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Personality Disorders

What are Personality Disorders?

Personality disorders (PD) are a group of mental health conditions that encompass an enduring pattern of inflexible and reactive thoughts, feelings, mood, and behaviors that cause significant distress in interpersonal relationships and cause impairment in occupational, academic, and other important settings. The behaviors and inner experiences are significantly different from the expectations of the individual’s culture.

Personality disorders do not discriminate between sex, race, or ethnicity. Most people with personality disorders develop symptoms their teen years.  Almost all who are diagnosed are above the age of 18 (there are some exceptions). There are

10 types of personality disorders, which include:

Cluster A

  • Paranoid personality disorder. This PD exhibits an extreme and pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent (evil, malicious, vindictive, etc.). This PD usually develops in early adulthood and is present in various contexts.
  • Schizoid personality disorder. This PD exhibits a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. This PD usually develops in early adulthood and is present in a variety of contexts. 
  • Schizotypal personality disorder. This PD exhibits a pervasive pattern of interpersonal and social deficits. The deficits are indicated by a severe discomfort with, and diminished capacity for, close relationships. Additionally, people with schizotypal PD exhibit cognitive and perceptual distortions and eccentricities of behavior. This PD usually develops in early adulthood and is present in a variety of contexts. 
Cluster B

  • Antisocial personality disorder. This PD exhibits a pervasive pattern of disregard for and violation of the rights of others (including the safety of others). This PD develops by age 15 (diagnosed as conduct disorder as a minor) but must be 18 to be diagnosed with antisocial personality disorder.
  • Borderline personality disorder. This PD exhibits a pervasive pattern of instability in interpersonal relationship, self-image, emotional dysregulation or reactivity, and significant impulsivity. The disorder usually develops in early adulthood and presents in various contexts. 
  • Histrionic personality disorder. This PD exhibits a pervasive pattern of excessive emotionality and attention seeking behaviors. Usually, this PD develops in early adulthood.
  • Narcissistic personality disorder. This PD exhibits a pervasive pattern of grandiosity (in behavior or in fantasy), need for admiration, and a lack of empathy. This disorder typically develops in early adulthood and is present in multiple contexts. 
Cluster C

  • Avoidant personality disorder. This PD exhibits a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to judgment and negative evaluation. This begins in early adulthood and presents in various contexts.
  • Dependent personality disorder. This PD exhibits a pervasive and excessive need to be taken care of, leading to clingy and submissive behavior and fear of separation. This PD presents in early adulthood and a variety of contexts.
  • Obsessive-compulsive personality disorder. This PD exhibits a pervasive pattern of preoccupation with orderliness, mental and interpersonal control, and perfectionism, lack of flexibility, openness, or efficiency. This PD develops in early adulthood and presents in various contexts.

Signs and Symptoms

Every personality disorder has a unique set of symptoms, but each cluster is also characterized by a unique theme. The themes for each cluster include:

  • Cluster A (odd/eccentric)
  • Cluster B (dramatic/erratic)
  • Cluster C (anxious/inhibited)
In general, personality disorders involve identity, sense of self, and relationships. People with personality disorders often have an unstable view of self and of the world around them. Their perceptions, thoughts, emotions, and behaviors tend to be more unstable. 

Personality disorders typically exhibit instability within interpersonal relationships, making initiating and maintaining relationships extremely difficult. Many people with personality disorders lack awareness to how their thoughts, perceptions, beliefs, feelings, and behaviors can be problematic.

If you or your loved one exhibit symptoms of a personality disorder, please consult with your healthcare or mental healthcare provider to take the next step toward healing and growth.

Causes

There is no singular cause for developing a personality disorder. Most personality disorders develop in teenage years or young adulthood. Antisocial personality disorder may start to develop before teenage years (symptoms usually present by age 11) but would be diagnosed as conduct disorder. Research has indicated that personality disorders develop from a combination of genetic and environmental factors. 

