What are personality disorders?
Personality is vital to defining who we are as individuals. It involves a unique blend of traits—including attitudes, thoughts, behaviors, and moods—as well as how we express these traits in our contacts with other people and the world around us. Some characteristics of an individual’s personality are inherited, and some are shaped by life events and experiences. A personality disorder can develop if certain personality traits become too rigid and inflexible.
People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning. People with personality disorders generally also have poor coping skills and difficulty forming healthy relationships.
Unlike people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control. Because they do not believe they have a disorder, people with personality disorders often do not seek treatment on their own.
How common are personality disorders?
Personality disorders are among the most common of the severe mental disorders and often occur along with other mental illnesses, such as substance abuse disorders, mood disorders (depression or bipolar disorder), and anxiety disorders. It is estimated that 10 percent to 13 percent of the world’s population suffer from some form of personality disorder.
Most personality disorders begin in the teen years, when the personality further develops and matures. As a result, almost all people diagnosed with personality disorders are above the age of 18.
Some personality disorders—such as borderline personality disorder and histrionic personality disorder—are more common in women, and others—such as antisocial personality disorder and obsessive-compulsive personality disorder—are more common in men. Many people in prison also have a diagnosable personality disorder.
What are the types of personality disorders?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard reference book for recognized mental illnesses, organizes personality disorders into three main categories, with several types of personality disorders in each category.
Eccentric personality disorders
People with these disorders often appear odd or peculiar. The eccentric personality disorders include:
- Paranoid personality disorder. Paranoia is the hallmark of this disorder. People with paranoid personality disorder have a constant mistrust and suspicion of others. They believe that others are trying to demean, harm, or threaten them.
- Schizoid personality disorder. People with this disorder are distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion.
- Schizotypal personality disorder. People with this disorder display unusual thinking and behavior, as well as appearance. People with schizotypal personality disorder might have odd beliefs and often are very superstitious.
Dramatic personality disorders
People with these disorders have intense, unstable emotions and a distorted self-image. They also often tend to behave impulsively. These disorders include:
- Antisocial personality disorder. People with this disorder are sometimes called “sociopaths” or “psychopaths.” This disorder is characterized by rash, irresponsible, and aggressive behavior, which often is expressed by a disregard for others and an inability to abide by society’s rules. People with this disorder often commit serious crimes and have a lack of remorse for their actions.
- Borderline personality disorder. This disorder is marked by unstable moods, poor self-image, chaotic relationships, and impulsive behavior (such as sexual promiscuity, substance abuse, over-spending, and reckless driving).
- Histrionic personality disorder. People with this disorder are shallow and constantly seek attention. They often are very dramatic, possibly even childish, and overly emotional.
- Narcissistic personality disorder. This disorder is characterized by an exaggerated sense of superiority, and a preoccupation with success and power. However, this preoccupation is fueled by a fragile self-esteem. People with this disorder are very self-centered, tend to lack empathy, and require constant attention and admiration.
Anxious personality disorders
People with these disorders often are nervous or fearful. These disorders include:
- Avoidant personality disorder. People with this disorder tend to avoid social contacts. This behavior is not the result of a desire to be alone but due to excessive concern over being embarrassed or harshly judged. They often miss out on many valuable social experiences because of their fear of being rejected.
- Dependent personality disorder. This disorder is marked by dependency and submissiveness, a need for constant reassurance, feelings of helplessness, and an inability to make decisions. People with dependent personality disorder often become very close to another individual and spend great effort trying to please that person. They tend to display passive and clinging behavior, and have a fear of separation.
- Obsessive-compulsive personality disorder. This disorder is characterized by a pattern of perfectionism and inflexibility, control and orderliness, with a strong fear of making mistakes. This fear often results in an inability to make decisions, difficulty finishing tasks, and a preoccupation with details.
People might have mixed symptoms of more than one personality disorder.
Symptoms and Causes
What causes personality disorders?
Personality disorders are among the least understood and recognized of the mental disorders. It is believed that both genetics and environment play a role in the development of personality disorders. Certain personality disorders seem to be linked to a family history of mental illness. For example, people with antisocial personality disorder are more likely to have family members who also have personality disorders; and a family history of depression might be a risk factor for borderline personality disorder or obsessive-compulsive personality disorder.
Although research on personality disorders has been limited, no study has been able to show that a person is born with a personality disorder. As is the case with many other mental disorders, the tendency to develop a personality disorder might be inherited, not the disorder itself. The disorder arises when something interferes with the development of a healthy personality.
Personality disorders might develop as a way of coping with a troubling situation or unreasonable stress. For example, a person who was abused or neglected as a child might develop a personality disorder as a way of coping with the pain, fear, and anxiety that exists in his or her surroundings. One thing is known: personality disorders develop over time. A person does not suddenly “come down with” a personality disorder.
What are the symptoms of a personality disorder?
Symptoms vary depending on the type of personality disorder. They can range from mild to severe.
Diagnosis and Tests
How are personality disorders diagnosed?
It is important to understand the difference between personality styles and personality disorders. A person who is shy or likes to spend time alone does not necessarily have an avoidant or schizoid personality disorder. The difference between personality style and a personality disorder often can be determined by assessing the person’s personality function in certain areas, including:
- Awareness of reality
- Behavior and impulse control
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness as the cause of the symptoms.
If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder. The doctor or therapist bases his or her diagnosis on the person’s description of the symptoms and on his or her observation of the person’s attitude and behavior. The therapist then determines if the person’s symptoms point to a personality disorder as outlined in the DSM-5.
Management and Treatment
How are personality disorders treated?
People with personality disorders might not seek treatment on their own; and as a result, many go untreated. One reason for the failure to seek treatment might be that many people with personality disorders can function normally in society, outside of the limitations of their disorder.
Most personality disorders are constant and unrelenting, and very hard to cure. However, treatment can help relieve some of the disturbing symptoms of many types of personality disorders.
Treatment varies depending on the type of disorder, but psychotherapy (a type of counseling) is the main form of treatment. In some cases, medication might be used to treat extreme or disabling symptoms that might occur. Medications that might be used include antidepressants, anti-psychotics, anti-anxiety drugs, and impulse-stabilizing medications.
Psychotherapy focuses on evaluating faulty thinking patterns, and teaching new thinking and behavior patterns. Therapy also aims to improve coping and interpersonal skills.
What are the complications of personality disorder?
Untreated, personality disorders can result in great personal and social costs, including lost productivity, hospitalizations, significant unhappiness, and imprisonment. People with untreated personality disorders also are at risk for alcohol or drug abuse, and violent or self-destructive behavior, even suicide.
Can personality disorders be prevented?
At this time, there is no known way to prevent personality disorders, but many of the related problems might be lessened with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family, and friendships.
Outlook / Prognosis
What is the outlook for people with personality disorder?
It is difficult to accurately assess the outlook, because people with personality disorders often do not follow the treatment recommendations.