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Personality Disorders

An ongoing series of informational entries

Our First Blog Entry

January 15, 2017

A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work and school. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face.

Personality disorders usually begin in the teenage years or early adulthood. There are many types of personality disorders. Some types may become less obvious throughout middle age.


Symptoms

Types of personality disorders are grouped into three clusters, based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one additional personality disorder. It's not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed.


Cluster A personality disorders

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.


Paranoid personality disorder

  • Pervasive distrust and suspicion of others and their motives
  • Unjustified belief that others are trying to harm or deceive you
  • Unjustified suspicion of the loyalty or trustworthiness of others
  • Hesitancy to confide in others due to unreasonable fear that others will use the information against you
  • Perception of innocent remarks or nonthreatening situations as personal insults or attacks
  • Angry or hostile reaction to perceived slights or insults
  • Tendency to hold grudges
  • Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

Schizoid personality disorder

  • Lack of interest in social or personal relationships, preferring to be alone
  • Limited range of emotional expression
  • Inability to take pleasure in most activities
  • Inability to pick up normal social cues
  • Appearance of being cold or indifferent to others
  • Little or no interest in having sex with another person

Schizotypal personality disorder

  • Peculiar dress, thinking, beliefs, speech or behavior
  • Odd perceptual experiences, such as hearing a voice whisper your name
  • Flat emotions or inappropriate emotional responses
  • Social anxiety and a lack of or discomfort with close relationships
  • Indifferent, inappropriate or suspicious response to others
  • "Magical thinking" — believing you can influence people and events with your thoughts
  • Belief that certain casual incidents or events have hidden messages meant only for you

Cluster B personality disorders

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.


Antisocial personality disorder

  • Disregard for others' needs or feelings
  • Persistent lying, stealing, using aliases, conning others
  • Recurring problems with the law
  • Repeated violation of the rights of others
  • Aggressive, often violent behavior
  • Disregard for the safety of self or others
  • Impulsive behavior
  • Consistently irresponsible
  • Lack of remorse for behavior

Borderline personality disorder

  • Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
  • Unstable or fragile self-image
  • Unstable and intense relationships
  • Up and down moods, often as a reaction to interpersonal stress
  • Suicidal behavior or threats of self-injury
  • Intense fear of being alone or abandoned
  • Ongoing feelings of emptiness
  • Frequent, intense displays of anger
  • Stress-related paranoia that comes and goes

Histrionic personality disorder

  • Constantly seeking attention
  • Excessively emotional, dramatic or sexually provocative to gain attention
  • Speaks dramatically with strong opinions, but few facts or details to back them up
  • Easily influenced by others
  • Shallow, rapidly changing emotions
  • Excessive concern with physical appearance
  • Thinks relationships with others are closer than they really are

Narcissistic personality disorder

  • Belief that you're special and more important than others
  • Fantasies about power, success and attractiveness
  • Failure to recognize others' needs and feelings
  • Exaggeration of achievements or talents
  • Expectation of constant praise and admiration
  • Arrogance
  • Unreasonable expectations of favors and advantages, often taking advantage of others
  • Envy of others or belief that others envy you

Cluster C personality disorders

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.


Avoidant personality disorder

  • Too sensitive to criticism or rejection
  • Feeling inadequate, inferior or unattractive
  • Avoidance of work activities that require interpersonal contact
  • Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
  • Extreme shyness in social situations and personal relationships
  • Fear of disapproval, embarrassment or ridicule

Dependent personality disorder

  • Excessive dependence on others and feeling the need to be taken care of
  • Submissive or clingy behavior toward others
  • Fear of having to provide self-care or fend for yourself if left alone
  • Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
  • Difficulty starting or doing projects on your own due to lack of self-confidence
  • Difficulty disagreeing with others, fearing disapproval
  • Tolerance of poor or abusive treatment, even when other options are available
  • Urgent need to start a new relationship when a close one has ended

Obsessive-compulsive personality disorder

  • Preoccupation with details, orderliness and rules
  • Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don't meet your own strict standards
  • Desire to be in control of people, tasks and situations, and inability to delegate tasks
  • Neglect of friends and enjoyable activities because of excessive commitment to work or a project
  • Inability to discard broken or worthless objects
  • Rigid and stubborn
  • Inflexible about morality, ethics or values
  • Tight, miserly control over budgeting and spending money
  • Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, a type of anxiety disorder.

When to see a doctor

If you have any signs or symptoms of a personality disorder, see your doctor or other primary care professional or a mental health professional. Untreated, personality disorders can cause significant problems in your life that may get worse without treatment.


Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of:

  • Your genes. Certain personality traits may be passed on to you by your parents through inherited genes. These traits are sometimes called your temperament.
  • Your environment. This involves the surroundings you grew up in, events that occurred, and relationships with family members and others.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Your genes may make you vulnerable to developing a personality disorder, and a life situation may trigger the actual development.


Risk factors

Although the precise cause of personality disorders is not known, certain factors seem to increase the risk of developing or triggering personality disorders, including:

  • Family history of personality disorders or other mental illness
  • Abusive, unstable or chaotic family life during childhood
  • Being diagnosed with childhood conduct disorder
  • Variations in brain chemistry and structure

Complications

Personality disorders can significantly disrupt the lives of both the affected person and those who care about that person. Personality disorders may cause problems with relationships, work or school, and can lead to social isolation or alcohol or drug abuse.


