PERSONALITY DISORDERS

What is a Personality Disorder?

The term "Personality Disorder" implies there is something not-quite-right about someone's personality. However, the term "personality disorder" simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world.

But, first let's start with what is a personality? 

 

Personality is what makes everyone unique. We all have different ways of thinking, feeling and behaving based on our own personal experiences and genetics. For most people, differences in personality fall under a general spectrum of normal behaviors, but people with personality disorders have greater difficulties navigating everyday stresses and situations, which interfere with their social and professional relationships. Defined as long-term patterns of behavior and experiences that cause distress or difficulty functioning, personality disorders are classified as a mental illness.

 

The Diagnostic and Statistical Manual of the American Psychiatric Association,(abbreviated, DSM-5), captures the differences between healthy and unhealthy personalities. According to the definition of personality disorders in DMS-5 (APA 2013), the key elements of a personality disorder are:

 

1. A personality disorder is an enduring pattern of inner experience and behavior. This pattern manifests in two or more of the following areas:

  • Thinking

  • Feeling

  • Interpersonal relationships

  • Impulse control 

 

2. This pattern deviates markedly from cultural norms and expectations.

3. This pattern is pervasive and inflexible.

4. It is stable over time.

5. It leads to distress or impairment

 

The DSM-5 (APA, 2013) identifies and describes ten specific personality disorders. These ten diagnoses represent ten specific enduring patterns of thoughts, feelings, and behavior. However, each of these ten patterns can be distilled down to four core features of personality disorders:

 

1.    Rigid, extreme and distorted thinking patterns (thoughts)

2.    Problematic emotional response patterns (feelings)

3.    Impulse control problems (behavior)

4.    Significant interpersonal problems (behavior)

 

In fact, in order to diagnose a personality disorder a person must exhibit at least two of these four core features.

What are the 10 main types of personality disorders? 

Avoidant Personality Disorder

The problems faced by people with avoidant personality disorder are focused inward. This disorder is marked by extreme shyness, sensitivity to criticism, and feelings of inadequacy. People with avoidant personality disorder are usually unwilling to form relationships and will even avoid work activities that rely on interpersonal contact. Other common signs of avoidant personality disorder include:

  • Extreme feelings of inferiority or unattractiveness

  • Social inhibition, timid and isolated

  • Extreme fear of disapproval, embarrassment, ridicule, and rejection

  • Avoidance of strangers or any new activities that require socializing

Obsessive-Compulsive Personality Disorder

Not to be confused with obsessive compulsive disorder (OCD), obsessive-compulsive personality disorder is defined by a preoccupation with perfection and control. People with obsessive-compulsive personality disorder are often overly focused on details and schedules, and work excessively to the point where they don’t have time for leisure or socialization. Other signs of obsessive-compulsive personality disorder include:

  • Extreme distress when perfection or orderliness is not achieved 

  • Desire to control people and situations

  • Inability to delegate tasks

  • Rigid and stubborn, with inflexible morals, ethics or personal beliefs

Dependent Personality Disorder

People with dependent personality disorder have an excessive need to be cared for by others, exhibiting extremely submissive and clingy behavior. Making daily decisions is very difficult and dependent on the reassurance of others due to a fear of having to provide self-care, and a strong aversion to disagreements often leads to tolerance of poor or abusive treatment from others. Other signs of dependent personality disorder include:

  • Lack of self-confidence

  • Excessive need for advice and reassurance

  • Difficulty starting or completing projects 

  • Fear of disapproval

  • Urgency to start a new relationship when one has ended

Antisocial Personality Disorder

People with antisocial personality disorder display a general disregard for others’ needs and feelings, along with impulsive behavior and sometimes aggressive, often violent actions. Such individuals typically have recurring problems with the law and interpersonal relationships, and usually lack remorse for their behavior. Other common signs of antisocial personality disorder include:

  • Disregard for the safety of self or others

  • Repeated violation of the rights of others

  • Persistent lying, stealing and conning 

  • Consistently irresponsible

Histrionic Personality Disorder

People with histrionic personality disorder are excessively emotional and dramatic, especially when they are not the center of attention. They often use their physical appearance and sexually provocative behavior to draw attention, and they usually perceive relationships with others to be closer than they actually are. Other common signs of histrionic personality disorder include:

  • Shallow, rapidly-shifting and exaggerated emotions

  • Easily influenced by others

  • Speaks dramatically with strong opinions

Borderline Personality Disorder

Reflecting a pattern of intense emotions, impulsive and risky behavior, and general instability within relationships, borderline personality disorder is also marked by suicidal behavior and threats of self-injury. People with borderline personality disorder usually have an intense fear of being alone or abandoned and experience up and down moods, usually in reaction to stress. Other signs of borderline personality disorder include:

  • Unstable or fragile self-image

  • Ongoing feelings of emptiness

  • Frequent and intense displays of anger

  • Stress-related paranoia

Narcissistic Personality Disorder

Generally mild compared to other personality disorders, narcissistic personality disorder is defined by a grandiose sense of self-importance and entitlement, and a general lack of empathy for others. People with narcissistic personality disorder tend to harbor fantasies about power and success, and often exaggerate their own achievements and talents. Other signs of narcissistic personality disorder include:

  • Expectation of constant praise and admiration

  • Unreasonable expectations of favors and advantages

  • Often taking advantage of others 

  • Extreme arrogance

  • Failure to recognize others’ needs and feelings

Schizotypal Personality Disorder

Schizotypal personality disorder is similar to schizoid personality disorder in that those who suffer from it are uncomfortable in close relationships and often display odd or peculiar behavior or speech. However, the social anxiety involved is less extreme, and schizotypal personality disorder is more defined by indifference, flat emotions, and odd perceptual experiences, such as hearing voices whisper their name.

Other signs of schizotypal personality disorder include:

  • Peculiar ways of dressing, speaking, behaving, or thinking

  • Inappropriate or suspicious response to others

  • Magical thinking, or believing in the power to influence people and events with thoughts

  • Belief that certain incidents or events hold special hidden messages

Paranoid Personality Disorder

People with paranoid personality disorder expect the worst from everyone, assuming others are out to get them or mean them harm without evidence. Such pervasive distrust and suspicion leads to extreme difficulty in forging relationships, a reluctance to confide in others, and the belief that any information shared will be used against them. Other common signs of paranoid personality disorder include:

  • Angry or hostile reaction to perceived insults or slights

  • Perceiving innocent remarks or non threatening situations as personal attacks

  • Tendency to hold grudges 

  • Unjustified, recurring suspicion of infidelity with spouses or sexual partners

Schizoid Personality Disorder

People with schizoid personality disorder usually prefer to be alone, with a strong lack of interest in social or personal relationships. Schizoid personality disorder is also defined by a limited range of emotional expression, odd beliefs or peculiar behavior, and often a general coldness or indifference to others. Other signs of schizoid personality disorder include:

  • Inability to take pleasure in most activities

  • Inability to pick up normal social clues

  • Little to no interest in sexual relations

 What are the treatment options for personality disorder? 

 

Although there is no “cure” for personality disorders, certain types of psychotherapy can be effective in treating patients, allowing them to gain insight into their disorder and manage or cope with symptoms so they can lead healthy, productive lives. Some of the common types of therapy used for personality disorder patients include psychoanalytic therapy, cognitive behavioral therapy, and group therapy. While there are no specific medications to treat personality disorders, medications such as antidepressants or mood stabilizers are often used in conjunction with therapy to treat certain symptoms.

 

It is important to note that despite all our progress in this important area, the research investigating the treatment of personality disorders is still somewhat in its infancy. Most of what is known about the treatment of a specific personality disorder cannot be generalized to all personality disorders. This is similar to research findings regarding any broad category of disorders. For instance, cancer is a broad category of disorders. While certain treatment protocols may apply to all cancer treatments, each specific type of cancer, such as breast cancer and bone cancer, will have unique and specific treatment protocols that do not apply to both. Researchers do not generally study cancer, but rather study specific types of cancers. The same is true of personality disorders.

Since the current diagnostic system for personality disorders is difficult to use for the reasons cited above, we want to caution you to refrain from trying to diagnose yourself, or someone else.