  • Genetics. Research has indicated a genetic link (a malfunctioning gene) that may play a role in OCD. Researchers are also studying genetic links regarding temperament and links to aggression, anxiety, and fear. There have also been findings of brain differences in people with paranoid personality disorder and schizotypal personality disorder. Genetics do not necessarily guarantee developing a personality disorder, but they can make a person more vulnerable or predisposed to developing a personality disorder.
  • Environmental factors. The environment you grew up in, how you were treated by your caregivers and others, a felt lack of safety, and any traumatic situations or events that occurred in childhood may contribute to the development of a personality disorder.

Risk Factors

The specific cause for personality disorders remains unknown. However, there are certain risk factors that may increase the risk of developing a personality disorder. Risk factors include:

  • Family history of personality disorders or other related mental health disorders
  • Childhood trauma (abusive, unstable, or chaotic upbringing; extreme poverty; natural disaster; complex grief)
  • Changes or differences in brain chemistry or brain structures
  • Being diagnosed in childhood with conduct disorder

Complications

Personality disorders can be debilitating if left untreated, and often affects the friends and family members of those with the personality disorder. Personality disorders can lead to social isolation or extremely volatile or unstable relationships. Often, people diagnosed with a personality disorder also struggle with significant anxiety and depression.

If left untreated, people may seek unhealthy ways of coping through destructive behaviors such as substance abuse, reckless driving, excessive spending, reckless sexual behaviors, self-harm, or suicidal thinking.

It is important to reach out to your healthcare or mental healthcare provider if you suspect you or your loved one has a personality disorder. 

Diagnosis

Personality disorders can be difficult to diagnose, and often people with personality disorders lack enough awareness or insight to seek help. Usually, someone with a personality disorder will seek help only when it is significantly impacting their ability to function in their daily life, or when a friend or family member takes them to get help. Often, it is the inability to keep a job, financial stress, extreme anxiety or depression, substance abuse or addiction, or self-harm behaviors that lead a person to seek help.

A mental health professional will perform a thorough intake, which gathers information about presenting problems, symptoms, family history of mental health issues, medical history, and social engagement. A mental health professional may also give assessments or recommend various testing to determine whether a person has a personality disorder. Mental health professionals will refer to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine an appropriate diagnosis. 

Treatment

The earlier personality disorders are diagnosed, the better the treatment outcomes. Personality disorders are long-standing, usually requiring months or years for treatment. It is an enduring process that requires commitment and patience, and usually takes a team approach. People with personality disorders usually require help from a primary care physician or psychiatrist to help with medication management, a mental health counselor or social worker, or a psychologist. People with personality disorders may also benefit from group counseling. In more severe cases, people may require inpatient care.
 
It is important to remember that personality disorders are on a spectrum and the severity of the symptoms will dictate much of treatment. Sometimes mental health professionals will focus on the debilitating symptoms of anxiety and depression first to make things more manageable to work on the deeper inner structural issues. The two main forms of treatment for personality disorders are psychotherapy and medication.

  • Psychotherapy. Mental health professionals will work with patients to help identify maladaptive beliefs, perceptions, thoughts, feelings, and behaviors and work to create more adaptive ones. Another important component in treating personality disorders is helping patients develop distress tolerance by utilizing various coping skills and resourcing exercises. Personality disorders are long-standing and may take months to years for treatment to be completed.
  • Medications. There are several different types of medications that can help treat personality disorders. Psychiatrists or primary care physicians usually prescribe antidepressants, mood stabilizers, antianxiety medication, or antipsychotic medication to treat symptoms of a personality disorder. Sometimes a combination of these medications will be prescribed.
  • Hospital/ Inpatient facilities. Depending on the severity of the personality disorder, some people may need to be hospitalized, specifically if they plan to harm themselves or anyone else. Once the person has stabilized and is released, they may be referred to an intensive outpatient program, where they can continue to receive treatment.