Personality Disorders
Personality disorders are deeply ingrained, rigid ways of thinking and behaving that result in impaired relationships with others and often cause distress for the individual who experiences them. Many mental health professionals formally recognize 10 disorders that fall into three clusters, although there is known to be much overlap between the categories.
Cluster A disorders are characterized by odd or eccentric patterns of thinking, such as extreme social detachment, distrust, or unusual beliefs.
- Paranoid personality disorder, which involves pervasive distrust and suspicion of others
- Schizoid personality disorder, which involves detachment and limited emotion in social contexts
- Schizotypal personality disorder, which features difficulty with close relationships along with abnormal thinking and behavior patterns
Cluster B disorders feature unstable emotional states and erratic behavior, which can involve aggression toward or manipulation of others.
- Antisocial personality disorder, which involves disregard for others and often impulsiveness and aggression
- Borderline personality disorder, marked by instability in one’s relationships, emotions, and sense of self, and impulsiveness
- Histrionic personality disorder, which involves over-the-top expressiveness and attention-seeking
- Narcissistic personality disorder, often involving an unusually strong desire for admiration, an inflated self-image, and lack of empathy
Cluster C disorders involve anxious or fearful patterns of thinking and relating to others.
- Avoidant personality disorder, characterized by avoidance of social closeness and fear of what others think
- Dependent personality disorder, which involves a tendency to become overly reliant on others and afraid to disrupt relationships
- Obsessive-compulsive personality disorder, marked by a rigid fixation on details and personally held standards
Signs of a personality disorder usually appear by late adolescence or early adulthood. Although the disorders grouped within each cluster have similar symptoms and traits, one person may not have the exact same symptoms as another person with the same diagnosis, nor exhibit symptoms to the same degree. People who exhibit symptoms of a personality disorder may be unaware that they do so because they perceive their own distorted thought processes, emotional responses, and behaviors as normal.
A personality disorder is a long-term set of tendencies in one’s thinking and behavior that impair the person’s functioning in the world. While personality disorders are commonly described in terms of distinct categories, research suggests that, for the most part, they reflect various combinations of multiple underlying personality traits, including extreme levels of traits that all people have.
While the signs of a personality disorder—characteristics like lack of empathy and remorse, or consistently chaotic relationships with others—may be evident to many people in someone’s life, only a clinical professional, such as a clinical psychologist or psychiatrist, can make an official determination that the person meets the criteria for a personality disorder.
Obsessive-compulsive personality disorder (OCPD)—which is distinct from obsessive-compulsive disorder (OCD)—appears to be the most common personality disorder in Western countries, with a recent review estimating its prevalence at more than 4 percent. More than 12 percent of adults were estimated to have at least one personality disorder.
Dependent personality disorder seems to be the least common personality disorder in Western samples, with an estimated prevalence of about 0.8 percent.
Yes. People with one personality disorder often have symptoms that fit the criteria of at least one additional personality disorder. Someone with a personality disorder may also have other forms of mental disorders, such as a substance use disorder or depression.
Cluster A, Cluster B, and Cluster C are three groupings of personality disorder categories used in the psychiatric guide, the DSM. The clusters are based on clinicians’ perspectives on how aspects of certain disorders seem similar to one another. However, scientific analysis of personality disorder symptoms does not necessarily support these three clusters as the most valid way of representing personality disorders.
Yes. Like other kinds of mental disorders, they can lead to suffering and dysfunction for the individual with the disorder, even if the characteristics that make up a personality disorder seem acceptable or reasonable to that person.
In a sense, yes—the behaviors and tendencies associated with psychopathy can be severely dysfunctional—though psychopathy is not an official category in official diagnostic texts such as the DSM. Its closest match in the DSM is antisocial personality disorder, which is thought to be a more encompassing diagnosis; not everyone who has it would be considered a psychopath.
Multiple personality disorder, also known as multiple personality syndrome, is not a personality disorder, nor is it a diagnosis per se. It describes what is now called dissociative identity disorder (DID). DID is a disorder in which a person experiences two or more different identities or states in which they show distinct, consistent patterns of thinking and relating. It also involves atypical gaps in both distant and recent memory.
While people with personality disorders in general do not necessarily pose a threat to others, antisocial personality disorder involves a disregard for the rights of others and has been linked with increased likelihood of violent behavior. Individuals with personality disorders such as narcissistic personality disorder are more likely to be manipulative and deceitful than to be physically violent.
Personality disorders present unique treatment challenges. Most personality disorders are ego-syntonic, meaning they are compatible with a person's self-concept. As such, there may initially be little or no motivation to change. Nevertheless, mental health professionals have developed and applied different therapeutic techniques to help those with these conditions learn more adaptive ways of thinking and behaving, and research suggests that positive change is possible for many.
While the tendencies that comprise a personality disorder may never go away entirely, research indicates that a person can show decreased symptoms over time. Therapy can also be helpful for certain conditions. A number of approaches have been used in the treatment of borderline personality disorder, including Dialectical Behavior Therapy (DBT) and psychodynamic psychotherapy. In some cases, psychotropic drugs—such as antidepressants or antipsychotics—may be used as part of the treatment of personality disorder symptoms.
While it may be very difficult to convince someone who may have a personality disorder to see a therapist, therapy may offer the most promising route to long-term reduction in dysfunctional thoughts and behaviors. In the meantime, there are some precautions that could be helpful in dealing with someone who has a personality disorder, including limiting time together and avoiding topics that lead to friction or conflict.
Antisocial personality disorder can be exceptionally challenging to treat, in part because those with this disorder may be inclined to create the appearance of change in order to get what they want (such as release from incarceration).
Not necessarily. There is evidence, for example, that many people with borderline personality disorder may show reductions in certain symptoms over time.