Personality disorders are life-long conditions that impact behavioral patterns. Those experiencing personality disorder symptoms often report relationship problems, impaired overall functioning, and emotional distress. The DSM identifies distinct personality disorders categorized as Cluster A, Cluster B, or Cluster C diagnoses.
What Is a Personality Disorder?
Personality disorders are enduring pervasive and inflexible behavior patterns associated with personality. People with personality disorders face symptoms that inhibit functioning, often resulting in significant relationship, cognitive, self-esteem, and occupational problems.
Symptoms of personality disorders vary but generally include impaired interpersonal relationships. Professionals identify personality disorders by one of three general behavioral symptoms “clusters.” Cluster A personality disorders include odd or eccentric behaviors; Cluster B results in dramatic, emotional, and erratic behavior; and Cluster C relates to anxiousness, avoidance, and fearfulness.1
The personality disorders clusters include:
Cluster A Personality Disorders
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Cluster B Personality Disorders
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Antisocial personality disorder
Cluster C Personality Disorders
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
Personality Disorders Types
Experts categorize personality disorders into three clusters. Cluster A personality disorders include odd or eccentric behaviors, often exhibited as social isolation or awkwardness. Cluster B personality disorders result in dramatic or erratic behaviors, while cluster C personality disorders include anxious or inhibited behaviors.
Below are the different types of personality disorders:
Paranoid Personality Disorder
Paranoid personality disorder includes pervasive trust issues, extreme sensitivity to criticism, aggressive behavior, and hypervigilance.2 Those experiencing symptoms of paranoid personality disorder may believe others are plotting to harm them (persecutory delusions) and become easily angered when criticized.
Paranoid personality disorder symptoms may include:
- Lack of trust in others
- Refusing to confide in others due to trust issues
- Tendency to hold grudges
- Suspecting others of disloyalty (i.e., cheating in relationships)
- Viewing innocent statements or criticism as direct insults or threats
Schizoid Personality Disorder
Schizoid personality disorder results in social detachment, withdrawal, and restricted affect.3 Many may also experience anhedonia or an inability to experience pleasure. Others may view these individuals as reclusive because they tend to avoid social interactions and connections. Some individuals may appear “detached” from relationships.
Symptoms of schizoid personality disorder may include:
- Cold or aloof behavior
- Choosing to be alone
- Avoiding social situations
- Lacking pleasure in activities and social interactions
- Having little interest in sexual activities
Schizotypal Personality Disorder
Individuals with schizotypal personality disorder exhibit eccentric behaviors and discomfort in social relationships.4 Others may see these patients as peculiar due to their odd language, habits, and rituals. Some may also believe they have “special powers” or the ability to influence random events.
Symptoms of schizotypal personality disorder may include:
- Odd thinking, behavioral, or belief patterns
- Flat affect or limited emotional range
- Magical thinking
- Strange or peculiar speech
- Social anxiety
- Ideas of reference
Antisocial Personality Disorder
Those with antisocial personality disorder (ASPD) can be dangerous due to impulsive, delinquent, manipulative, and criminal behavior.5 Individuals with ASPD use others for personal gain without concerns for their rights or opinions.
People with ASPD may purposefully impede the happiness or safety of others for pleasure. In extreme cases, some may be cut-throat politicians, abusers, or even serial killers.6 Substance abuse is also prevalent among these individuals.
Not all people with personality disorders are violent, but violence is a common symptom of ASPD.7 Individuals with this disorder may be associated with psychopathy or sociopathy.
Symptoms of antisocial personality disorder may include:
- Violating the rights of others
- Disregarding social norms
- Impulsive or risky behavior
- Little or no regret for actions
- Taking advantage of others
- Frequent criminal behavior
Borderline Personality Disorder
Borderline personality disorder (BPD) manifests as unstable relationships, poor self-image, and impulsive behavior. BPD can create numerous other problems, including eating disorders, mood disorders, suicidal ideation, self-harm, substance abuse, and aggression. Sadly, nearly 75% of these patients attempt suicide, and approximately 10% succeed.8
Symptoms of borderline personality disorder may include:
- Fears of abandonment
- Chaotic relationships
- Unstable sense of self
- Mood swings
- Impulsive or risky behavior
- BPD hypersexuality
Histrionic Personality Disorder
Individuals with histrionic personality disorder (HPD) crave being the center of attention, often through emotionality and sexually provocative behavior.9 Histrionic personality disorder more commonly affects women than men. However, measurement issues may lend to this discrepancy rather than gender difference.
