21st Dec 2022
A personality disorder is a mental health condition categorized by an inability to tolerate stressful and emotionally challenging situations, causing unhelpful thoughts and behaviors that impact interpersonal relationships, school or work, and daily functioning. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , there are 10 types of personality disorder with varying symptoms, which are grouped, depending on their similarities, into three clusters.
Cluster A symptoms and behaviors are categorized as eccentric, odd, and distrustful. Although these types include disordered thinking, psychosis is not present.
Symptoms of paranoid personality disorder include :
Symptoms of schizoid personality disorder include :
Symptoms of schizotypal personality disorder include :
Cluster B symptoms and behaviors are categorized as dramatic, emotional, and impulsive.
Symptoms of antisocial personality disorder include :
Symptoms of borderline personality disorder include :
Symptoms of histrionic personality disorder include :
Symptoms of narcissistic personality disorder include :
Cluster C symptoms and behaviors are categorized as anxious and fearful.
Symptoms of avoidant personality disorder include :
Symptoms of dependent personality disorder include :
Symptoms of obsessive-compulsive personality disorder include :
Although the impact of genetics on the development of a personality disorder is not completely understood, there is a belief that genes can contribute. For example, some research has found links in family members with personality disorders in the genes that impact the neurotransmitters serotonin, dopamine, and norepinephrine, which aid in mood regulation .
Several people with personality disorders have a parent with a similar diagnosis, which suggests there is a genetic link, but this may be due to upbringing rather than genes . It is widely accepted that further research is required in this area, to better understand the genetic factors involved.
Many social and environmental factors can increase the risk of developing a personality disorder, including poverty and poor education .
Cultural factors may also impact this risk, as indicated by the fact that the prevalence of personality disorders differs in countries around the world.
Growing up in a home with volatile interpersonal dynamics, or with a parent who has a mental health condition or substance use disorder, can increase the risk of developing a personality disorder.
Experiencing sexual, physical, or emotional abuse, neglect, or a traumatic event in childhood has been shown to greatly increase the risk of personality disorders .
Age can be a risk factor in developing a personality disorder as, typically, they will emerge in adolescence and may reduce in severity with age. However, while symptoms of antisocial and borderline personality disorder typically get better with age, this may not apply to other personality disorders.
Gender is also a factor, as the prevalence of certain types of personality disorder differ between males and females. For example, antisocial personality disorder is more likely to be diagnosed in males, while borderline, histrionic, and dependent personality disorders are more likely to be diagnosed in females .
Personality disorders can be very challenging to diagnose, as the various symptoms can be similar to several other mental health conditions, including depression, anxiety disorders, bipolar disorder, and schizophrenia or psychosis. The presenting symptoms may also overlap criteria of more than one personality disorder type, making a specific diagnosis more challenging.
As such, when attempting to diagnose a personality disorder, a doctor or mental health professional will try to gather as much information as possible, to give them a clear understanding of the individual’s symptoms and lifestyle .
They will gather a full history of mental and physical health conditions within the individual and their family, potentially requesting information from family members, healthcare professionals who have previously been involved, and police, if criminal behavior has been observed.
The doctor will ask the individual to explain the symptoms and emotional changes they may have experienced, with a view to gather an understanding of how well they are able to regulate their emotional and behavioral responses to certain situations, including whether they have experienced any thoughts or behaviors of harming themselves or others.
The doctor will ask several questions to try and gain an understanding of the individual’s views of themselves, reality, their relationships, their professional life, and any other aspects of their daily life, while determining how their symptoms may have affected these areas of their life.
With the information they have gathered, the doctor will then use the diagnostic criteria in the DSM-5  to make a diagnosis, thereby informing how treatment should be administered.
Therapeutic interventions, either alone or alongside medication, are generally the most effective treatment for most personality disorders .
However, this requires commitment and attendance, which can be challenging, particularly for those with narcissistic personality disorder, who may question or refuse this treatment, or Cluster A types, who may be suspicious or untrusting.
As such, the development of a therapeutic relationship is crucial to positive and effective treatment, which may require differing strategies for each personality disorder type and each individual.
Individual psychotherapy can be helpful for all types, in understanding and dealing with the underlying causes of the disorder and reducing any trust issues, anxieties, or aggression that may be present.
Group therapy can be helpful, particularly for Cluster B types, but may not be appropriate for Clusters A and C, due to their respective trust and social anxiety issues.
Cognitive behavioral therapy (CBT) can help to reduce negative thoughts and the associated harmful or aggressive behaviors, and increase confidence and independence.
Dialectical behavior therapy (DBT) is a therapy based on CBT, specifically designed to treat borderline personality disorder, and is considered the most effective treatment for this type .
There are no approved medications for the treatment of personality disorders, but medication may be prescribed to reduce certain symptoms.
For example, antipsychotic medication may be prescribed to treat certain personality disorders, to reduce disordered thinking or impulsivity , while antidepressant medication, particularly selective serotonin reuptake inhibitors (SSRIs), might be prescribed to reduce feelings of depression and anxiety .