Personality disorders are very serious and disruptive mental health conditions. They cause individuals to have unusual, unhealthy, and flawed thoughts that lead to inappropriate behaviors and emotional responses. There are 10 types of personality disorders and all cause significant impairment in relationships and other areas of a person’s life. Many people with these conditions resist treatment and fail to see that their own behaviors and thought patterns are causing the problems in their lives. This makes treatment challenging, but acceptance and with ongoing therapy the prognosis is positive.
What Are Personality Disorders?
Personality disorders are mental illnesses that cause unhealthy and abnormal thought patterns and behaviors. These conditions cause significant impairment in a person’s life, including in relationships and home life, at school, and at work. Although it is often clear to others that the thinking of someone with a personality disordered is skewed, to the individual struggling with it, this can be very hard to see.
This fact makes it difficult to treat personality disorders; the individual with the condition often cannot recognize that there is anything wrong with how they think or act. When someone with a personality disorder does accept treatment, long-term therapy and working with family or a partner or spouse can be helpful. Managing a personality disorder takes time, dedication, and patience.
Types of Personality Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), lists 10 types of personality disorder, grouped into three clusters. They are placed in these clusters, A, B and C, based on similar characteristics, thought patterns, and symptoms.
Cluster A personality disorders are grouped together because they all cause eccentric thoughts and odd behaviors:
- Schizoid Personality Disorder. Schizoid personality disorder is characterized by detached relationships, lack of emotional expression, and a cold demeanor.
- Paranoid Personality Disorder. This type of personality disorder causes a person to always be suspicious of other people, their actions and their motives. Trust is difficult, as is confiding in anyone.
- Schizotypal Personality Disorder. With this kind of personality disorder a person has very unusual thoughts and inappropriate emotional responses to people and situations. They are not comfortable in personal relationships.
The personality disorders in cluster B are characterized by dramatic, exaggerated emotions, thoughts, and responses. Behaviors are erratic and difficult to predict:
- Narcissistic Personality Disorder. Narcissistic personality disorder is characterized by grandiosity, inflated sense of self-worth and abilities, and a lack of empathy. People with this condition need a lot of attention and may take advantage of others for their own gain.
- Antisocial Personality Disorder. An antisocial personality disorder includes a lack of empathy and related behaviors, such as using people, lying or cheating, and disregarding the needs or boundaries of others.
- Borderline Personality Disorder. Someone with borderline personality disorder struggles to develop a sense of self and relies on reactions of others to determine self-worth. They experience extreme mood swings and extreme emotional reactions, and are afraid of being abandoned.
- Histrionic Personality Disorder. Histrionic personality disorder also causes big shifts in mood and is characterized by attention-seeking behaviors.
Cluster C personality disorders cause fear, anxiety, and worry, which dictate fearful and avoidant or overly-dependent behaviors:
- Dependent Personality Disorder. Someone with this type of personality disorder tends to be submissive in relationships, is clingy and needy, and wants to be reassured and cared for.
- Avoidant Personality Disorder. Avoidant personality disorder is characterized by feelings of inadequacy, fear of rejection, and social inhibition as well as an avoidance of personal relationships.
- Obsessive-Compulsive Personality Disorder. Distinct from obsessive-compulsive disorder, this personality disorder triggers extreme attention to detail, a strong desire to have control, and a need for orderliness.
Facts and Statistics
Personality disorders are not that uncommon, but they are difficult to diagnose and may be under-reported. Because it is difficult for the affected person to recognize his or her own flawed thinking, many cases likely to go undiagnosed.
- A National Institutes of Health survey found that as much as 15 percent of the adult U.S. population meets the criteria for a personality disorder.
- Other estimates of the prevalence of personality disorders put it closer to nine percent.
- Obsessive-compulsive type is the most common personality disorder, followed by paranoid, antisocial, and schizoid personality disorder.
- Less than 40 percent of people who meet the criteria for a personality disorder are actually getting treatment.
