Personality Disorders

The specific symptoms, or “traits,” of personality disorders include thinking, feeling, and behaving that deviates from the expectations of the culture.

Once viewed solely in moral terms, personality differences are now better understood as adaptations to genetic and environmental influences in childhood. Research has revealed that certain factors affect personality development in measurable and predictable ways. Not only do mental health professionals now know that pathological personality styles typically develop in response to trauma or neglect, but they also have learned that these painful disorders can be successfully treated.

What Are Personality Disorders?

What is a personality disorder? It is a condition that arises in a chaotic environment that becomes maladaptive outside of that environment. The American Psychiatric Association defines a personality disorder as “a way of thinking, feeling, and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.”

What characteristics are typical of personality disorders? The specific symptoms, or “traits,” of personality disorders, vary significantly but are all stable over time and generally inflexible. They also directly reflect childhood circumstances. For example, someone with an anxious temperament and demanding parents might develop a rigid and fearful way of relating to the world that later becomes avoidant personality disorder.

Like the DSM-IV, the DSM-V categorizes personality disorders into three clusters. Each of the three clusters of personality disorders includes three to four disorders that differ in details but share broad traits.

Types of Personality Disorders

What are the different types of personality disorders? Traditionally, Cluster A personality disorders are categorized as odd or eccentric, Cluster B personality disorders as dramatic and Cluster C personality disorders as anxiety-driven. These personality disorder types are deeply ingrained and typically established by late adolescence or early adulthood.

Cluster A Personality Disorders

The Cluster A disorders are considered by many to be the most severe group of personality disorders. They all share characteristics in common with schizophrenia, which was once defined in the DSM as a similar condition. However, none feature the hallucinations of that disorder and all are defined by various types of delusional thinking that are not characteristic of schizophrenia.

Paranoid Personality Disorder

According to the DSM, people with paranoid personality disorder exhibit “a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent” as exhibited by four or more of the following symptoms:

• Suspicion, without basis, that people are exploiting, harming or deceiving them
• Preoccupation with unjustified doubts about people’s loyalty or trustworthiness
• Reluctance to confide in people due to fear this information will be used against them
• Perception of demeaning or threatening meanings in neutral statements or events
• Retention of grudges and refusal to forgive insults or slights
• Inaccurate perceptions of hostility in people and quick aggressive counter-reactions
• Recurrent unjustified suspicions about the sexual fidelity of a partner

While paranoid personality disorder is not defined by the significant social withdrawal of the other two Cluster A personality disorders, it makes it difficult for people to maintain long-term relationships, especially intimate relationships.

Related Topic: Treatment for paranoid personality disorder

Schizoid Personality Disorder

Schizoid personality disorder is diagnosed when someone exhibits four or more of these specific symptoms of restricted emotional range and social withdrawal:

• An absence and lack of interest in close relationships, even family relationships
• A persistent and overwhelming preference for solitary activities
• A lack of interest in having sexual experiences with others
• Disinterest and lack of pleasure in most activities
• Absence of friends or confidants other than first-degree relatives
• Apparent indifference to peoples’ praise or criticism
• Emotional coldness, detachment or flat affect

This disorder is distinguished from introversion or social anxiety by a lack of expressed emotion, whether positive or negative, in reaction to social isolation.

Schizotypal Personality Disorder

Like people with schizoid personality disorder, people with schizotypal personality disorder are socially avoidant. They exhibit additional features of eccentric behavior and distorted cognition, as defined by four or more of the following traits:

• Ideas of reference, or beliefs that neutral events have personal significance
• Odd beliefs or magical thinking that is inconsistent with cultural norms
• Strange perceptions, including bodily illusions
• Odd thinking and speech, such as stereotyped or circular speech
• Suspicious or paranoid ideation
• Inappropriate or constricted affect
• Peculiar behavior or appearance
• Lack of close friends or confidants other than first-degree relatives
• Excessive, paranoid social anxiety that does not diminish with familiarity

The delusions associated with schizoid personality disorder tend not to be as elaborate as those associated with schizophrenia and are not necessarily paranoid in nature.

Cluster B Personality Disorders

The Cluster B personality disorders are associated with dramatic, impulsive and emotionally dysregulated behavior. These personality disorders all reflect shared traits of disinhibition and negative temperament or neuroticism. People with these personality disorders are risk-prone and more susceptible to self-harm and substance abuse than the general population.

