Personality Disorders

A personality disorder is a type of mental health condition characterized by unhealthy patterns of thoughts and behaviors that are not normal and are unhealthy.

These patterns disrupt a person’s ability to function in various aspects of their lives, including relationships or at work.

This is a group of 10 mental illnesses categorized by whether they cause odd or unusual thinking, overly dramatic and unpredictable behaviors, or anxiety and fear.

According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are 10 different types of personality disorders, categorized in three groups that are called clusters A, B, and C. Although there are significant differences between each type of personality disorder, they all cause impairments in how a person relates to others, perceives situations, and functions in most aspects of their lives. The clusters are grouped by dominant traits:

• Cluster A Personality Disorders. The personality disorders in Cluster A are all characterized by unusual thought patterns and behaviors, and include schizoid, schizotypal, and paranoid personality disorders.
• Cluster B Personality Disorders. These disorders are characterized by unpredictable, erratic, and overly emotional and dramatic thoughts and behaviors. The cluster includes narcissistic, antisocial, borderline, and histrionic personality disorders.
• Cluster C Personality Disorders. In Cluster C are the personality disorders that cause more anxious and fearful thoughts and behaviors, including avoidant, dependent, and obsessive-compulsive personality disorder.

There are important and distinct differences between all 10 of these disorders, related to how a person thinks, the way they behave, and how they relate to other people and function:

• Paranoid Personality Disorder. Someone with paranoid personality disorder is suspicious of others and finds it difficult to trust or to confide in anyone.
• Schizoid Personality Disorder. This type of personality causes a person to form detached relationships with others, never really expressing much emotion or responding to what other people think or say about them. They often seem cold and uncaring.
• Schizotypal Personality Disorder. Schizotypal personality disorder causes a person to be uncomfortable in relationships and to have distorted perceptions and thoughts as well as eccentric and odd behaviors and beliefs. Inappropriate emotional responses are typical.
• Antisocial Personality Disorder. Someone who is antisocial disregards other people’s rights or boundaries, acts impulsively, and may lie or manipulate other people while lacking remorse.
• Borderline Personality Disorder. A person with borderline personality disorder struggles to form a strong self-identity and takes self-worth from others. They fear abandonment and have intense emotional and mood swings, often feeling excessively angry or empty.
• Histrionic Personality Disorder. Histrionic personality disorder is characterized by attention-seeking behaviors and extreme emotional shifts.
• Narcissistic Personality Disorder. A narcissist has inflated sense of self-worth and abilities, lacks empathy, and needs admiration from others. They may take advantage of others because of a sense of entitlement.
• Avoidant Personality Disorder. Someone with this personality type feels socially inhibited and inadequate. They are sensitive to criticism and rejection and avoid close relationships out of fear.
• Dependent Personality Disorder. Dependent personality disorder is characterized by submissive behavior in relationships, a need to be cared for, and clinginess. Someone with this disorder needs a lot of reassurance and fears being alone.
• Obsessive-Compulsive Personality Disorder. Not the same as obsessive compulsive disorder, this personality type is characterized by a need for control, perfectionism, details, and orderliness.

Personality disorders are very serious mental illnesses because they significantly impair a person’s ability to function and to have and enjoy normal relationships. It is important to get an accurate diagnosis for a personality disorder to receive the best treatment.

• According to a National Institutes of Health survey, nearly 15 percent of American adults meet the criteria for a personality disorder. Other studies place the prevalence rate closer to nine percent.
• The most prevalent personality disorder, at eight percent, is obsessive-compulsive personality disorder, followed by paranoid, antisocial, and schizoid personality disorders.
• Estimates are that only 39 percent of people with personality disorders are receiving treatment.
• Personality disorders are difficult to treat, because people with these disorders often don’t believe that their patterns of thought or behaviors are incorrect or harmful.

The symptoms of personality disorders vary depending on the type, but there are some common general symptoms and general criteria for diagnosing someone with a personality disorder of any type. To be diagnosed with any personality disorder, a person must meet the following criteria:

• A person has impairments in relating to other people or in self-identity that are significant.
• At least one pathological personality trait, such as being manipulative, detachment, or attention-seeking, is present.
• The impairments and pathological traits are consistent over a long period of time and in different situations.
• These traits and impairments cannot be explained by a temporary developmental stage or a specific environment.
• And they cannot be explained or solely caused by substance use or a medical condition.

There are more specific criteria relating to the types of impairments and the actual personality traits that are associated with and used to diagnose each of the specific personality disorders. Some of the signs and symptoms of personality disorders are:

• Difficult and troubled relationships with other people
• Detached relationships or limited and minimal relationships
• Extreme and exaggerated emotional responses and mood swings
• Limited emotional responses, or inappropriate responses
• A strong need for reassurance, admiration, or praise
• Distorted perceptions of situations or of what other people say or think
• Anger, aggression, and impulsivity
• Disregard for the feelings or needs of others
• Lack of self-identity or an inflated sense of self-worth
• Difficulties at work or school and in any social situation

The cause of a personality disorder in a given person cannot be determined, but genetics are thought to play a role, as is environment. Environmental factors like relationships with family members, family dynamics, trauma, and others may influence whether or not a person develops a personality disorder. There are also known factors that increase the risk someone may be diagnosed:

• A family history of mental illness and personality disorders
• An unstable home life or family during childhood
• Childhood trauma
• A diagnosis of childhood conduct disorder

Common co-occurring disorders with personality disorders are substance use disorders and other mental illnesses. One study found that among people with borderline personality disorder, more than 84 percent also had struggled with an anxiety disorder, and nearly 80 percent had been diagnosed with a substance use disorder.

Substance use disorders are so common for a few reasons: someone with a personality disorder may be more likely to use substances as a way to cope; substance use can trigger or worsen mental illness symptoms; and both substance use disorders and mental illnesses have similar risk factors.

Personality disorders can also cause significant complications in a person’s life. A criterion for having one of these disorders is that it impairs the way a person functions, and this can lead to a number of issues and complications:

• Substance abuse and addiction
• Troubled and broken relationships
• Social isolation and a lack of meaningful relationships
• Mental illnesses, including anxiety and depression
• Difficulty at work and resulting unemployment or financial issues
• Poor academic performance
• Legal troubles
• Suicidal thoughts and behaviors

Personality disorders are difficult but possible to treat. The difficulty comes from the fact that people with these disorders generally don’t think there is anything wrong with how they are thinking or behaving. They tend to think that other people are causing their difficulties, not their own abnormal thought and behavior patterns. This is a challenge to overcome, but if someone can be talked into getting treatment and is committed to it, they can learn to manage their symptoms and see improvements in relationships and overall functioning.

Treatment for personality disorders is largely based on therapy and, because of the time commitment it takes to really make positive changes, residential treatment is most effective. Therapy is focused on first helping the patient realize that his or her thoughts and behaviors are problematic, then the work can focus on recognizing and changing those unhealthy thoughts and behavior patterns.

Behavioral therapies are most useful for treating personality disorders, including cognitive behavioral therapy. Dialectical behavior therapy is also useful and was designed specifically for people struggling with personality disorders. It involves using support, collaboration, and learning to be mindful and to respond in more appropriate ways to stress and other types of stimulation while also regulating emotions.

While treating personality disorders can be difficult, the prognosis for someone who is committed to making changes is good. Residential treatment is most effective, especially for patients with extreme impairment. With good support, intensive therapy, and skills that will help the patient after a residential stay, managing a personality disorder is possible.

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