Diagnosis

If your doctor suspects you have a personality disorder, a diagnosis may be determined by:

  • Physical exam. The doctor may do a physical exam and ask in-depth questions about your health. In some cases, your symptoms may be linked to an underlying physical health problem. Your evaluation may include lab tests and a screening test for alcohol and drugs.
  • Psychiatric evaluation. This includes a discussion about your thoughts, feelings and behavior and may include a questionnaire to help pinpoint a diagnosis. With your permission, information from family members or others may be helpful.
  • Diagnostic criteria in the DSM-5. Your doctor may compare your symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Diagnostic criteria

Each personality disorder has its own set of diagnostic criteria. However, according to the DSM-5, generally the diagnosis of a personality disorder includes long-term marked deviation from cultural expectations that leads to significant distress or impairment in at least two of these areas:

  • The way you perceive and interpret yourself, other people and events
  • The appropriateness of your emotional responses
  • How well you function when dealing with other people and in relationships
  • Whether you can control your impulses

Sometimes it can be difficult to determine the type of personality disorder, as some personality disorders share similar symptoms and more than one type may be present. Other disorders such as depression, anxiety or substance abuse may further complicate diagnosis. But it's worth the time and effort to get an accurate diagnosis so that you get appropriate treatment.


Treatment

The treatment that's best for you depends on your particular personality disorder, its severity and your life situation. Often, a team approach is needed to make sure all of your psychiatric, medical and social needs are met. Because personality disorders are long-standing, treatment may require months or years.

Your treatment team may include your primary doctor or other primary care provider as well as a:

  • Psychiatrist
  • Psychologist or other therapist
  • Psychiatric nurse
  • Pharmacist
  • Social worker

If you have mild symptoms that are well-controlled, you may need treatment from only your primary doctor, a psychiatrist or other therapist. If possible, find a mental health professional with experience in treating personality disorders.


Psychotherapy, also called talk therapy, is the main way to treat personality disorders. During psychotherapy with a mental health professional, you can learn about your condition and talk about your moods, feelings, thoughts and behaviors. You can learn to cope with stress and manage your disorder.


Psychotherapy may be provided in individual sessions, group therapy, or sessions that include family or even friends. There are several types of psychotherapy — your mental health professional can determine which one is best for you.


You may also receive social skills training. During this training you can use the insight and knowledge you gain to learn healthy ways to manage your symptoms and reduce behaviors that interfere with your functioning and relationships.


Family therapy provides support and education to families dealing with a family member who has a personality disorder.


Medications or pharmacotherapy

There are no medications specifically approved by the Food and Drug Administration (FDA) to treat personality disorders. However, several types of psychiatric medications may help with various personality disorder symptoms.

  • Antidepressants. Antidepressants may be useful if you have a depressed mood, anger, impulsivity, irritability or hopelessness, which may be associated with personality disorders.
  • Mood stabilizers. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.
  • Antipsychotic medications. Also called neuroleptics, these may be helpful if your symptoms include losing touch with reality (psychosis) or in some cases if you have anxiety or anger problems.
  • Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior, so they're avoided in certain types of personality disorders.

Hospital and residential treatment programs

In some cases, a personality disorder may be so severe that you need to be admitted to a hospital for psychiatric care. This is generally recommended only when you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else. After you become stable in the hospital, your doctor may recommend a day hospital program, residential program or outpatient treatment.


Preparing for your appointment

Because personality disorders often require specialized care, your primary doctor may refer you to a mental health professional, such as a psychiatrist or psychologist, for evaluation and treatment. Taking a family member or friend along can help you remember something that you missed or forgot.


Prepare for your appointment by making a list of:

  • Your symptoms, including any that seem unrelated to the reason for the appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, including over-the-counter medications, vitamins, herbal preparations or other supplements that you're taking, and the doses

Questions to ask your doctor

  • What type of personality disorder might I have?
  • How do you treat my type of personality disorder?
  • Will talk therapy help?
  • Are there medications that might help?
  • How long will I need to take medication?
  • What are the major side effects of the medication you're recommending?
  • How long will treatment take?
  • What can I do to help myself?
  • Are there any brochures or other printed material that I can have?
  • What websites do you recommend visiting?
  • Don't hesitate to ask any other questions during your appointment.

During your appointment, your doctor or mental health professional will likely ask you a number of questions about your mood, thoughts, behavior and urges, such as:

  • What symptoms have you noticed or have others said they notice in you?
  • When did you or they first notice symptoms?
  • How is your daily life affected by your symptoms?
  • What other treatment, if any, have you had?
  • What have you tried on your own to feel better or control your symptoms?
  • What things make you feel worse?
  • Have your family members or friends commented on your mood or behavior?
  • Have any relatives had a mental illness?
  • What do you hope to gain from treatment?
  • What medications, vitamins, herbs or supplements do you take?

Self-management

Along with your professional treatment plan, consider these lifestyle and self-care strategies:

  • Be an active participant in your care. This can help your efforts to manage your personality disorder. Don't skip therapy sessions, even if you don't feel like going. Think about your goals for treatment and work toward achieving them.
  • Take your medications as directed. Even if you're feeling well, don't skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
  • Learn about your condition. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get active. Physical activity can help manage many symptoms, such as depression, stress and anxiety. Activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, jogging, swimming, gardening or taking up another form of physical activity that you enjoy.
  • Avoid drugs and alcohol. Alcohol and street drugs can worsen personality disorder symptoms or interact with medications.
  • Get routine medical care. Don't neglect checkups or skip visits to your primary care professional, especially if you aren't feeling well. You may have a new health problem that needs to be addressed, or you may be experiencing side effects of medication.

Coping and support

Having a personality disorder makes it hard to engage in behavior and activities that may help you feel better. Ask your doctor or therapist how to improve your coping skills and get the support you need.  


If you have a loved one with a personality disorder, work with his or her mental health professional to find out how you can most effectively offer support and encouragement.

You may also benefit from talking with a mental health professional about any distress you experience. A mental health professional can also help you develop boundaries and self-care strategies so that you're able to enjoy and succeed in your own life.