Personality Disorders
Definition:
A personality disorder is a mental health condition that involves long-lasting, all-encompassing,
disruptive patterns of thinking, behavior, mood and relating to others. These patterns cause a
person significant distress and/or impair their ability to function.
Personality is vital to 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 with the world around us.
Personality disorders may cause distorted perceptions of reality, abnormal behaviors and
distress across various aspects of life, including work, relationships and social functioning.
Additionally, people with a personality disorder may not recognize their troubling behaviors or
the negative effect they have on others.
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 thinking or behaviors. These
include:
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Overview
What is a personality disorder?
A personality disorder is a mental health condition that involves long-lasting, all-encompassing,
disruptive patterns of thinking, behavior, mood and relating to others. These patterns cause a
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 to 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 with the world around us.
Personality disorders may cause distorted perceptions of reality, abnormal behaviors and
distress across various aspects of life, including work, relationships and social functioning.
Additionally, people with a personality disorder may not recognize their troubling behaviors or
the negative effect they have on others.
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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 thinking or behaviors. These
include:
Paranoid personality disorder:
The main feature of this condition is paranoia, which is a relentless mistrust and suspicion of
others without adequate reason for suspicion. People with paranoid personality disorder often
believe others are trying to demean, harm or threaten them.
Schizoid personality disorder:
This condition is marked by a consistent pattern of detachment from 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 condition display a consistent pattern of intense discomfort with and limited
need for close relationships. Relationships may be hindered by their distorted views of reality,
superstitions and unusual behaviors.
Cluster B personality disorders
Cluster B personality disorders involve dramatic and erratic behaviors. People with these types
of conditions display intense, unstable emotions and impulsive behaviors. Cluster B personality
disorders include:
Antisocial personality disorder (ASPD):
People with ASPD show a lack of respect toward others and don’t 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 display
disregard for the negative consequences of their actions.
Borderline personality disorder (BPD):
This condition is marked by difficulty with emotional regulation, resulting in low self-esteem,
mood swings, impulsive behaviors and subsequent relationship difficulties.
Histrionic personality disorder:
This condition is marked by intense, unstable emotions and a distorted self-image. For people
with histrionic personality disorder, their self-esteem depends on the approval of others and
doesn’t come from a true feeling of self-worth. They have an overwhelming desire to be noticed
by others, 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 anxiety and fear. They include:
Avoidant personality disorder:
People with this condition have chronic feelings of inadequacy and are highly sensitive to being
negatively judged by others. Though they would like to interact with others, they tend to avoid
social interaction due to the intense fear of being rejected.
Dependent personality disorder:
This condition is marked by a constant and excessive need to be cared for by someone else. It
also involves submissiveness, a need for constant reassurance and the inability to make
decisions. People with dependent personality disorder often become very close to another
person and spend great effort trying to please that person. They tend to display passive and
clinging behavior and have a fear of separation.
Obsessive-compulsive personality disorder (OCPD):
This condition is marked by a consistent and extreme need for orderliness, perfectionism and
control (with no room for flexibility) that ultimately slows or interferes with completing a task. It
can also interfere with relationships.
Affect:
Anyone can have a personality disorder. But different types of personality disorders affect
people differently.
Most personality disorders begin in the teen years when your personality further develops and
matures. As a result, almost all people diagnosed with personality disorders are above the age
of 18. One exception to this is antisocial personality disorder. Approximately 80% of people with
this disorder will have started to show symptoms by the age of 11. Antisocial personality
disorders are more likely to affect people assigned male at birth. Borderline, histrionic and
dependent personality disorders are more likely to affect people assigned female at birth.
Symptoms:
Identity and a sense of self:
People with a personality disorder generally lack a clear or stable image of themselves, and
how they see themselves often changes depending on the situation or the people they’re with.
Their self-esteem may be unrealistically high or low.
Relationships:
People with a personality disorder struggle to form close, stable relationships with others due to
their problematic beliefs and behaviors. They may lack empathy or respect for others, be
emotionally detached or be overly needy of attention and care.
Another distinguishing sign of personality disorders is that most people who have one often
have little to no insight or self-awareness of how their thoughts and behaviors are problematic.
Causes:
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 can play a role in personality disorders.
Brain changes:
Researchers have identified subtle brain differences in people with certain personality disorders.
For example, findings in studies on paranoid personality disorder point to altered amygdala
functioning. The amygdala is the part of your brain that’s involved with processing fearful and
threatening stimuli. In a study on schizotypal personality disorder, researchers found a
volumetric decrease in the frontal lobe of their brain.
Childhood trauma:
One study revealed a link between childhood traumas 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
issues with intimacy and trust, both of which may be related to childhood abuse and trauma.
Verbal abuse:
In one study, people who experienced verbal abuse as children were three times as likely to
have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in
adulthood.
Cultural factors:
Cultural factors may also play a role in the development of personality disorders, as
demonstrated by the varying rates of personality disorders between different countries.
Diagnosis:
Personality disorders can be difficult to diagnose since most people with a personality disorder
don’t think there’s a problem with their behavior or way of thinking.
Because of this, people with a personality disorder typically don’t 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 difficulty for others.
When they do seek help, it’s often due to conditions such as anxiety, depression or substance
use, or because of the problems created by their personality disorder, such as divorce or
unemployment, not the disorder itself.
Healthcare providers base the diagnosis of a specific personality disorder on criteria provided in
the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
When a mental health professional, like a psychologist or psychiatrist, suspects someone might
have a personality disorder, they often ask broad, general questions that won’t create a
defensive response or hostile environment. They ask questions that will shed light on:
● Past history
● Relationships
● Previous work history
● Reality testing
● Impulse control
Because a person suspected of having a personality disorder may lack insight into their
behaviors, mental health professionals often work with the person’s family, friends and/or parole
officers to collect more insight about their behaviors and history.
Personality disorders are generally underdiagnosed because providers sometimes focus on the
symptoms of anxiety or depression, which are much more common in the general population
than personality disorders. These symptoms may overshadow the features of any underlying
personality disorder.
Treatment:
Personality disorders are some of the most difficult disorders to treat in psychiatry. This is mainly
because people with personality disorders don’t think their behavior is problematic, so they don’t
often seek treatment.
And even if a person with a personality disorder seeks treatment, modern medicine is still
lacking in available treatment options there are no medications currently approved 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 a
term for a variety of treatment techniques that aim to help you identify and change troubling
emotions, thoughts and behaviors. Working with a mental health professional, like a
psychologist or psychiatrist, can provide support, education and guidance to you and your
family.
How are personality disorders treated?
Personality disorders are some of the most difficult disorders to treat in psychiatry. This is mainly
because people with personality disorders don’t think their behavior is problematic, so they don’t
often seek treatment.
And even if a person with a personality disorder seeks treatment, modern medicine is still
lacking in available treatment options — there are no medications currently approved 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 a
term for a variety of treatment techniques that aim to help you identify and change troubling
emotions, thoughts and behaviors. Working with a mental health professional, like a
psychologist or psychiatrist, can provide support, education and guidance to you and your
family.
The main goals of psychotherapy for treating personality disorders include:
Reducing immediate distress, such as anxiety and depression.
Helping the person understand that their problems are internal and not caused by other people
or situations.
Decreasing unhealthy and socially undesirable behavior.
Modifying the personality traits that are causing difficulties.
There are several different types of psychotherapy, and each personality disorder requires
different types.
For example, studies show that dialectical behavior therapy (DBT) is effective for treating those
with borderline personality disorder, and people with histrionic personality disorder often benefit
from cognitive-behavioral therapy (CBT).