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Symptoms and Diagnosis of Personality Disorders
To diagnose a personality disorder, a mental health professional follows the criteria in the DSM-5. Making a diagnosis is often difficult because the individual being evaluated is likely to resist professional help. The specific thoughts and behaviors that a person may have or exhibit vary depending on the type of personality disorder. But for any type, these criteria must be met for a positive diagnosis:
- Significant impairments relative to relationships with other people or with self-identity
- One or more pathological characteristics, such as detachment, lack of empathy, avoiding relationships, or neediness and attention-seeking
- Impairments and pathological characteristics that occur over a long period of time and are consistent in various situations and at different times
- Characteristics and impairments that cannot be better explained by substance abuse, physical health or illness, a developmental stage, or environmental factors
These are general criteria that must be met for any personality disorder diagnosis. The characteristic traits and the impairments they cause in a person’s life are the symptoms that vary by individual and by type of personality disorder. Just a few examples of these are:
- Unusual, extreme, limited, or inappropriate emotional responses
- Difficult and tumultuous relationships with other people
- Few or limited relationships, or no close relationships or a lack of intimacy
- Inaccurate or distorted perceptions of other people and situations
- An inability to empathize with other people and disregarding the feelings or needs of others
- Skewed sense of self-worth or value, either lacking or overinflated
- Unusual and extreme bouts of anger, aggression, or irritability
- Difficulty performing well at school or work
- Discomfort in or avoidance of social situations
Causes and Risk Factors
What causes someone to develop a personality disorder isn’t well understood, and it may never be possible to know for sure. It is likely that there are multiple contributing factors. For instance, family history and genetics, environment and childhood and family experiences, and trauma all seem to play a role in the unhealthy behavioral and thought patterns of personality disorders. Childhood experiences may be particularly important because this is when personality develops and is shaped.
There are also risk factors that are known to increase the likelihood that someone will have a personality disorder. These include family history of personality disorders or any mental illness, an unstable childhood, abuse in childhood, a dysfunctional family environment, and being diagnosed with childhood conduct disorder.
Co-occurring disorders refer to being diagnosed with more than one mental illness or substance use disorder simultaneously. It is common for someone with personality disorder to have one or more co-occurring disorders. As an example, over 84 percent of people with borderline personality disorder, according to one study, were also diagnosed with anxiety and 80 percent struggled with substance use. Depression may also co-occur with personality disorders.
The reason for these co-occurrences are complex but may be related to the fact that many mental illnesses and substance use disorders have risk factors in common. The relationship between personality disorders and substance use may also be explained by attempts to self-medicate. Someone struggling with a personality disorder and all the complications it causes may turn to drugs or alcohol to cope. This unhealthy pattern can quickly turn into a substance use disorder.
Treatment and Prognosis of Personality Disorders
It is possible to treat and successfully manage personality disorder, but it is difficult because of the resistance individuals often have to being evaluated and treated. Many people with personality disorders struggle just to recognize and accept that the way they think and behave is not normal or healthy. They tend to believe their problems are the result of the actions of others, not themselves, and this can be a big barrier to treatment.
Because of this resistance, an important first goal of treatment is simply to help an individual recognize and accept a diagnosis. Once this has been achieved and the patient is prepared to go through treatment, a long journey of therapy can begin. It takes time to change the thoughts and behaviors of personality disorders, so a commitment to long-term psychotherapy and behavioral therapy is necessary.
Some of the types of therapy commonly used for personality disorders are cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). DBT was specifically developed, based on CBT, to help treat patients with borderline personality disorder. Therapists using DBT guide patients to learn how to be more mindful and aware of their environments, triggers, thoughts, and behaviors, and to consciously choose healthier ways to respond, act, and regulate emotions.
The prognosis for treating personality disorders is positive for individuals who recognize that they need help and are committed to treatment. It may take a lot of time and require support from loved ones, but eventually a patient can learn to better manage emotions, change negative behaviors, and develop healthier relationships with others.