Personality Disorders in Teens: Signs, Symptoms, & Treatment

Types & Signs of Personality Disorders in Teens

Personality disorders occur in one or more of three clusters of defining traits: clusters A, B, or C. The DSM-5 describes cluster A disorders as “odd and eccentric,” cluster B as “dramatic and erratic,” and cluster C as “anxious and fearful.”¹ Some people may exhibit characteristics from only one, two, or all three clusters. These clusters become a disorder when the teen begins to experience impairments in their ability to socialize with others or even maintain daily tasks due to how they interact with others and the world around them.

“Key signs of personality disorders in teens include problems in consolidating a solid sense of self and identity and struggling to self-regulate their behaviors. These challenges can lead to difficulty getting along with others beyond what is expected of similar-age peers. Adolescents with a personality disorder will also report intense feelings of loneliness and isolation, feeling misunderstood by those around them. These problems lead to emotion dysregulation and impulsivity, which can lead to self-harm, suicidal ideation and attempts, along with intense and frequent outbursts of anger from an inability to manage stress.” – Carla Sharp, Ph.D.

The symptoms of these personality disorders may also be signs of other social or mental health disorders, which may better explain the symptoms that are being observed. Specialists can confirm if a personality disorder causes these symptoms when the endurance of these characteristics stays gradual over time and presents itself in situations that distinguish them as a distinct diagnostic category.

There are a number of personality disorders a teenager may experience, all of which may be demonstrated by varying symptoms, such as:

Cluster A Personality Disorders

Signs of a Cluster A personality disorder in teens include:

• Unusual coldness or suspiciousness
• Easily offended
• Lacking close friends
• Unusual level of discomfort in social situations
• Restricted or inappropriate affect

Cluster A personality disorders include:

• Paranoid personality disorder: A teen with a paranoid personality disorder may hesitate to share their personal thoughts with peers, teachers, or healthcare providers. They may be unjustifiably suspicious of others or hold grudges about minor slights.
• Schizotypal personality disorder: Teens with this schizotypal personality disorder may present a coldness, lack of interest in forming relationships with others, and indifference to praise or criticism.
• Schizoid personality disorder: Those with a schizoid personality disorder may appear odd to others, present peculiarities of speech or thought, and possess a constricted emotional range.

Cluster B Personality Disorders

Signs of a Cluster B personality disorder in teens include:

• Labile or quickly changing moods
• Dramatic or intense reactions
• Impulsivity
• Unusual frequency or degree of interpersonal conflicts with peers, family members, or persons in authority (teachers, coaches, bosses)
• Truancy, fighting, theft or destructiveness

Cluster B personality disorders include:

• Borderline personality disorder: Borderline personality disorder is marked by a person moving from one crisis of mood or behavior to another. A teen may show a pattern of impaired attachments to friends and family. The teen’s relationships can run from extreme likes to dislikes, and their sense of self-identity is unstable and chaotic.
• Antisocial personality disorder: Teens with an antisocial personality disorder often engage in criminality, violence, and aggression with people or animals before the age of 15 and typically don’t feel remorse for their behaviors.
• Histrionic personality disorder: An adolescent with a histrionic personality disorder may seem to be overly expressive to the point of attention seeking, with a superficiality to their personal expression and relationships.
• Narcissistic personality disorder: Teens suffering from narcissistic personality disorder demonstrate unusual grandiosity and preoccupation with fantasies of beauty, brilliance, love, or success. They also lack empathy toward others, which may, in turn, create rifts in peer or family relationships.

Cluster C Personality Disorders

Signs of a Cluster C personality disorder in teens include:

• Anxious, tense, or overcontrolled behaviors
• Embarrassed to show emotion
• Lack of close friends
• Excessive dependence on the approval of others
• Perfectionistic or preoccupied with detail

Cluster C personality disorders include:

• Obsessive-compulsive personality disorder: Teens with an obsessive-compulsive personality disorder may evidence perfectionistic, inflexible, and unusual detail orientation. This can lead to either a one-sided pursuit of task completion at the expense of other things or the opposite, stubborn refusal to complete tasks unless their definition of perfection can be met.
• Avoidant personality disorder: A person with an avoidant personality disorder may present unusual social inhibition, sensitivity to criticism, and significant feelings of inadequacy leading to isolation.
• Dependent personality disorder: Teens with a dependent personality disorder may evidence severe fears of disapproval, resulting in clingy, submissive relationships with peers and authority figures.

What Can Cause Personality Disorders in Teens?

There are a handful of identified risk factors for the development of personality disorders and their expression during the teenage years. Some of these risk factors are familial, developmental, and genetic. For example, families with a history of personality disorders will have a higher prevalence of such among members. This may especially be the case with Antisocial and Paranoid Personality Disorder.²

Regarding developmental factors, teens with a history of trauma, neglect, or chaotic family dynamics may be more likely to suffer from personality disorders. Recent research suggests there may be a significant association between poor parent-child relationships and the development of Borderline Personality Disorder (BPD).³
Furthermore, Adverse childhood experiences (ACES) are known risk factors for various psychiatric and somatic concerns.³

Some independent, personal characteristics may also be a risk or protective factor for the onset of personality disorders. Individuals who are highly emotionally reactive may experience personality disorders at an increased rate, as opposed to those who possess the ability to develop a strong, stable relationship with a peer, teacher, or relative. Teens bullied by peers may also experience BPD more frequently, in particular.³

How Are Teenage Personality Disorders Diagnosed?

