Personality Disorders

What are personality disorders?

Personality disorders are mental health conditions. They cause disruptive and long-lasting patterns of thinking, mood and behavior. These patterns can impair your ability to function, impact your relationships, and cause significant distress. Many people with personality disorders don’t realize that their behaviors and thoughts are a problem.

There are many different types of personality disorders, which are grouped into three categories or ‘clusters’, each with different symptoms. These are called cluster A personality disorder, cluster B and cluster C.

Cluster A personality disorders

Cluster A personality disorders usually involve eccentric and unusual behaviors or thinking.

Cluster A personality disorders include:

• Paranoid personality disorder: This condition is characterized by paranoia, with feelings of suspicion and mistrust of others for no reason.
• Schizoid personality disorder: Characterized by detachment and disinterest in relationships, with limited emotions when interacting socially.
• Schizotypal personality disorder: Characterized by a pattern of a limited need for, and discomfort with, close relationships.

Cluster B personality disorders

Cluster B personality disorders involve erratic and dramatic behaviors. Unstable, intense and impulsive emotions and behaviors may be displayed.

Cluster B personality disorders include:

• Antisocial personality disorder (ASPD): This condition is characterized by lack of respect to others. People with ASPD may not follow socially accepted rules and may break the law, causing emotional or physical harm to others.
• Borderline personality disorder (BPD): Characterized by impaired emotional regulation, leading to low self-esteem, impulsive behaviors, mood swings and relationship difficulties.
• Histrionic personality disorder: Leads to unstable and intense emotions. Can cause distorted self-image and feelings of self-worth, with self-esteem dependent on approval from others.
• Narcissistic personality disorder: Characterized by perceived superiority, a need for admiration and praise from others, and lack of empathy towards others. These behaviors are often caused by a lack of self-confidence and low self-esteem.

Cluster C personality disorders

Cluster C personality disorders involve severe fear and anxiety.

Cluster C personality disorders include:

• Avoidant personality disorder: Causes feelings of intense inadequacy and a sensitivity to being judged by others. People often avoid social interaction as they have a fear of rejection.
• Dependent personality disorder: Characterized by an excessive need for care by others. People seek reassurance constantly, tend to cling to one person, are people pleasers and lack the ability to make decisions.
• Obsessive-compulsive personality disorder (OCPD): OCPD is marked by an extreme need for perfectionism and control, which interferes with daily tasks and relationships. OCPD is different from obsessive-compulsive disorder (OCD), which is a type of anxiety disorder.

Who is affected by personality disorders?

Personality disorders can affect anyone, and the different types can affect people differently.

Most personality disorders develop in teenagers, when our personality matures and develops, meaning most are diagnosed in those over the age of 18. Antisocial personality disorder is an exception, with most cases showing symptoms by 11 years of ages.

More men are affected by antisocial personality disorders, while more women are affected by histrionic, dependent and borderline personality disorders.

Antisocial personality disorder and borderline personality disorder are the most frequently diagnosed.

What causes personality disorders?

Very little is known about the exact cause of personality disorders. Doctors believe several factors may contribute to their development, including:

• Genetics: A faulty gene has been identified that may contribute to obsessive-compulsive personality disorder.
• Brain changes: There are small brain differences in people who have certain personality disorders.
• Childhood trauma: There may be a link between trauma in childhood and some personality disorders.
• Cultural factors: There are varying rates of personality disorders in different countries, suggesting cultural factors may play a role.

What are the symptoms of personality disorders?

Cluster A, B and C personality disorders all have different, specific symptoms and signs. However, in general, symptoms of personality disorders include:

• Problems with identity and sense of self: Those living with a personality disorder usually lack a rationale image of themselves. This can also change depending on the situation they are in, or who they are with. Self-esteem can be extremely high or low.
• Relationship issues: Those with personality disorders often lack stable and close relationships due to their emotions and behaviors. They might lack respect or empathy, be overly needy, or be emotionally detached.
• No self-awareness: Most people with a personality disorder have no insight into how their behavior or thoughts are causing problems.

It is important to not confuse personality types or traits with personality disorders. Just because someone is shy or prefers their own company, it does not mean they have a form of personality disorder.

Other signs of a personality disorder can include:

• Frustrating, inconsistent and confusing behavior towards other people and loved ones.
• No understanding of acceptable ways to behave and treat those around them.
• An inability to recognize how their actions are causing problems.

How are personality disorders diagnosed?

The only way to confirm a personality disorder is with a diagnosis from a medical professional. They can sometimes be difficult to diagnose, as the person with the condition often doesn’t think there is a problem. Help is usually sought by a loved one.

If the person with a personality disorder does seek help, it is usually because they are experiencing depression or anxiety, or because it has affected another area of their life, such as work or marriage.

If a mental health professional thinks someone has a personality disorder, they begin by asking general questions, about things like medical history, relationships, work history and impulse control. Mental health professionals will also work with the individual’s loved ones to get an insight into their behaviors.

How are personality disorders treated?

Personality disorders are difficult to treat and there are no approved medications available to treat specific disorders. Often, the person living with the personality disorder doesn’t seek treatment as they don’t think there is a problem.

Medications and other therapies can help address the symptoms of personality disorders, such as depression and anxiety.

Psychotherapy (also called talk therapy) can help to manage personality disorders. It uses a range of treatment techniques which aim to help identify and change any problematic thoughts, emotions and behaviors.

The aims of psychotherapy include:

• Reducing immediate distress.
• Increase understanding around how problems are internal, rather than being caused by others.
• Decreasing socially unacceptable behavior.
• Adjusting personality traits which are problematic.