Personality disorders are a group of 10 mental health conditions that involve enduring and disturbing patterns of thinking, behavior, mood, and relating to others. People with personality disorders often do not realize that their thoughts and behaviors are problematic.
What is a personality disorder?
A personality disorder is a mental health condition that involves long-lasting, all-encompassing patterns of thinking, behavior, mood, and relating to others. These patterns cause the person significant distress and/or impair their ability to function.
There are 10 types of personality disorders, each with different characteristics and symptoms.
Personality is vital in defining who we are as individuals. It involves a unique blend of traits-including attitudes, thoughts, and behaviors-as well as how we express these traits in our interactions with others and the world around us.
Personality disorders can cause distorted perceptions of reality, abnormal behaviors, and discomfort in various aspects of life, such as work, relationships, and social functioning. In addition, people with a personality disorder may not recognize their problematic behaviors or the negative effect they have on others.
what are the types of personality disorders?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard reference publication for recognized mental illnesses, organizes the 10 types of personality disorders into three main clusters (categories). Each cluster has different symptoms in common.
Cluster A Personality Disorders
Cluster A personality disorders involve unusual and eccentric thoughts or behaviors. These include:
- Paranoid personality disorder: the main feature of this disorder is paranoia, which consists of unrelenting distrust and suspicion of others without adequate reason for it. People with paranoid personality disorder often believe that others are trying to degrade, harm or threaten them.
- Schizoid personality disorder: This disorder is characterized by a consistent pattern of detachment and general disinterest in interpersonal relationships. People with schizoid personality disorder have a limited range of emotions when interacting with others.
- Schizotypal personality disorder: People with this disorder show a consistent pattern of intense discomfort with and limited need for close relationships. Relationships may be hindered by their distorted view of reality, superstitions, and unusual behaviors.
Cluster B Personality Disorders
Cluster B personality disorders involve dramatic and erratic behaviors. People with this type of disorder display intense, unstable emotions and impulsive behaviors. Cluster B personality disorders include:
- Antisocial personality disorder (ASPD)-People with ASPD show a lack of respect for others and do not follow socially accepted norms or rules. People with ASPD may break the law or cause physical or emotional harm to others around them. They may refuse to take responsibility for their behaviors and/or show disregard for the negative consequences of their actions.
- Borderline personality disorder (BPD): This disorder is characterized by difficulty regulating emotions, resulting in low self-esteem, mood swings, impulsive behaviors and consequent difficulties in relationships.
- Histrionic personality disorder: This disorder is characterized by intense and unstable emotions and a distorted self-image. For people with histrionic personality disorder, their self-esteem depends on the approval of others and does not stem from a true sense of self-worth. They have an overwhelming desire for others to notice them, and may display dramatic and/or inappropriate behaviors to get attention.
- Narcissistic personality disorder: This condition involves a consistent pattern of perceived superiority and grandiosity, an excessive need for praise and admiration, and a lack of empathy for others. These thoughts and behaviors often stem from low self-esteem and a lack of self-confidence.
Cluster C Personality Disorders
Cluster C personality disorders involve severe fear anxiety and severe fear. They include:
- Avoidant personality disorder: People with this disorder have chronic feelings of inadequacy and are very sensitive to being negatively judged by others. Although they would like to interact with others, they tend to avoid social interaction due to intense fear of rejection.
- Dependent personality disorder: This disorder is characterized by a constant and excessive need to be cared for by another person. It also involves submissiveness, the need to be constantly reassured and the inability to make decisions. People with dependent personality disorder are often very attached to another person and devote great effort to trying to please that person. They tend to show passive and clingy behavior and are afraid of separation.
- Obsessive-compulsive personality disorder (OCPD): This disorder is characterized by a constant and extreme need for order, perfectionism and control (with no room for flexibility) that ultimately slows down or interferes with the completion of a task. It can also interfere with relationships.
This is a distinct condition from obsessive-compulsive disorder (OCD), which is classified as an anxiety disorder. While people with OCD are often aware that OCD is the cause of their behavior and accept that they need to change, people with OCD often have little or no awareness of their behaviors.
People may have mixed symptoms of more than one personality disorder.
Who is affected by personality disorders?
Anyone can have a personality disorder. But different types of personality disorders affect people differently.
Most personality disorders begin in adolescence, when the personality is developing and maturing. As a result, almost all people diagnosed with personality disorders are over the age of 18. An exception is antisocial personality disorder: approximately 80% of people with this disorder will have begun to show symptoms by the age of 11.
Antisocial personality disorders affect more people assigned to the male sex at birth. Borderline, histrionic and dependent personality disorders affect more people assigned female at birth.
What are the causes of personality disorders?
Personality disorders are one of the least known mental illnesses. Scientists are still trying to find out their cause.
So far, they believe that the following factors may contribute to the development of personality disorders:
- Genetics: Scientists have identified a malfunctioning gene that may be a factor in obsessive-compulsive personality disorder. Researchers are also exploring genetic links to aggression, anxiety and fear, which are traits that may play a role in personality disorders.
- Brain changes: Researchers have identified subtle brain differences in people with certain personality disorders. For example, results from studies of paranoid personality disorder point to altered functioning of the amygdala. The amygdala is the part of the brain responsible for processing fearful and threatening stimuli. In a study of schizotypal personality disorder, researchers found a volumetric decrease in the frontal lobe of their brain.
