8 min read
A Guide to Personality Disorders
Author
Octave Therapy
Despite the fact that personality disorders impact roughly 9% of the population, they remain highly misunderstood and stigmatized. Without understanding that their behaviors stem from an underlying disorder, many people may interpret the behaviors of those with personality disorders without having full context.
This lack of understanding perpetuates stigma and can even prevent those with a personality disorder from accessing support: according to one study, less than 40% of those with a personality disorder report having gotten any treatment for their condition in the last year.
What is a Personality Disorder?
A personality disorder is a mental health condition that significantly impacts a person’s thoughts, emotions, and behavior. These complex conditions are characterized by inflexible and pervasive patterns of thoughts that differ from societal expectations.
Unlike conditions like depression and anxiety that might present in temporary episodes during your life, personality disorders persist over time. Because they impact one’s functioning in multiple areas of life, most require long-term therapeutic treatment to address these deep-seated and persistent patterns. They usually emerge in adolescence or early adulthood, as your personality fully develops, and continue throughout life.
If you live with a personality disorder evidence-based therapeutic interventions like Cognitive-Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) can help. Modalities like these can help someone with a personality disorder process unhelpful thinking patterns, improve relationships with others, and develop coping skills.
If you have a loved one who has a personality disorder, therapy can support you in navigating the complex challenges that may arise.
The 10 Types
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes 10 personality disorders, each with unique features. They are grouped into three clusters based on similar characteristics:
Cluster A includes odd or eccentric behaviors.
Cluster B involves dramatic or erratic behaviors.
Cluster C is characterized by anxious or fearful behaviors.
Cluster A
Cluster A includes odd or eccentric behaviors.
Paranoid Personality Disorder
People with Paranoid Personality Disorder (PPD) are often highly suspicious and distrustful of other people. Someone with PPD might interpret other peoples’ actions as deliberately malevolent or harmful, whereas someone without PPD might see them as accidental or give them the benefit of the doubt. Because of their distrust of others, it’s very challenging for someone with PPD to form close connections to others.
Schizoid Personality Disorder
Schizoid Personality Disorder (SPD) often involves persistent detachment from social relationships and a limited range of emotions (also known as flat affect). Unlike schizophrenia, there are no hallucinations of delusions in SPD. Someone with SPD might seem aloof, withdrawn, or uninterested in connecting with other people.
Schizotypal Personality Disorder
Schizotypal Personality Disorder (STPD) is characterized by discomfort with close relationships, superstitious thinking patterns, and suspicious attitudes towards others. Those with STPD often have distorted views of reality and engage in behavior that others may deem eccentric. Unlike those with schizophrenia, people with STPD typically do not experience hallucinations or delusions.
Cluster B
Cluster B involves dramatic or erratic behaviors.
Histrionic Personality Disorder
People with Histrionic Personality Disorder (HPD) exhibit emotional instability and attention-seeking behavior. People with HPD are sometimes described as striving to be the center of attention, using their behavior and appearance to draw the attention of others. Those with HPD can be easily influenced by others and often engage in relationships that are characterized by high conflict.
Antisocial Personality Disorder
Antisocial Personality Disorder (ASPD) features a persistent pattern of disregard for others. Someone with ASPD might engage in deceitfulness, manipulation, impulsivity, and show a lack of remorse for causing direct harm to others.
Those with ASPD may also be more likely to engage in criminal behavior, showing a disregard for following societal norms. This pervasive disregard for other people’s well-being creates issues within social relationships, and often the legal system.
Narcissistic Personality Disorder
Narcissistic Personality Disorder (NPD) manifests as an exaggerated sense of self-importance and need for admiration from others. Those with NPD might engage in behaviors that exploit other people for their own gain or put their own needs first in a way that causes harm to others. Despite seeming confident, people with NPD typically have fragile self-esteem and can have extreme reactions to criticism.
