Personality Disorder

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a personality disorder?

Your personality is the way you think, perceive, react, behave and relate. These traits combine to make you unique and they stay rather stable over the course of your life. When these traits are healthy, you can deal with normal stresses and relationships. A personality disorder occurs when these traits become very rigid, inflexible and pronounced in a way that causes distress and impairs a person’s ability to function and have relationships. These deviations in traits must persist long-term to qualify as a personality disorder.

Your personality is the product of both your genes, experiences and environment. These things play a role in the development of personality disorders, as well. Your genes may make you more susceptible to a personality disorder, while experiences and your environment can act as triggers. Your risk of a personality disorder is higher if you have a family history of one or if you have a history of trauma or abuse.

Doctors group personality disorders into three clusters. The basic personality disorder definition stays the same, but each cluster has a slightly different focus. Within each cluster, there are several personality disorder types. Currently, the DSM-5 (Diagnostic and Statistical Manual) outlines 10 personality disorders.

Symptoms vary somewhat with the specific type, but relate to changes in thinking and behavior. In cluster A, thinking and behavior is odd or eccentric. In cluster B, they are overly emotional or dramatic. And in cluster C, they are fearful or anxious. These ways of thinking and behaving result in a person diverging from expected cultural norms.

Psychotherapy—or talk therapy—is the main treatment for a personality disorder. This can include both individual and group therapy. Medications can be helpful in dealing with specific symptoms, such as depression, anxiety or insomnia.

Left untreated, a personality disorder can cause significant disruptions in the person’s life and the lives of people around them. It can also lead to social isolation, substance abuse, and addiction. Antisocial personality disorder can lead to violence and criminal behavior. See your doctor, or encourage a loved one to, if you notice symptoms of a potential personality disorder.

What are the symptoms of a personality disorder?

Currently, there are 10 different personality disorder types classified into three clusters. Personality disorder symptoms vary with the specific cluster and type. It is possible to have traits from more than one personality disorder.

Cluster A

Cluster A disorders involve thinking or behavior that is odd or eccentric including:

  • Paranoid personality disorder is a pattern of unjustified suspicion and distrust of others. They see others as inherently mean, spiteful, deceitful and disloyal. They often hold grudges, don’t confide in anyone, and think others will harm them.
  • Schizoid personality disorder is a pattern of being detached from others and having little emotional expression. They often prefer being alone, appear indifferent to others, and do not seek close relationships.
  • Schizotypal personality disorder is a pattern of flat emotion, social anxiety, and discomfort with close relationships. They often display peculiar behaviors, such as dress or speech, and odd perceptions, such as magical thinking or hearing voices.

Cluster B

Cluster B disorders involve thinking or behavior that is overly emotional, dramatic or unpredictable including:

  • Antisocial personality disorder is a pattern of disregard for or violation of the rights of others and the safety of self or others. They are often angry, aggressive, impulsive, irresponsible, and lack remorse. This can lead to lying, manipulation, stealing, violence, and cruelty to animals. This can be a very difficult disorder to treat due to the inclination to deceive and manipulate for self-gain.
  • Borderline personality disorder is a pattern of poor self-image, unstable relationships, impulsivity, and intense emotions. They often suffer with deep feelings of emptiness and fear of being alone. They may display mood swings, go to great lengths to avoid abandonment, and repeatedly threaten or attempt self-harm or suicide.
  • Histrionic personality disorder is a pattern of attention-seeking, drama, and excessive, exaggerated, or rapidly changing emotion. They often use physical or sexual appearance to draw attention and are overly concerned with how they look. Their relationships are often shallow, although they aren’t aware of this.
  • Narcissistic personality disorder is a pattern of fragile self-esteem leading to a need for admiration from others. They often display grandiose self-importance and entitlement, while lacking empathy for others. Their relationships often revolve around them taking advantage of others.