A diagnosis for a personality disorder must be performed by a licensed mental health professional– such as a psychiatrist, psychologist, clinical social worker, or licensed counselor. Additionally, it can be helpful to work with a professional who is experienced with teens and receive a thorough medical exam to rule out other possible causes for symptoms.

As part of a diagnostic process, you should expect a thorough biopsychosocial assessment. This focuses on family medical history and the youth’s medical, psychological, educational, and social history. Symptoms will be reviewed for their duration, diffuse contexts (the different life domains where symptoms are in evidence), and for differential diagnosis (to demonstrate clinical evidence for one diagnosis over another). The SAPAS (Standardized Assessment of Personality Scale) or other standardized diagnostic tools may also be used in a diagnostic evaluation.

Challenges for Diagnosis of Teenage Personality Disorders

Often, mental health professionals are reluctant to diagnose a personality disorder in adolescents under a certain age and may require a second opinion before rendering this diagnosis. The diagnosis may be considered if the symptoms are significant and have lasted at least one year.

There are many reasons to be careful in rendering any diagnosis, which leads professionals to prefer:

• Avoiding premature labeling of a personality disorder
• Differentiating symptoms from similar issues that may present in other disorders
• Recognizing that adolescents are growing and changing rapidly, with apparent character traits evolving and changing during emotional maturation.

Personality development occurs over many years, with personality traits becoming increasingly stable as an individual matures. Other terms used for personality are disposition or temperament. Youth with consistently inflexible and maladaptive reactions and behaviors and who meet the criteria for a personality disorder will benefit from early identification and assistance. If you suspect your teen has evidence of traits like those described here, do not hesitate to seek a referral for a diagnostic exam.

How Are Personality Disorders in Teens Treated?

Treating personality disorders in any age group requires a holistic diagnosis and treatment strategy to achieve the best outcomes. Personality disorder symptoms can be distressing to the sufferer and their family members and resistant to change. It is critical to ensure that the teen and family members have wrap-around support. A typical care team for a teen with a personality disorder may include a psychiatrist, therapist, and PCP. This way, you can be sure that your child will receive the proper treatment they need.

A treatment plan for personality disorders in teens may include:

Therapy

Therapy is useful for teens with a diagnosed personality disorder or those displaying similar characteristics. However, a primary barrier can be lack of insight or commitment to therapy in general, especially for adolescents. Still, a few options can be beneficial as a part of a treatment plan. Through therapy, teens will learn to stay in the moment, identify areas in their life that are not working, and learn new coping skills.

Because teens may be more likely to commit to therapy and make progress if family members are involved, some therapy methods may be adapted to involve both parties.

Therapy options for personality disorders in teens may include:

• Motivational interviewing: Motivational interviewing works to help teens identify areas where they would like to change and subsequently agree to work on them with a therapist. Such “change talk” can be leveraged to achieve commitment to therapy, try new skills or approaches, or accept help.
• Dialectical behavioral therapy (DBT): DBT adapted for teens is an evidence-based method of skill building and supportive coaching to help youth learn mindfulness, self-acceptance, dialectics, and other important skills to promote behavior change.
• Cognitive behavioral therapy (CBT): CBT for teens is generally recognized as an efficient model of changing thinking and coping patterns in many psychiatric disorders.⁵
  When used to treat personality disorders, a longer treatment period may be needed.
• Support groups: Online and in-person support groups may help reduce the isolation of the teen and their family members.

Medication

Medication may be used in conjunction with therapy for teens suffering from a personality disorder. However, there are no medications that the FDA has approved specifically to treat these conditions. Prescriptions can be useful for treating comorbid symptoms of anxiety, depression, or mood instability that may co-occur with the disorder. Not all instances of personality disorder symptoms require or benefit from pharmacological treatment. A psychiatrist or psychiatric nurse practitioner will be able to determine whether medication is beneficial for your teen’s treatment plan.

Medications that may be prescribed to a teen with a personality disorder include:

• Antidepressants
• Mood stabilizers
• Antipsychotic medications
• Anti-anxiety medications.

Inpatient & Residential Treatment

Teens who experience severe symptoms or are at risk of self-harm may be recommended for inpatient or residential treatment settings. These facilities can offer the teen an environment that allows for stabilizing the most distressing symptoms while receiving intensive therapeutic help.

Final Thoughts

Families and teens may feel confused and hopeless when presented with the daunting diagnosis of a personality disturbance. There may also be a significant stigma associated with seeking behavioral health treatment. However, help is available, and more research into treatment options is performed regularly. Finding the right providers and taking a structured approach to care will allow you and your teen to see symptom improvement.