Borderline Personality Disorder
Borderline Personality Disorder (BPD) is marked by intense and unstable relationships, emotional volatility, impulsive behaviors, and a distorted sense of self. Because there’s a strong fear of abandonment, many people with BPD are highly sensitive to interpersonal cues and engage in extreme behaviors to avoid real or perceived rejection from others.
The most common symptoms of BPD are:
Black and white thinking
Viewing things in absolutes or extremes
Seeing specific relationships as whole supportive or completely rejecting
Cluster C
Cluster C is characterized by anxious or fearful behaviors.
Obsessive-Compulsive Personality Disorder
People with Obsessive-Compulsive Personality Disorder (OCPD) tend to display a propensity for tidiness, order, and a need to control. People with OCPD tend to have very high standards for themselves and others, to the point that they can be extremely inflexible.
OCPD differs from Obsessive-Compulsive Disorder (OCD), in that those with OCPD don’t tend to experience intrusive thoughts that lead them to engage in compulsive behaviors to alleviate their anxiety.
Avoidant Personality Disorder
People with Avoidant Personality Disorder (AvPD) experience pervasive feelings of inadequacy and high levels of rejection sensitivity, leading them to withdraw socially and avoid forming relationships with others. Those with AvPD fear criticism, rejection, and disapproval, leading them to limit their interactions with others in an attempt to minimize potential rejection.
Dependent Personality Disorder
Dependent Personality Disorder (DPD) is characterized by a pervasive need for reassurance and support from others, leading to behavior that can be perceived as clingy or needy. Those with DPD often fear separation or rejection from others, and as a result may struggle with decision-making and display a high level of dependency on others for emotional and practical support. This can in turn put a strain on their social relationships.
Getting a Diagnosis
Because most personality disorders have co-occurring mental health issues like anxiety and depression, diagnosis usually happens when someone is seeking treatment for those. Diagnostic criteria are detailed in the DSM-V.
While each personality disorder has its own specific diagnostic criteria, typically someone would be evaluated based on the following criteria:
Enduring patterns of behavior that are stable over time
Impairments in functioning
Consistency across situations
Inflexibility
Duration of symptoms
Exclusion of other mental health conditions
The pattern is stable with onset in early adulthood or adolescence
Risk Factors
Risk factors include:
Genetics: Studies suggest that the heritability of Borderline Personality Disorder accounts for around 50% of a person’s risk of developing it while others have found that the heritability rate for Schizoid Personality Disorder is 30%.
Brain structure: Some research has indicated that people with Borderline Personality Disorder have heightened activation during processing of negative emotional stimuli. Other studies have found specific prefrontal brain structure correlated with narcissistic traits.
Childhood trauma: Children who had experienced verbal abuse were three times as likely as other children to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.
Demographic Differences
While people of all genders experience personality disorders, certain types tend to be more prevalent in men and women. For instance, Borderline Personality Disorder is more common in women, while Narcissistic Personality Disorder is more common in men.
Similarly, they are present among people of all races and ethnicities, but there is some evidence that personality disorders are underdiagnosed and under-treated among BIPOC populations.
Types of Treatment
Although personality disorders can be challenging to treat, there are ways to manage the symptoms for those living with personality disorders.
Seek Specialized Therapists
Therapists who have experience treating people with personality disorders, or supporting loved ones who have relationships with someone with a personality disorder, are experts in navigating the complex challenges these disorders present. Their specialized knowledge enables them to tailor interventions that address the unique needs of each individual, fostering a more effective path to healing and improved well-being.
Consider Medication With the Support of a Psychiatrist
There are several types of psychiatric medications that can reduce the intensity of symptoms like antidepressants, mood stabilizers, and antipsychotic medications. While research is limited on psychiatric medication effectiveness, some studies suggest that using medication in addition to psychotherapy has been proven to have positive outcomes for patients.
Develop Your Own Set of Coping Skills
While there is no cure for a personality disorder, there are various ways you can cope with the symptoms like joining a support group, practicing relaxation strategies, avoiding substances, and staying active.