Cluster C

Cluster C disorders involve thinking or behavior that is fearful or anxious including:

  • Avoidant personality disorder is a pattern of avoiding interpersonal contact and relationships due to feelings of inadequacy and extreme fear of rejection, disapproval or criticism. They are often very shy, appear socially inept, and timid. They avoid new activities or people.
  • Dependent personality disorder is a pattern of submissiveness, excessive dependence on others, and a need to be taken care of. They are often clingy, act helpless, fear being alone, and can’t make decisions. They tend to always need a close relationship and will stay in one, even if it is abusive, to avoid being alone.
  • Obsessive-compulsive personality disorder is a pattern of perfectionism, orderliness and control of people, tasks and situations. They are often preoccupied with rules and are inflexible and rigid in their values. They can experience distress when perfection and control are not achieved. They may neglect relationships in favor of excessive commitment to work or projects. This disorder is not the same as obsessive-compulsive disorder (OCD), which is a form of anxiety disorder.

Most of the time, signs of a personality disorder become apparent by adolescence or early adulthood and continue throughout adulthood. However, some symptoms may soften or diminish after middle age.

See a doctor if you, or a loved one, notice symptoms of a personality disorder. Early treatment can help you regain the ability to function in your life and relationships. Left untreated, the symptoms can get worse and lead to more problems, such as substance abuse.

What causes a personality disorder?

Doctors don’t fully understand what causes personality disorders. They believe it is an interplay of your genes, experiences and environment. It’s likely that some people are predisposed to personality disorders because of their genetics. Your experiences and life situations can act as triggers to set off a personality disorder. It seems that the environment you grow up in can have an especially important influence on the development of one of these disorders. This includes events, surroundings and relationships throughout your childhood.

What are the risk factors for a personality disorder?

Estimates suggest about 10% of the population has some form of personality disorder. And up to half of patients in psychiatric clinics and hospitals display characteristics of one. These disorders can affect anyone, regardless of sex, race, or socioeconomic class. However, antisocial personality disorder predominantly affects males. Females are more likely to have borderline personality disorder.

Certain factors may increase the risk of developing a personality disorder including:

  • Child abuse and trauma, including physical, sexual or verbal abuse
  • Childhood conduct disorder
  • Family history of personality disorders or other mental health problems. Up to 50% of personality disorders are thought to be hereditary.
  • High reactivity, including extreme sensitivity to stimuli, such as light, noise and texture
  • Unstable or chaotic childhood living environment or family life

Reducing your risk of a personality disorder

Since the exact cause is not certain, it isn’t always possible to prevent a personality disorder. According to the APA (American Psychological Association), peers can help offset negative consequences of childhood experiences and environments. Having one strong relationship with a friend or a relative, teacher, coach or similar adult may be all that a child needs to prevent a personality disorder.

If you have a family history of a personality disorder, talk with your doctor or a therapist. Find out about warning signs and what to do to get help.

How is a personality disorder treated?

The main personality disorder treatment is psychotherapy. Also called ‘talk therapy,’ psychotherapy helps you explore your thoughts, feelings and behaviors. It can teach you ways to cope with your symptoms and change how they affect your ability to function and relationships.

There are several different types of psychotherapy and types of providers who offer psychotherapy. This includes psychiatrists, psychologists, and various kinds of therapists. The provider you work with can help you decide what kind of talk therapy is best for you. Most people use a combination of individual, family and group therapy. Treatment generally takes months or years.

For some people, medications can help manage specific symptoms or other related mental problems. This may include antidepressants, anti-anxiety drugs, antipsychotics, and mood stabilizers.

What are the potential complications of a personality disorder?

Without treatment, a personality disorder can wreak havoc on a person’s life. It can disrupt relationships and interfere with a person’s ability to function at work, in school, or in social situations. In some cases, it can lead to social isolation, unemployment, substance abuse, and even addiction. Antisocial personality disorder can result in violence and criminal behavior resulting in incarceration.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jul 14
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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