Antisocial Personality Disorder

The DSM defines antisocial personality disorder as “a pervasive pattern of disregard for and violation of the rights of others” as demonstrated by three or more of the following symptoms:

• Failing to conform to social norms or laws and acting in ways that could lead to an arrest
• Being deceitful, using aliases and conning others for personal profit or pleasure
• Engaging in impulsive behavior and failing to plan ahead
• Exhibiting irritability and aggression, as indicated by repeated physical assaults
• Acting in ways that show disregard for the safety of oneself and other people
• Consistently acting irresponsibly, such as failing to uphold work or financial obligations
• Showing a lack of remorse and rationalizing hurtful actions

To receive a diagnosis of antisocial personality disorder, a person must be at least 18 years old, have shown some evidence of conduct disorder before the age of 15, and must not experience these traits solely in the course of schizophrenia or a manic episode. People with this disorder typically have a history of involvement with the criminal justice system.

Borderline Personality Disorder

Borderline personality disorder (BPD) is a disorder of emotional regulation that also affects a person’s sense of identity and interpersonal relationships. To be diagnosed with BPD, a person must exhibit five or more of the following traits:

• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable, intense relationships characterized by extremes of idealization and devaluation
• Identity disturbance or a persistently unstable sense of self
• Impulsivity in at least two areas that are potentially harmful to the self
• Recurrent suicidal actions, gestures or threats, or self-mutilating behavior
• Unstable affect and reactivity of mood with episodic dysphoria, irritability and anxiety
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger
• Transient, stress-related paranoid ideation or severe dissociative symptoms

While some people with BPD are more extroverted and prone to self-destructive behavior, others keep their emotional intensity largely hidden. In general, people with the disorder are the most reactive in response to real or perceived rejection or abandonment.

Histrionic Personality Disorder

Histrionic personality disorder also affects emotional regulation but is primarily defined by a pattern of attention seeking as exhibited by five or more of the following:

• Not being comfortable with not being the center of attention
• Interacting with others in inappropriately sexual or provocative ways
• Exhibiting rapidly changing and shallow emotions
• Using physical appearance to gain attention from others
• Speaking in vague and excessively impressionistic ways
• Engaging in dramatic, theatrical and exaggerated displays of emotion
• Being suggestible or easily influenced by others or by circumstances
• Thinking of relationships as being more intimate than they are

While people with a healthy degree of extraversion also like attention, they are not as dependent on it or as reactive to its absence as individuals with histrionic personality disorder.

Related Topic: Histrionic personality disorder treatment

Narcissistic Personality Disorder

Narcissistic personality disorder develops in response to a lack of empathic responses from parents or other authority figures in childhood. It is defined by five or more of the following symptoms of diminished empathy and grandiosity:

• Having a grandiose sense of self-importance and an unmerited sense of superiority
• Being preoccupied with fantasies of unlimited power or success, or ideal love or beauty
• Believing they are special, and needing recognition from other special or high-status people and institutions
• Requiring excessive admiration
• Having a sense of entitlement, or unreasonable expectations of especially favorable treatment
• Exploiting others or taking advantage of others for personal ends
• Lacking empathy or being unable to recognize or identify with other people’s feelings or needs
• Frequently envying others or perceiving that others are envious of them
• Exhibiting arrogant or haughty behavior or attitudes

People with narcissistic personality disorder often keep vulnerable emotional reactions hidden from others and even from themselves. As a result, they can come across as cold or aloof when they are neither. Like people with antisocial personality disorder, they are prone to exploiting others but are driven by a desire for social status and admiration rather than power.

Cluster C Personality Disorders

Just as the Cluster A personality disorders all share characteristics with schizophrenia, Cluster C personality disorders all share characteristics with anxiety disorders like social anxiety disorder and obsessive-compulsive disorder.

What distinguishes anxiety disorders from the personality disorders related to them is a matter of debate. However, in general, personality disorders are considered to be more deeply internalized and pervasive, as well as more difficult (though not impossible) to treat.

Avoidant Personality Disorder

People with avoidant personality disorder avoid social situations not because they prefer solitude but because they fear judgment and rejection. People are diagnosed with this disorder when they exhibit four or more of the following symptoms:

• Avoiding social activities at work due to fears of criticism, disapproval or rejection
• Being unwilling to get involved with people without being certain of being liked
• Holding back in close relationships out of fear of being shamed or ridiculed
• Being preoccupied with criticism or rejection in social situations
• Shutting down in new interpersonal situations due to feelings of inadequacy
• Seeing oneself as socially inept, personally unappealing or inferior to others
• Being unusually reluctant to take risks or try new activities out of fear of embarrassment

While the symptoms are similar, avoidant personality disorder is distinguished from social anxiety disorder by the extent to which negative self-evaluation and avoidance are integrated into a person’s identity and fundamental sense of self.