Histrionic personality disorder symptoms may include:
- Attention-seeking behavior
- Shallow and fluctuating emotions
- Dramatic actions or speech
- Extreme concern with appearance
- Being easily manipulated by others
- Displaying sexual behavior or feelings for attention
Narcissistic Personality Disorder
Grandiose self-thoughts and a need for admiration characterize narcissistic personality disorder (NPD). These individuals are hard to identify because they mask their manipulative characteristics behind inflated egos, charm, and sociality.10 They are entitled, lack empathy, and hypersensitive to criticism.
Symptoms of narcissistic personality disorder may include:
- Grandiosity
- Low self-esteem
- Lack of empathy
- Narcissistic manipulation tactics
- Taking advantage of others for personal gain
- Feeling superior to others
- Becoming easily jealous
- Extreme sensitivity to criticism
Avoidant Personality Disorder
Those with avoidant personality disorder face challenges in social relationships. Individuals experience inhibited social functioning, feelings of inadequacy, and hypersensitivity to criticism.11 They may appear quiet, shy, and reserved.
Symptoms of avoidant personality disorder may include:
- Sensitivity to criticism or rejection
- Avoidance of social interaction
- Extreme shyness
- Fears of embarrassment
- Socially isolated
Dependent Personality Disorder
Individuals with dependent personality disorder rely on others to meet their needs. They typically experience an inability to be alone, submissiveness, intense fear of rejection (sometimes called rejection-sensitive dysphoria), and clinginess.1 They are easily wounded by criticism and will go to great lengths to please others indiscriminately.
Dependent personality disorder symptoms may include:
- Relying on others for care
- Being submissive to others
- Fears of being alone
- Intense clinginess
- Lack of self-confidence in abilities
- Needing to be in relationships
Obsessive Compulsive Personality Disorder
Obsessive-compulsive personality disorder (OCPD) affects entire personalities with a pervasive and persistent need for order, control, and perfection. While some of these traits may be adaptive, the tendency to value work over relationships causes severe relationship challenges. Their adherence to lists, morals, rules, and schedules can leave them rigid, critical, authoritarian, and stubborn. They may hold onto money and objects unnecessarily.
Symptoms of obsessive-compulsive personality disorder may include:
- Extreme rigidity in following rules
- Needing everything to be perfect
- Inability to complete projects if expectations are not met
- Needing to control situations and tasks
- Inflexible about morals
- Ignoring or neglecting others to focus on tasks or work
Personality Disorder Trait Specified
The DSM-5 replaced Unspecified Personality Disorder with Personality Disorder Trait Specified (PD-TS) (mixed personality disorder). Individuals with PD-TS may meet some criteria for one or more personality disorders, but these traits do not qualify for a specific diagnosis. Some may also exhibit pathological manifestations that do not otherwise fit an existing condition but still cause issues in their relationships or self-concept.
Trait domains associated with PD-TS include disinhibition, antagonism, psychoticism, detachment, and negative affectivity. Not everyone with PD-TS will exhibit these characteristics and most present mixed traits.
What Causes Personality Disorders?
Researchers have various theories on the etiology of personality disorders. Most speculate that these disorders develop from complex interactions between biology and environmental influence.
Possible causes of personality disorders include:
- Childhood trauma: Childhood trauma can result in intimacy or trust deficits related to BPD or antisocial personality disorder.12
- Neglect or abuse: Physical, sexual, and emotional abuse or neglect can influence or exacerbate personality disorder symptoms across the three clusters.13
- Specific personality traits: Most personality disorders generally correlate with high neuroticism and low agreeableness.14
- Genetic factors: Genes may influence the development of antisocial personality disorder, BPD, or schizotypal when involved in regulating neurotransmitters such as serotonin (5-HT), dopamine (DA), and norepinephrine(NE).12
- Brain abnormalities: Certain personality disorders may be associated with structural brain abnormalities. Individuals with BPD often have differences in prefrontal and frontal-limbic regions, which are involved in emotion regulation, memory, and cognitive functioning.14
- Cultural influences: Certain cultural influences may play into the development of personality disorders. For example, there are low incidences of antisocial personality disorder in China, Japan, and Taiwan but a higher prevalence of cluster C personality disorders.12
Complications of Personality Disorders
By adulthood, personality disorders often result in intrusive problems with family, friends, social groups, and work that cause significant impairment in life. Individuals with a personality disorder may also experience comorbid psychiatric disorders such as depression, anxiety, and substance abuse.15
Many people with personality disorders exhibit problems with:
- Self-harm: More than 75% of individuals with BPD engage in active self-harm, sometimes exacerbated by their struggles with impulsiveness, shifting self-concept, and dissociation.12
- Suicidal ideation: People with diagnosed personality disorders are more likely to suffer early deaths from suicide.12
- Eating disorders: Sometimes, individuals with personality disorders may have a co-occurring eating disorder. For example, those with BPD may develop an eating disorder because of shifting self-image, while those with OCPD may develop similar disordered eating habits due to struggles with perfectionism.
