Personality disorders

People have unique personalities made up of a complex combination of different traits. Personality traits affect how people understand and relate to the world around them, as well as how they see themselves.

Ideally, people's personality traits allow them to flexibly adapt to their changing environment in ways that lead to more healthy relationships with others and better coping strategies. When people have personality traits that are less adaptive, this leads to inflexibility and unhealthy coping. For example, they may manage stress by drinking or misusing drugs, have a hard time managing their anger, and find it hard to trust and connect with others.

Personality forms early in life. It is shaped through a blend of your:

• Genes — Your parents may pass down some personality traits to you. Sometimes these traits are called your temperament.
• Environment — This includes your surroundings, events that have happened to you and around you, and relationships and patterns of interactions with family members and others.

A personality disorder is a mental health condition where people have a lifelong pattern of seeing themselves and reacting to others in ways that cause problems. People with personality disorders often have a hard time understanding emotions and tolerating distress. And they act impulsively. This makes it hard for them to relate to others, causing serious issues, and affecting their family life, social activities, work and school performance, and overall quality of life.

In some cases, you may not know that you have a personality disorder. That's because how you think and behave seems natural to you. You also may think others are responsible for your challenges.

There are many types of personality disorders, each with important differences. These disorders are organized into three groups, or clusters, with shared features and symptoms:

Group A personality disorders

Group A personality disorders have a consistently dysfunctional pattern of thinking and behavior that reflects suspicion or lack of interest in others. They include:

Paranoid personality disorder

• Lacks trust and is suspicious of others and the reasons for their actions.
• Believes that others are trying to do harm with no reason to feel this way.
• Doubts the loyalty of others.
• Is not willing to trust others.
• Hesitates to confide in others for fear that others will use that information against them.
• Takes innocent remarks or situations that are not threatening as personal insults or attacks.
• Becomes angry or hostile to what are believed to be slights or insults.
• Has a habit of holding grudges.
• Often suspects that a spouse or sexual partner is unfaithful with no reason to feel this way.

Schizoid personality disorder

• Appears to be cold to or not interested in others.
• Almost always chooses to be alone.
• Is limited in how emotions are expressed.
• Cannot take pleasure in most activities.
• Cannot pick up typical social cues.
• Has little to no interest in having sex with another person.

Schizotypal personality disorder

• Has unusual thinking, beliefs, speech or behavior.
• Feels or thinks strange things, such as hearing a voice whisper their name.
• Has flat emotions or emotional responses that are socially unusual.
• Has social anxiety, including not being comfortable making close connections with others or not having close relationships.
• Responds to others in ways that are not proper or shows suspicion or lack of interest.
• Has "magical thinking"— the belief that their thoughts can affect other people and events.
• Believes that some casual incidents or events have hidden messages.

Group B personality disorders

Group B personality disorders have a consistently dysfunctional pattern of dramatic, overly emotional thinking or unpredictable behavior. They include:

Borderline personality disorder

• Has a strong fear of being alone or abandoned.
• Has ongoing feelings of emptiness.
• Sees self as being unstable or weak.
• Has deep relationships that are not stable.
• Has up and down moods, often due to stress when interacting with others.
• Threatens self-harm or behaves in ways that could lead to suicide.
• Is often very angry.
• Shows impulsive and risky behavior, such as having unsafe sex, gambling or binge eating.
• Has stress-related paranoia that comes and goes.

Histrionic personality disorder

• Always seeks attention.
• Is overly emotional or dramatic or stirs up sexual feelings to get attention.
• Speaks dramatically with strong opinions but has few facts or details to back them up.
• Is easily led by others.
• Has shallow emotions that change quickly.
• Is very concerned with physical appearance.
• Thinks relationships with others are closer than they are.

Narcissistic personality disorder

• Has beliefs about being special and more important than others.
• Has fantasies about power, success and being attractive to others.
• Does not understand the needs and feelings of others.
• Stretches the truth about achievements or talents.
• Expects constant praise and wants to be admired.
• Feels superior to others and brags about it.
• Expects favors and advantages without a good reason.
• Often takes advantage of others.
• Is jealous of others or believes that others are jealous of them.

Antisocial personality disorder

• Has little, if any, concern for the needs or feelings of others.
• Often lies, steals, uses false names and cons others.
• Has repeated run-ins with the law.
• Often violates the rights of others.
• Is aggressive and often violent.
• Has little, if any, concern for personal safety or the safety of others.
• Behaves impulsively.
• Is often reckless.
• Has little, if any, regret for how their behavior negatively affects others.

