for personality disorders includes:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Rational Emotive Behavior Therapy (REBT)

Currently, no medications are specifically approved by the Food and Drug Administration (FDA) to treat personality disorders. However, several psychiatric medications may help with various personality disorder symptoms.

Common medications for managing symptoms of personality disorders include:

• Antidepressants: helpful with depressed mood, anger, impulsivity, irritability, or hopelessness, which may be associated with personality disorders.
• Mood stabilizers: helpful with evening mood swings or reducing irritability, impulsivity, and aggression.
• Antipsychotic medications: helpful if symptoms include losing touch with reality (psychosis).
• Anti-anxiety medications: helpful with anxiety, agitation, or insomnia. However in some cases, they can increase impulsive behavior, so they’re avoided in certain types of personality disorders.

Get Treatment For Personality Disorders

Society frequently misunderstands and stigmatizes personality disorders, but living a happy, fulfilling life with a personality disorder is possible with the right treatment and support.

With the right primary healthcare provider and therapist, you can learn coping skills and receive medications for success in daily life and relationships with others.

Check out SAMHSA’s online treatment locator or call them at 1-800-662-4357 for mental health information and services near you.