- Substance abuse: Higher rates of substance use are prevalent in individuals with diagnosed personality disorders.12
- Mood disorders: Some individuals with personality disorders may have a co-occurring mood disorder along the anxiety or depression spectrum.12
- Anxiety disorders: People may sometimes present with treatment-resistant anxiety, particularly those experiencing a cluster C disorder.12
- Poor relationships: One complication of most personality disorders is poor interpersonal relationships. These problems often result from impaired social functioning and a lack of functional self-concept.12 Individuals with personality disorders also have higher rates of divorce.12
- Unstable employment or housing: Individuals experiencing PDs also exhibit higher rates of both unemployment and homelessness.12
- Criminal activity: Those with cluster B personality disorders often disregard the well-being of others, leading to a life of crime.12 Crimes may include arson, animal cruelty, or physical altercations.12
- Domestic violence: Individuals with diagnosed personality disorders have higher rates of domestic violence than the general public.12
How Are Personality Disorders Diagnosed?
Personality disorders can often elude diagnosis because most individuals do not consider their symptoms maladaptive or seek therapy for personality-specific issues.12 Through assessing personal and social history, clinicians may uncover the presence of pathological traits.12 They may also use firsthand accounts from friends, family, or authority figures to make a diagnosis.12
Treatments for Personality Disorders
Treatment for personality disorders depends on the individual and diagnosis. However, therapy is often a first-line approach, sometimes combined with medication to treat co-occurring conditions. While “persistent disorder” or “genetic in cause” sounds ominous, evidence suggests patients with personality disorders can improve.16
Therapy Options
Therapy approaches often depend on the type of personality disorder. For example, social skills training can help address mistrust and confusion seen with cluster A disorders.12 For cluster B disorders, individuals may benefit from group and individual therapy to learn relevant social skills and emotion regulation.12 Cluster C disorders may particularly benefit from CBT to target underlying anxieties and develop assertive communication skills.12
Therapy for personality disorders may include:
- Cognitive behavioral therapy (CBT): CBT can help address underlying maladaptive thoughts that affect emotions and behaviors.12
- Psychoanalytic therapy: Psychoanalytic therapy focuses on the root causes behind behaviors and can be helpful for those with obsessive-compulsive personality disorder.12
- Dialectical behavioral therapy (DBT): DBT teaches individuals skills for mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. DBT can benefit individuals with BPD struggling with impulsivity.12
- Individual social skills training: Cluster A disorders can benefit from practicing assertiveness and addressing trust issues in a controlled therapeutic environment.12
Medications
The FDA has not approved any medications specifically for personality disorders.12 Provides may instead prescribe medications for co-occurring conditions or symptoms. For example, some cluster A disorders might benefit from antipsychotics to address delusional ideas.12 Individuals with cluster C disorders may take SSRIs* to help with underlying anxiety symptoms.12
*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.
Coping With a Personality Disorder
Living a functional and fulfilling life with a personality disorder diagnosis is possible. Securing a care team and following the prescribed treatment plan can help you cope with your symptoms and achieve relief.
Below are healthy ways to cope with a personality disorder:
- Avoid substances: Substances may exacerbate existing symptoms. If possible, make a plan to limit or control substance use.
- Educate yourself about your disorder: Asking your care team about your symptoms and how to cope will help you develop a plan of action. This knowledge can help you prepare for treatment obstacles.
- Start a journal: Journaling can help you document symptoms and patterns. Reviewing this record with a counselor or therapist can aid in identifying what skills you can improve.
- Maintain treatment: Trusting your care team and following their instructions are important when managing your symptoms.
- Seek social support: Social support is an inherent piece to any treatment. Reaching out to friends or loved ones can help you maintain a sense of purpose and connection with the world.
- Maintain a healthy routine: Routines can show you which habits support your well-being. They can also offer stability while you change other facets of life, like medications or coping skills.
- Practice relaxation techniques: Relaxation techniques can help you prepare for stressful life situations, or they can be used to cope once a stressful event comes up.
- Stay active: Finding a physical activity you enjoy can help facilitate a positive mind-body connection throughout your treatment.
Final Thoughts
Although personality disorders are life-long conditions, there are effective strategies to manage symptoms. Educating yourself and your loved ones about your specific diagnosis can help you prepare for a proper course of treatment. Seeking the guidance of a care team, such as a therapist, primary care provider, and psychiatrist (or prescribing provider), can help you set realistic goals for treatment and plan for obstacles.
For Further Reading
- Personality Disorders | Mental Health America
- Hearts4Minds
- Emotions Matter
Personality Disorders Infographics