Group C personality disorders

Group C personality disorders have a consistently dysfunctional pattern of anxious thinking or behavior. They include:

Avoidant personality disorder

• Is very sensitive to criticism or rejection.
• Does not feel good enough, important or attractive.
• Does not take part in work activities that include contact with others.
• Is isolated.
• Does not try new activities and does not like meeting new people.
• Is extremely shy in social settings and in dealing with others.
• Fears disapproval, embarrassment or being made fun of.

Dependent personality disorder

• Relies on others too much and feels the need to be taken care of.
• Is submissive or clingy toward others.
• Fears having to take care of self if left alone.
• Lacks confidence in abilities.
• Needs a lot of advice and comforting from others to make even small decisions.
• Finds it hard to start or do projects due to lack of self-confidence.
• Finds it hard to disagree with others, fearing they will not approve.
• Endures poor treatment or abuse, even when other options are available.
• Has an urgent need to start a new relationship when a close one ends.

Obsessive-compulsive personality disorder

• Focuses too much on details, orderliness and rules.
• Thinks everything needs to be perfect and gets upset when perfection is not achieved.
• Cannot finish a project because reaching perfection is not possible.
• Needs to be in control of people, tasks and situations.
• Cannot assign tasks to others.
• Ignores friends and enjoyable activities because of too much focus on work or a project.
• Cannot throw away broken or worthless objects.
• Is rigid and stubborn.
• Is not flexible about morality, ethics or values.
• Holds very tight control over budgeting and spending money.

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, which is an anxiety disorder.

Many people with one type of personality disorder also have symptoms of at least one other type. The number of symptoms a person has may vary.

When to see a doctor

If you have any symptoms of a personality disorder, see your doctor or a mental health professional. When personality disorders are not treated, they can cause serious issues in relationships and mood. Also, the ability to function and pursue personal goals may get worse without treatment.

It's believed that personality disorders are caused by a blend of how genetics and your environment affect you. Your genes may make it more likely that you develop a personality disorder, and what happens to you in life may set a personality disorder into motion.

Although the specific causes of personality disorders are not known, some factors seem to increase the risk of having one:

• Specific personality traits. This includes always trying to stay away from harm, or the opposite — a strong need to seek out new activities that get the adrenaline pumping. It also includes poor impulse control.
• Early life experiences. This includes a home environment that is not stable, predictable or supportive. It also includes a history of trauma — physical neglect or abuse, emotional neglect or abuse, or sexual abuse.

Personality disorders can seriously disrupt your life and the lives of those who care about you. They may cause issues in relationships, work or school. And they can lead to social isolation, other mental health issues with addictions, as well as occupational and legal issues.

Finding out if you have a personality disorder may involve:

• A physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, your doctor may link your symptoms to an underlying physical health concern. Your evaluation may include lab tests and a screening test for alcohol and drugs.
• A mental health evaluation. Your doctor may refer you to a mental health professional. This evaluation includes a discussion about your thoughts, feelings and behavior, and it may include a questionnaire to help pinpoint a diagnosis. With your permission, information from family members or others may help.
• Comparing your symptoms to standard guidelines. Your mental health professional may compare your symptoms to the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association.
• Neuropsychological testing. Your doctor may refer you to a neuropsychologist or clinical psychologist for personality or cognitive testing to better understand how you see and interpret the world around you.

Sometimes it's hard to find out the type of personality disorder because there's a lot of overlap between types of personality disorders. Other mental health conditions, such as depression, anxiety, post-traumatic stress disorder, eating disorders or substance abuse, may make it harder to know which personality disorder a person has or if a person has a personality disorder at all. It's worth the time and effort to get a correct diagnosis so that you get the proper treatment.

The treatment that's best for you depends on your personality disorder, how serious it is and your life situation. Often, a team approach is needed to meet your mental, medical and social needs. You may need to be treated for months or years.

Your treatment team may include your doctor and a:

• Psychiatrist.
• Psychologist or another therapist.
• Psychiatric nurse.
• Pharmacist.
• Social worker.

Dialectical behavioral therapy, a form of psychotherapy that also is known as talk therapy, is the main way to treat personality disorders. Medicines also may be used during treatment.

Dialectical behavioral therapy

Dialectical behavioral therapy (DBT), a form of talk therapy, is used to treat personality disorders. This therapy focuses on treating dangerous behavior, including behavior that can lead to suicide, as well as behavior that can get in the way of treatment or affect quality of life.