Related Topic: Avoidant personality disorder treatment

Dependent Personality Disorder

Dependent personality disorder is defined by the DSM as “a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts,” as demonstrated by five or more of the following:

• Struggling to make daily decisions without excessive advice and reassurance from others
• Depending on others to take responsibility for major life decisions and routines
• Being reluctant to disagree with people out of fear of loss of support or approval
• Resisting new projects or independent activities due to a lack of self-confidence
• Making excessive efforts to please others, even when they are personally unpleasant
• Being uncomfortable with being alone due to fear of being unable to care for oneself
• Urgently seeking other relationships as a source of care when a close relationship ends
• Having an unrealistic preoccupation with fears of being left alone

There are no qualifiers for a diagnosis of dependent personality disorder other than meeting five or more of the above criteria as an adult.

Obsessive Compulsive Personality Disorder

When people have obsessive-compulsive personality disorder (OCPD), they are driven by a need for perfectionism, order and control as exhibited by four or more of the following:

• Preoccupation with details or rules to an extent that the point of any given activity is lost
• Perfectionism that interferes with the ability to complete tasks
• Excessive devotion to work and productivity at the expense of leisure and friendship
• Extreme conscientiousness and inflexibility about matters of morality, ethics or values
• Inability to discard worn-out or worthless objects even when they lack sentimental value
• Reluctance to delegate tasks to others without control over how they perform those tasks
• Miserly spending style and fixation on hoarding money for catastrophes
• Excessive rigidity and stubbornness

Unlike people with obsessive-compulsive disorder (OCD), people with OCPD rarely recognize their obsessions and compulsions as irrational. They are less likely to engage in the repetitive compulsions typical of OCD and more likely to exhibit a generally rigid approach across a wide variety of life situations.

Related Topic: Obsessive compulsive personality disorder treatment

Causes and Symptoms of Personality Disorders

What are the symptoms of personality disorders? While specific traits vary across disorders, shared characteristics include a lack of trust in others and a distorted sense of self.

Most personality disorder symptoms develop by early adulthood. This is because what causes personality disorders is a combination of factors rooted in childhood experiences, including early trauma, natural temperament and environmental factors.

The symptoms of personality disorders vary, but there are some general signs that a person has a personality disorder. The most significant is that the way they relate to the world does not change according to circumstances. This is part of what distinguishes a personality disorder. A person experiences these qualities as traits, not symptoms of a transient, circumstance-specific condition.

Distrust of Others

Mistrust of others is to some extent a component of all personality disorders. A person with paranoid personality disorder is overtly suspicious of everyone’s motives, while people with borderline or dependent personality disorders may find it difficult to trust the legitimacy of their relationships with others. People with obsessive-compulsive personality disorder don’t trust that others can help them, while people with avoidant personality disorder don’t trust that others will like or accept them.

The reason for this nearly universal element of mistrust lies in the origin of personality disorders. They develop when a child cannot trust their parents, other authority figures or general circumstances. These rigid personality styles reflect different ways of trying to establish a sense of order and security in a world that lacks these qualities.

Paranoia

Paranoia is another common personality disorder symptom. It is especially prominent in Cluster A personality disorders, in which people prescribe motives to actions where none exist. Paranoia is present in subtler ways in Cluster C disorders, especially avoidant personality disorder. People with these anxious personality styles fear being judged and rejected by others, as do people with borderline personality disorder.

The origin of this shared trait is that people with personality disorders often had experiences in which others had harmful intentions toward them as children, which they then project onto others in a generalized way as adults. Their childhoods taught them not to trust other people.

Distorted Perception of Reality

Each personality disorder can be understood as a different way of seeing the world through a distorted lens. People with Cluster C disorders mistrust their own or others’ ability to handle everyday events and interactions. People with Cluster B disorders misapprehend the way others see them and are prone to grandiosity, whether projected onto the self or others.

People with Cluster A disorders experience the most profoundly distorted perceptions of reality, especially those with paranoid personality disorder or schizotypal personality disorder. Both of these disorders involve some degree of delusional thinking. In each, people read intentions and meanings into actions and events that are not actually there.

