Personality Disorders Articles

 Medically reviewed by Julie Dodson, MA, LCSW

According to the National Institute of Mental Health, personality disorders directly affect approximately 9.1% of the population. There are 10 personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and they can all affect people in unique ways. In general, personality disorders tend to affect people’s sense of self and their relationships with others. People who live with a personality disorder may have no understanding of how their condition affects them. Understanding the symptoms and individual manifestations may lead to more detection and better outcomes for those living with personality disorders.

Personality disorders: Definition and summary

According to the DSM-5, to be diagnosed with a personality disorder, a person must have a persistent way of thinking and behaving that is different from the norm and that causes distress or difficulty functioning. People living with personality disorders may engage in black-and-white thinking in line with their internalized beliefs (which may be influenced by the disorder), which can lead to difficulty seeing matters from others’ points of view. 

As a result, an individual with a personality disorder may find that they have difficulty relating to others in social situations and may demonstrate difficulty maintaining healthy boundaries at times. They may also experience challenges maintaining healthy long-term relationships and connecting to people. Manifestations of personality disorders and subsequent effects can vary by every individual’s lived experience.  

Some people might be in denial that they could have a personality disorder, or they may not be fully aware of their symptomatic presentation. In either case, if no diagnosis or treatment is sought, they may not get adequate support. 

Most personality disorders manifest in the teen years as a person’s personality further develops. Researchers don’t fully understand the cause of personality disorders, but they are believed to be caused by genetics, brain changes, childhood trauma, verbal abuse, or cultural factors. 

Getting a diagnosis

There are three different recognized categories of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A psychological evaluation conducted by a mental health professional may help you determine if you are experiencing symptoms of a personality disorder. Once you receive a diagnosis, you can learn what your treatment options are and begin addressing your symptoms. In many cases, treatment may involve different types of therapy, supplemental support from medication, or a combination of both.

Types of personality disorders

Personality disorders are grouped into three categories: Cluster A, Cluster B, and Cluster C. The personality disorders in each cluster share some characteristics but have unique diagnostic criteria.

Cluster A

Individuals with Cluster A personality disorders may display eccentric or strange behaviors that differ from societal norms. As a result, their actions might appear odd to the average observer. The Cluster A personality disorders are paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Paranoid personality disorder

Symptoms of this disorder can include:

• Marked feelings of distrust of others
• Persistent beliefs that others are trying to harm or deceive them
• Angry or hostile reactions to perceived slights or insults
• Predispositions that may prompt grudges
• Persistent beliefs that a partner is unfaithful, regardless of whether there is evidence confirming or denying the supposition 

Schizoid personality disorder

Symptoms of schizoid personality disorder can include:

• Little to no interest in relationships
• Stoic or cold expressions when communicating with others
• Limited expression of emotions

Schizotypal personality disorder

While these conditions may sound similar, there are marked differences between schizoid and schizotypal personality disorders. Symptoms of schizotypal personality disorder may include:

• Discomfort with personal relationships (as opposed to disinterest, as manifested in schizoid personality disorder)
• Auditory hallucinations
• The belief that the individual can influence major events by thinking about them, otherwise known as “magical thinking”
• Eccentric thinking or way of dressing
• Social nervousness or comorbid social anxiety disorder
• The belief that there are hidden messages for the individual in certain events, occurrences, or moments in their daily life

Cluster B

Cluster B personality disorders are generally characterized by intensely emotional behavior and related emotionally based symptoms. Their behavior may appear unpredictable and turn volatile if left untreated. The Cluster B personality disorders are antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Antisocial personality disorder

• Generalized lack of care or concern for other people’s feelings
• Frequent lying, cheating, or stealing
• Violent behaviors or thought processes 
• Impulsivity
• Lack of personal responsibility for one’s actions

Borderline personality disorder

Symptoms of borderline personality disorder may include:

• Fear of abandonment
• Risky behavior
• Unstable or fluctuating self-image
• Volatile or unstable interpersonal relationships
• Frequent mood swings
• Suicidal ideation or active suicide attempts
• Self-harm
• Outbursts of anger

Histrionic personality disorder

Histrionic personality disorder is considered rare and is estimated to affect 1% of the population. Symptoms of histrionic personality disorder can include:

• Persistent attention-seeking behavior
• Provocative displays, including overtly sexual behavior
• Overly dramatic speech or regular engagement in attention-seeking conversation
• A tendency to be easily swayed by other people’s opinions
• Mood swings that can change quickly within minutes or hours
• Preoccupation with physical appearance

Narcissistic personality disorder

Symptoms of narcissistic personality disorder can include:

• A fundamental belief of one’s superiority to others
• Preoccupation with high achievement and fame
• Inability to acknowledge other people’s emotions
• Inaccurate or grandiose perception of self and accomplishments
• A need for ongoing praise and validation for accomplishments
• A tendency to manipulate others for personal gain

Cluster C

The Cluster C personality disorders are generally categorized as conditions in which a person tends to be anxious and engage in behaviors due to fear. Cluster C includes avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.

Avoidant personality disorder

Symptoms of avoidant personality disorder can include:

• High sensitivity to criticism or rejection compared to age group peers
• Feelings of inadequacy in one’s sense of self or physical appearance
• Social isolation and fear of meeting new people
• Excessive shyness or introversion 
• Ongoing fear of being mocked or having their choices disapproved by others

Dependent personality disorder

Dependent personality disorder is considered rare. According to the Cleveland Clinic, it affects less than 1% of the adult population. Symptoms of dependent personality disorder can include:

• Feelings of “neediness” toward loved ones 
• Fear of being alone and caring for oneself
• Lack of self-esteem or self-worth
• A tendency to avoid responsibility

Obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder is generally characterized by a preoccupation with order and perfectionism. Symptoms of obsessive-compulsive personality disorder can include:

• Obsession with minute details
• Strong tendency toward perfectionism to the point of taking extreme measures to achieve goals
• Problems with relinquishing control or letting other people have the lead
• A tendency to overwork and neglect social activities
• Unwavering or rigid opinions 
• Extreme frugality with money
• Feelings of nervousness and frustration 
• Inclination to engage in compulsions

How can online therapy help those experiencing personality disorders? 

When a person is experiencing symptoms of a personality disorder, it may be difficult to confidently leave the home to seek care in an office setting. In these cases, online therapy can allow a person to get help from the comfort of their home. With online therapy, individuals with a personality disorder can communicate with a therapist in a way that’s most comfortable for them, whether by audio, video, or live chat. With online therapy, they may learn to identify inaccurate or problematic thoughts and replace them with positive thoughts, which may lead to better relationships. 

Effectiveness of online therapy

Online therapy has been shown to be effective for a variety of mental health conditions. One study published in 2017 found that online therapy was effective for generalized anxiety disorder, social anxiety, depression, bipolar disorder, and substance use disorder, among other conditions.  

Takeaway 

Personality disorders can affect people from all walks of life, and those affected may not realize the way their condition affects them and their relationships. There are treatments available for personality disorders, including various forms of therapy, depending on the specific disorder a person experiences. If you think you may be manifesting symptoms of a personality disorder, you may benefit from speaking with a licensed counselor, whether in your community or online. With BetterHelp, you can be matched with a therapist who has experience treating people who live with a personality disorder. Take the first step toward getting support and contact BetterHelp today.