What Is a Personality Disorder?

Personality disorders are a group of mental health conditions that cause unusual thoughts, feelings, or behaviors that disrupt a person’s life over a long period. These disorders can significantly affect daily life, work, relationships, and well-being. Those with a personality disorder usually begin to show signs of their condition by late adolescence or early adulthood.

Worldwide, an estimated 11% of people live with a personality disorder. There are several types of personality disorders—and the symptoms of each can vary. In general, people with a personality disorder have consistent patterns of thought or behavior that differ from what their culture expects from them.

A psychologist, psychiatrist, or other mental health professional can diagnose personality disorders. But unfortunately, personality disorders are difficult to treat, often because people with personality disorders don't often seek treatment for their condition. If someone does reach out for treatment, psychotherapy and psychiatric medications are the primary tools to help reduce symptoms.

Types of Personality Disorders

Mental health professionals have identified 10 distinct personality disorders, which they group into three main clusters based on symptoms.

Cluster A: Eccentric or Odd

People who have a cluster A personality disorder tend to display unusual thoughts or behaviors. The cluster A disorders are:

• Paranoid personality disorder: Involves distrust, paranoia, and suspicion of others, even when there's no evidence of wrongdoing
• Schizoid personality disorder: Being detached from social relationships and showing limited emotional expressions
• Schizotypal personality disorder: Causes odd beliefs, behaviors, and troubles forming close relationships

Cluster B: Dramatic, Emotional, or Erratic

People who have a cluster B personality disorder display highly dramatic or emotional thoughts or behaviors that may constantly change. The cluster B disorders include:

• Antisocial personality disorder: Shows disregard for the rights and feelings of others and behaves in a manipulative or deceitful manner in relationships
• Borderline personality disorder: Causes intense mood swings, unstable self-image, difficulty regulating emotions, and turbulent relationships
• Histrionic personality disorder: Involves excessive attention-seeking behavior and intense emotions
• Narcissistic personality disorder: Often leads to a grand sense of self-importance, a need for admiration, and a lack of empathy for others

Cluster C: Anxious or Fearful

People who have a cluster C personality disorder display overly anxious thoughts or behaviors. The cluster C disorders are:

• Avoidant personality disorder: Involves feelings of inadequacy and extreme sensitivity to rejection or criticism which often leads people to withdraw from social situations
• Dependent personality disorder: Causes an excessive dependence on other people for decision-making and reassurance
• Obsessive-compulsive personality disorder: Includes traits such as perfectionism, rigidity, and a need for order and control.

Common Symptoms of a Personality Disorder

The symptoms of these conditions can vary widely depending on the type of personality disorder someone has. However, there are some common, overarching symptoms, which include:

• Inappropriate behaviors
• Problems with self-image
• Difficulty making friends or maintaining relationships
• Inability to recognize that their behavior is unusual
• Blaming others for their feelings and behaviors
• Mood swings
• Trouble regulating emotions
• Impulsivity

Causes

The exact causes of a personality disorder are complex and not fully understood. They likely involve a combination of the following factors:

• Genetics: Scientists have found links between some personality disorders and certain genes. In particular, genes that regulate neurotransmitters (chemical messengers in the brain) that affect your emotions may play a role in these disorders.
• History of abuse and trauma: Experts believe that childhood abuse or trauma may contribute to the development of a personality disorder in adolescence or early adulthood. This may include physical abuse, emotional trauma, sexual assault, and bullying, among other traumatic events.
• Culture: Where a person grows up also may contribute to whether they develop a personality disorder and which type they have. For example, some Asian countries have notably low rates of antisocial personality disorder but high rates of anxiety-related personality disorders.

Risk Factors

More research on personality disorders is still needed. But studies on borderline personality disorder, one of the most common personality disorders, have identified several risk factors for developing cluster B disorders, such as:

• Lower socioeconomic status
• Poor parenting
• Having a parent with a personality disorder
• Childhood or generational trauma
• Certain personality traits, including emotional instability, negative attitude, impulsivity, and aggression

Diagnosis

To receive a diagnosis for a personality disorder, a mental health provider such as a psychiatrist or psychologist will likely perform a thorough evaluation. This assessment may involve:

• Understanding your symptoms
• Learning about your personal and family medical and psychological
• Taking a physical exam

A mental health provider will typically use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) to diagnose the condition. The DSM-5 is a reference book that contains the American Psychiatric Association’s standard diagnostic criteria for mental health conditions.

People with personality disorders may not consider their behavior unusual or problematic, so it may fall to a loved one to bring them in for a diagnosis. Or they may initially visit a healthcare provider for a different reason who may then recommend a psychiatric evaluation. It's worth noting that because children’s personalities are still developing, healthcare providers do not diagnose personality disorders until people reach adulthood. A diagnostic requirement in the DSM is that the person is at least 18 years of age.

Treatment

Personality disorders are difficult to treat compared to other mental health conditions. Treatment for personality disorders often involves a combination of psychotherapy, medication, and supportive interventions. Common treatment approaches include:

• Psychotherapy: Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy are common types of therapy for personality disorders. These methods help people gain insight into their thoughts, feelings, and behaviors. Then they can learn coping skills and find ways to improve their relationships.
• Medication: While the U.S. Food and Drug Administration has not approved any medications to treat personality disorders directly, some medications may help relieve related symptoms. Healthcare providers may prescribe anti-anxiety medications, antidepressants, or mood-stabilizing drugs for co-occurring anxiety and mood disorders.
• Group therapy: Group therapy sessions can provide social support and validation. Experts believe group therapy may especially be helpful for people with cluster B disorders, such as borderline personality disorder.
• Social skills training: This training is a type of behavioral therapy that can be particularly helpful for people living with avoidant personality disorder.
• Hospitalization: In severe cases where safety is a concern, hospitalization may be necessary. This can stabilize the person with a personality disorder and provide intensive treatment and support to help improve their symptoms and quality of life.

Related Conditions

Many people living with a personality disorder may also be at a higher risk of developing other health conditions, such as:

• Anxiety disorders
• Mood disorders
• Substance use disorder
• Cardiovascular (heart) disease
• Arthritis
• Diabetes
• Gastrointestinal (GI) disorders

Personality disorders also can lead to serious complications. People living with a personality disorder are more likely to experience:

• Poor relationships with others
• Unemployment
• Divorce
• Domestic abuse
• Substance use
• Homelessness
• Traumatic accidents
• Self-harm or premature death by suicide

Living With a Personality Disorder

The long-term outlook for people with personality disorders tends to be poor because those living with these conditions generally do not recognize that they need treatment. However, if they do seek treatment, many can successfully manage the condition. 

Research has shown that the collaborative care treatment model may be especially successful. This model involves teamwork between psychiatrists, nurse managers, and primary care providers. After six months of this type of care, 1 in 10 people with a personality disorder may improve enough to no longer meet the criteria for having this condition.

Along with their prescribed treatment plan, self-care and coping strategies can also help people manage some symptoms of a personality disorder. If you are living with a personality disorder, consider the following:

• Learn as much as you can about your condition
• Exercise regularly, which has been shown to reduce depression and anxiety
• Avoid drugs and alcohol, which can make symptoms worse or interact with your medications
• Express your feelings by joining a support group or keeping a journal
• Engage in stress-reduction methods such as yoga and meditation
• Surround yourself with supportive friends, family members, or peers who understand what you are going through

Following your treatment plan and getting the support you need can help you improve your quality of life and live well with your condition.