People with paranoid personality disorder misread hostile motives into neutral or friendly actions. People with schizotypal personality disorder misread random coincidences as meaningful communications or signals, and often have idiosyncratic superstitions rooted in such beliefs. For example, they might believe that a television announcer is speaking directly to them and that they need to respond by tapping back on the television screen.

Blurred Senses of Identity

All personality disorders reflect a disturbance of the sense of self, but none feature a more potent disturbance of identity than the Cluster B disorders. The thread linking these disorders is the fear of a lost or absent sense of self. While people universally enjoy approval and validation, people with Cluster B disorders need affirmation to feel like they have a self at all.

The self-denial of a person with BPD has a similar origin as the self-affectation of someone with narcissistic personality disorder, which is an emptiness felt at the core of the self. People with these disorders look to interactions with others to fill that emptiness.

Where people with BPD yearn for love to affirm their existence, people with narcissistic personality disorder yearn for admiration. People with histrionic personality disorder seek attention, while people with antisocial personality disorder seek to experience a feeling of power over others.

Depression, Personality Disorders and Suicidal Thoughts

Research shows that people with any personality disorder in adolescence are more likely to develop depression as adults and that both Cluster C and Cluster B disorders are associated with a higher risk of suicidal thoughts and actions.

People with borderline personality disorder are particularly prone to self-harm and suicidal gestures and have a heightened risk of suicide. Their capacity to experience extremely intense emotions and to feel existentially threatened can turn deadly when combined with their impulsivity and inclination toward self-harm.

People with Cluster B personality disorders are generally more prone to act on impulses, including self-destructive ones. This makes them more likely to act on passing suicidal thoughts than others. People with Cluster C personality disorders are prone to overwhelming feelings of shame, which can be intense enough to drive them to suicide when their social circumstances seem helpless.

How Are Personality Disorders Diagnosed?

Like any mental health condition, personality disorders are primarily diagnosed through clinical interviews. Mental health professionals use the DSM as a guide, determining whether a person meets the full clinical criteria for a diagnosis through a series of targeted questions.

Diagnosing personality disorders can be tricky for a number of reasons, including their initial resemblance to other diagnoses. The consistency of a set of symptoms over time and across a variety of situations can help clarify that a person has a personality disorder.

Often, these disorders only reveal themselves after other diagnoses are attempted that do not match the symptoms that someone experiences. For example, people with Cluster A personality traits might initially give a clinician the impression that they have schizophrenia until the absence of hallucinations becomes apparent. People with BPD are often misdiagnosed with bipolar disorder due to their instability of mood. People with avoidant personality disorder might be diagnosed with social anxiety disorder until a clinician finds that they aren’t responding to normal interventions.

It takes clinical observation over a long period of time to accurately diagnose someone with a personality disorder. It is also a careful process. Mental health professionals often hesitate to formally diagnose people with personality disorders due to the stigma associated with them.

Risk Factors for Personality Disorders

Several factors put people at a greater risk of developing a personality disorder. These include:

• Family histories of mental illness
• Growing up in abusive, unstable or chaotic homes
• Being diagnosed with a conduct disorder in childhood
• Experiencing emotional abuse or neglect as children
• Being disciplined in a harsh or inconsistent way as children
• Having highly reactive or sensitive temperaments

Overall, while personality disorders have a genetic component, they are much more likely to develop when people grow up in chaotic or abusive homes.

Personality Disorder Statistics

Personality disorder statistics show that they are relatively common and carry significant associated risks:

• Personality disorders affect 10–13 percent of the general population.
• The most prevalent personality disorder in the United States is OCPD, which affects 8 percent of the population. It is followed by borderline and narcissistic personality disorders, which each affect about 6 percent of the population.
• Studies show that between 65–90 percent of people treated for a substance use disorder have at least one personality disorder.
• People with BPD have an unusually high risk of suicide. Seventy-five percent of these individuals attempt suicide at least once in their lives and 10 percent eventually commit suicide.
• Nearly two-thirds of people with personality disorders have a comorbid disorder. Having comorbid personality disorders makes a person 20 times more likely to engage in suicidal behavior.

If you struggle with a personality disorder and co-occurring addiction, help is closer than you think. With the right treatment, recovery is possible. Reach out to a representative at The Recovery Village today to take the first step toward a better life.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Stephanie Hairston, MSW

Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more