DBT consists of weekly one-on-one sessions with a therapist. Treatment can last for about a year.

Therapists treating patients using DBT regularly attend a consultation group where they talk about issues related to treatment. DBT therapists also are available by phone or other means so they can provide coaching to help make sure that treatment talked about during sessions is applied in real life.

This therapy also includes modules on:

• Controlling your emotions.
• Handling distress.
• Practicing mindfulness.
• Effectively relating with other people.

This therapy has been shown to be effective for adolescents and adults, but a group certified in DBT is essential.

Medicines

The Food and Drug Administration (FDA) has not approved any medicines to treat personality disorders specifically. But several types of psychiatric medicines may help with personality disorder symptoms:

• Antidepressants. Antidepressants may help if you feel depressed, angry, impulsive, irritable or hopeless. These symptoms may be related to personality disorders.
• Mood stabilizers. These medicines can even out mood swings or reduce how irritable, impulsive and aggressive you are.
• Antipsychotic medications. These medicines, also called neuroleptics, may help if your symptoms include losing touch with reality. This is known as psychosis. They also may help with some anxiety or anger issues.
• Anti-anxiety medications. These medicines may help if you are anxious, agitated or cannot sleep. But in some cases, they can make you more impulsive. That's why they are not used with some types of personality disorders.

Hospital and residential treatment programs

In some cases, a personality disorder may be so serious that you need to stay in a hospital for mental health care. This is generally recommended only when you cannot care for yourself properly or when you're in immediate danger of harming yourself or someone else. After you become stable in the hospital, your mental health professional may recommend a day hospital program, residential program or outpatient treatment.

Along with your treatment plan, it's also important to:

• Take part in your care. This can help you manage your personality disorder. Do not skip therapy sessions, even if you do not feel like going. Therapy can take 6 to 12 months. Think about your goals for treatment and work toward achieving them.
• Take your medicines as directed. Even if you're feeling well, do not skip your medicines. If you stop, your symptoms may come back. You also could experience withdrawal-like symptoms from stopping a medicine too quickly.
• Learn about your condition. Knowing more about your condition can motivate you to follow your treatment plan.
• Get active. Physical activity can help manage many symptoms such as depression, stress and anxiety. You can walk, jog, swim or garden — or take up another form of physical activity that you enjoy.
• Stay away from drugs and alcohol. Alcohol and street drugs can make personality disorder symptoms worse or affect how a medicine works.
• Get routine medical care. Do not ignore checkups or skip visits to your doctor, especially if you are not feeling well. You may have a new health concern that needs to be discussed, or you may be feeling the side effects of a medicine.

Having a personality disorder makes it hard to take actions that may help you feel better. Doctors or mental health professionals can help you learn better coping skills and get the support you need.

If your loved one has a personality disorder

If you have a loved one with a personality disorder, work with their mental health professional to find out how you can offer support and encouragement.

You also may benefit from talking with a mental health professional about your worries. A mental health professional can help you set limits and learn ways to care for yourself so that you can enjoy life more.

Because personality disorders often need care from a specialist, your doctor may refer you to a mental health professional, such as a psychiatrist or psychologist. Taking a family member or friend along can help you remember something that you might have missed or forgot.

What you can do

Prepare for your appointment by making a list of:

• Your symptoms, including any that do not seem to be related to the reason for the appointment.
• Key personal information, including any major stresses or recent life changes.
• All medicines, including medicines available without a prescription, vitamins, herbal preparations or other supplements that you take — and the doses.
• Questions to ask your doctor or mental health professional.

Basic questions to ask your doctor include:

• What type of personality disorder do I have?
• How do you treat my type of personality disorder?
• Will talk therapy help?
• Can medicines help?
• How long will I need to take medicine?
• What are the major side effects of the medicines you're recommending?
• How long will treatment take?
• What can I do to help myself?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend visiting?

Do not hesitate to ask any other questions during your appointment.

What to expect from your doctor

During your appointment, your doctor or mental health professional will likely ask you several questions about your mood, thoughts, behavior and urges, such as:

• What symptoms have you noticed or have others said they notice in you?
• When did you or they first notice symptoms?
• How do your symptoms affect your daily life?
• What other treatment, if any, have you had?
• What have you tried on your own to feel better or control your symptoms?
• What things make you feel worse?
• Have your family members or friends made any comments about your mood or behavior?
• Have any relatives had mental health conditions?
• What do you hope to gain from treatment?
• What medicines, vitamins, herbs or supplements do you take?