Personality Disorders

Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair an individuals’s ability to function.

• There are 10 types of personality disorders, and each has characteristic problems with self-image and patterns of response to others and to stressful events.
• Symptoms are different depending on the type of personality disorder, but in general, individuals have difficulty relating to others and handling stress and/or have a self-image that varies depending on the situation and that differs from how others perceive them.
• Medical professionals consider diagnosing a personality disorder when individuals persistently view themselves or others in ways that differ from reality or when they continue to act in ways that routinely have negative consequences.
• Drugs usually do not change personality disorders but may help lessen distressing symptoms.
• Psychotherapy may help the individual become aware of their role in creating their problems and help them change their socially undesirable behaviour.

Everyone has characteristic patterns of perceiving and relating to other people and stressful events (called response patterns). For example:

• Some individuals respond to a troubling situation by seeking someone else’s help.
• Others prefer to deal with problems on their own.
• Some individuals minimise problems.
• Others exaggerate them.

However, if their characteristic patterns of behaviour are ineffective or have negative consequences, most individuals are likely to try to change their response patterns.

In contrast, individuals with a personality disorder do not change their response patterns even when these patterns are repeatedly ineffective and the consequences are negative.

Such patterns are called maladaptive because the individual does not adjust (adapt) as circumstances require. Maladaptive patterns vary in how severe they are and how long they persist.

There are 10 types of personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association.

About 10% of individuals have a personality disorder.

These disorders usually affect men and women equally, although some types of personality disorder affect one sex more than the other.

For example, antisocial personality disorder is 6 times more common among men.

For most individuals with a personality disorder, the disorder causes moderate problems and lessens over time. However, some individuals have severe social and psychologic problems that last a lifetime.

Personality disorders usually appear during late adolescence or early adulthood, but they may appear earlier (during childhood).

How long they last varies greatly. Some types of personality disorders (such as antisocial or borderline) tend to lessen or resolve as people age. Others (such as obsessive-compulsive or schizotypal) are less likely to do so. In some individuals, symptoms may continue, but they are less severe.

Many individuals with a personality disorder also have one or more of the following:

Many people with a personality disorder also have one or more of the following:

• A mood disorder.
• An anxiety disorder.
• Somatic symptom disorder.
• A substance use disorder.
• An eating disorder.

Having a personality disorder and one of these other disorders makes people less likely to respond to treatment for either disorder and thus worsens their prognosis.

Causes

Personality disorders result from the interaction of genes and environment.

That is, some individuals are born with a genetic tendency to have a personality disorder, and this tendency is then suppressed or enhanced by environmental factors.

Generally, genes and environment contribute about equally to the development of personality disorders.

Types of Personality Disorders

The 10 types of personality disorders can be grouped into three clusters (A, B, and C).

The types in each cluster share certain basic personality traits, but each disorder has its own distinguishing features.

Cluster A

Cluster A is characterised by appearing odd or eccentric.

It includes the following personality disorders, each with its distinguishing features:

• Paranoid: Mistrust and suspicion.
• Schizoid: Disinterest in others.
• Schizotypal: Odd or eccentric ideas and behaviour.

Cluster B

Cluster B is characterised by appearing dramatic, emotional, or erratic.

It includes the following personality disorders, each with its distinguishing features:

• Antisocial: Social irresponsibility, disregard for others, and deceitfulness and manipulation of others for personal gain.
• Borderline: Problems with being alone (due to fear of being abandoned), problems controlling emotions, and impulsive behaviour.
• Histrionic: Attention seeking and dramatic behaviour.
• Narcissistic: Fragile self-esteem, a need to be admired, and an inflated view of self-worth (called grandiosity).

Cluster C

Cluster C is characterised by appearing anxious or fearful.

It includes the following personality disorders, each with its distinguishing features:

• Avoidant: Avoidance of interpersonal contact due to fear of rejection.
• Dependent: Submissiveness and dependency (due to a need to be taken care of).
• Obsessive-compulsive: Perfectionism, rigidity, and obstinacy.