- Childhood trauma: One study revealed a link between childhood trauma and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates of childhood sexual trauma. People with borderline and antisocial personality disorders have intimacy and trust issues, which may be related to childhood abuse and trauma.
- Verbal abuse: In one study, people who were verbally abused as children were three times more likely to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders as adults.
- Cultural factors: Cultural factors may also play a role in the development of personality disorders, as evidenced by the different rates of personality disorders between countries. For example, in Taiwan, China and Japan cases of antisocial personality disorders are remarkably low, along with significantly higher rates of cluster C personality disorders.
What are their symptoms?
Each of the 10 types of personality disorders has its own specific signs and symptoms.
But, in general, personality disorders involve problems with
- Identity and sense of self: People with a personality disorder usually lack a clear or stable self-image, and the way they see themselves often changes depending on the situation or the people they are with. Their self-esteem may be unrealistically high or low.
- Relationships: People with a personality disorder have difficulty establishing close and stable relationships with others because of their problematic beliefs and behaviors. They may lack empathy or respect for others, be emotionally distant, or be excessively needy for attention and care.
Another hallmark of personality disorders is that most people with them often have little or no awareness that their thoughts and behaviors are problematic.
how do you know if someone has a personality disorder?
You cannot know for sure if someone has a personality disorder unless they receive a professional, medical diagnosis.
It is important to understand the difference between personality types and personality disorders. A person who is shy or likes to spend time alone does not necessarily have a schizoid or avoidant personality disorder.
The difference between personality style and a personality disorder can often be determined by assessing how the person’s personality affects different parts of his or her life, including:
- Reality awareness.
- Behavior and impulse control.
Some general signs of people with a personality disorder are:
- Their behavior is inconsistent, frustrating, and confusing to loved ones and others with whom they interact.
- They may have trouble understanding realistic and acceptable ways of treating and behaving with others.
- They may be unaware of how their behaviors cause problems for themselves and/or others.
- If they are parents, their parenting style may be distant, overly emotional, abusive or irresponsible. This can sometimes lead to physical, emotional or mental problems in their children.
How are personality disorders diagnosed?
Personality disorders can be difficult to diagnose because most people with a personality disorder do not believe there is a problem with their behavior or thinking.
Because of this, people with a personality disorder often do not seek help or a diagnosis for their condition. Instead, their loved ones or a social agency may refer them to a mental health professional because their behavior causes difficulties for others.
When they do seek help, it is usually because of disorders such as anxiety, depression or substance use, or because of problems created by their personality disorder, such as divorce or unemployment, rather than because of the disorder itself.
Healthcare professionals base the diagnosis of a particular personality disorder on the criteria set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
When a mental health professional, such as a psychologist or psychiatrist, suspects that someone may have a personality disorder, they usually ask broad, general questions that will not create a defensive response or a hostile environment. They ask questions that shed light on
- Past history.
- Past work history.
- Reality testing.
- Impulse control.
Because a person suspected of having a personality disorder may lack information about his or her behaviors, mental health professionals often work with the person’s family, friends and/or probation officers to gather more information about his or her behaviors and history.
Personality disorders are often underdiagnosed because providers sometimes focus on symptoms of anxiety or depression, which are much more common in the general population than personality disorders. These symptoms can overshadow the characteristics of any underlying personality disorder.
How are personality disorders treated?
Personality disorders are some of the most difficult disorders to treat in psychiatry. This is primarily because people with personality disorders do not believe that their behavior is problematic, so they often do not seek treatment.
And even if a person with a personality disorder does seek treatment, modern medicine still lacks available treatment options: there are currently no approved medications to treat any personality disorder. But there are medications that can help with symptoms of anxiety and depression, which are common in people with a personality disorder.
But psychotherapy (talk therapy) can help manage personality disorders. Psychotherapy is an umbrella term for a range of treatment techniques aimed at helping to identify and change problematic emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to you and your family.
The main goals of psychotherapy to treat personality disorders are:
- Reduce immediate distress, such as anxiety and depression.
- Help the person understand that his or her problems are internal and not caused by other people or situations.
- To reduce unhealthy and socially undesirable behavior.
- Modify the personality traits that cause the difficulties.
There are several types of psychotherapy, and each personality disorder requires different types.
For example, studies show that dialectical behavior therapy (DBT) is effective in treating those with borderline personality disorder, and people with histrionic personality disorder often benefit from cognitive-behavioral therapy (CBT).
can personality disorders be prevented?
At this time, there is no known way to prevent personality disorders, but many of the related problems can be lessened with treatment. Seeking help as soon as symptoms appear can help lessen disruptions in the lives of the person, their family and friends.
what is the prognosis for personality disorders?
Because people with personality disorders often do not seek appropriate medical care, the overall prognosis for personality disorders is poor.
Untreated personality disorders can lead to:
- Poor relationships.
- Difficulty at work.
- Impaired social functioning.
Studies show that personality disorders are associated with elevated rates of:
- Domestic abuse.
- Substance abuse.
- Delinquency (especially antisocial personality disorder).
In addition, people with personality disorders are more prone to emergency department visits, traumatic accidents, and premature deaths by suicide.
Although the picture is bleak, studies show that collaborative care management can greatly improve outcomes for people with personality disorders if they stay engaged in treatment.
If you know someone who has or may have a personality disorder, try to convince them to seek treatment. It is also important to find out about the nature of the specific personality disorder so you can better understand what to expect.