Personality Disorders: Symptoms & Treatments

A personality disorder is a type of mental disorder characterized by deeply ingrained and unhealthy patterns of thinking and behaving that deviate significantly from the norms of generally acceptable behavior in the culture in which the person was raised. Symptoms typically appear by adolescence and cause long-term difficulties in personal relationships or the person’s ability to function at home, work, school, and other social settings. People who have a personality disorder often feel no guilt or regret over their behaviors. Understandably, they typically have trouble maintaining healthy long-term relationships or fully enjoying their lives.

Types of Personality Disorders

Personality disorders are grouped into three clusters based on their symptoms:

  • Cluster A: Characterized by odd or eccentric thinking and behavior, Cluster A personality disorders include:
    • Paranoid personality disorder
    • Schizoid personality disorder
    • Schizotypal personality disorder
  • Cluster B: Characterized by overly dramatic, emotional, or unpredictable thinking or behavior, Cluster B personality disorders include:
    • Antisocial personality disorder
    • Borderline personality disorder
    • Histrionic personality disorder
    • Narcissistic personality disorder
  • Cluster C: Characterized by anxious or fearful thinking and behavior, Cluster C personality disorders include:
    • Avoidant personality disorder
    • Dependent personality disorder
    • Obsessive-compulsive personality disorder

Symptoms of Personality Disorders

In the following sections, I list the symptoms of the various personality disorders, but simply exhibiting some or all of these symptoms is not sufficient for a diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), diagnostic criteria for any personality disorder include the following:

  • An enduring pattern of inner experience and behavior the deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
    • Cognition—ways of perceiving and interpreting self, other people, and events
    • Affectivity—the range, intensity, liability, and appropriateness of emotional response
    • Interpersonal functioning
    • Impulse control
  • The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
  • The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
  • The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
  • The enduring pattern is not due to the direct physiological effects of a substance (for example, drug abuse or a medication) or a general medical condition (for example, head trauma).

Cluster A Personality Disorders: Symptoms

Paranoid personality disorder

  • Pervasive distrust, without reason, of others and their motivations
  • Unjustified belief that others are “out to get you”
  • Reluctance to confide in others based on an irrational fear that they will use any information obtained from you against you
  • Perception of innocent remarks as personal insults
  • Perception of nonthreatening situations as threatening
  • Angry or hostile reaction to perceived slights or insults
  • Hypersensitivity to any degree of criticism
  • Unforgiving with a tendency to hold grudges
  • Unjustified, persistent suspicion, without reason, that a spouse or sexual partner is being unfaithful

Schizoid personality disorder

  • Strong desire to be alone and engage in solitary activities
  • Unemotional, cold, indifferent
  • Lacking any close friends or confidants
  • Infrequent participation in activities for fun or pleasure
  • Indifference to praise or criticism, affirmation or rejection
  • Inability to interpret normal social cues
  • Little or no interest in having sex with another person

Schizotypal personality disorder

  • Dressing, speaking, or acting in an odd or peculiar manner
  • Holding strange beliefs or superstitions
  • Believing you have magical powers, such as the ability to influence people and events with your mind
  • Having distorted perceptions, such as mistaking noises for voices
  • Exhibiting flat emotions or inappropriate emotional responses
  • Social anxiety, discomfort with close relationships
  • Believing that incidents or events have hidden messages intended only for you

Cluster B Personality Disorders: Symptoms

Antisocial personality disorder

  • Disregard for others’ feelings or needs and for right and wrong
  • Persistent lying, stealing, using aliases, or deceiving others
  • Aggressive, violent behavior
  • Dangerous risk-taking behavior without regard to the safety of self or others
  • Recurring problems with the law—criminal behavior
  • Impulsivity
  • Consistently irresponsible behavior such as repeatedly failing to fulfill work or financial obligations
  • Lack of empathy and remorse

Borderline personality disorder

  • Intense fear of abandonment or being alone
  • Depression—frequently feeling down, miserable, and/or hopeless or ashamed
  • Impulsive and risky behavior; for example, having unsafe sex or gambling
  • Unclear, unstable self-image often accompanied by excessive self-criticism
  • Intense and often unstable relationships
  • Up and down moods, often as a reaction to interpersonal stress
  • Suicidal thoughts and behaviors and/or self-harm
  • Persistent feelings of emptiness
  • Hostility and frequent bouts of explosive anger

Histrionic personality disorder

  • Preoccupation with physical appearance
  • Constantly seeking attention
  • Overly emotional, dramatic or sexually provocative
  • Expresses strong opinions with few facts to support them
  • Considers relationships closer than they really are
  • Easily influenced by others
  • Rapid shifts in emotions

Narcissistic personality disorder

  • Grandiose sense of self-importance
  • Delusions of grandeur related to power, success, or sexual prowess
  • Failure to recognize others’ feelings and needs
  • Needing constant praise and admiration
  • Arrogance
  • Sense of entitlement, often taking advantage of others
  • Being envious of others or believing they are envious of you

Cluster C Personality Disorders: Symptoms

Avoidant personality disorder

  • Overly sensitive to criticism or rejection
  • Few, if any close friends
  • Low self-esteem—feeling inadequate, inferior, or unattractive
  • Feeling extreme anxiety or fear in social settings and relationships
  • Avoiding jobs or activities that involve contact with others
  • Reluctance to try anything new or take chances
  • Fear of disapproval, embarrassment, or ridicule

Dependent personality disorder

  • Pervasive and excessive need to be taken care of
  • Submissive or “clingy”
  • Lack of self-confidence—struggling to make even everyday decisions without advice and reassurance from others
  • Difficulty starting or doing projects independently
  • Reluctance to disagree with others, fearing disapproval
  • Tolerance of abusive treatment, even when other options are available
  • Urgent need to start a new relationship as soon as a close one has ended

Obsessive-compulsive personality disorder

  • Preoccupation with details, rules, schedules, organization, and lists
  • Extreme perfectionism to the point of being unable to complete a project
  • A strong drive to be in control of people, tasks, and situations
  • Inability to delegate tasks
  • Excessive commitment to work or a project at the expense of relationships and leisure activities
  • Inability to discard broken or worthless objects, even those without sentimental value
  • Inflexibility and stubbornness, especially in terms of values, beliefs, or morality
  • Tight control over budgeting and spending money

Treating Personality Disorders

Treatment for personality disorders varies based on the disorder(s) the patient has, their severity, and the person’s situation. Because personality traits are deeply ingrained, intensive treatment may be required for months or even years. Psychotherapy (talk therapy) is the primary means for treating personality disorders. In some cases, medication may be helpful in treating the anxiety, depression, or irritability that may also play a role in the disorder.

Psychotherapies for Treating Personality Disorders

Certain psychotherapies have been proven to help in the treatment in personality disorders, particularly the following:

  • Cognitive behavioral therapy (CBT): With CBT, the therapist assists the patient in identifying and changing negative thinking and behavioral patterns.
  • Dialectical behavior therapy (DBT): DBT is a form of CBT that has a greater focus on emotional and social aspects. “Dialectical” refers to two opposing factors—acceptance and change. The therapist works to accept the client’s experience to reassure him or her and then work toward changing negative thought and behavioral patterns (which are unacceptable).
  • Interpersonal therapy (IPT): IPT strives to improve a client’s social functioning and interpersonal relationships through a focus on the following four areas:
    • Interpersonal deficits such as social isolation and getting involved in unfulfilling relationships
    • Unresolved grief
    • Difficult life transitions such as retirement and divorce
    • Interpersonal conflicts between partners, family members, coworkers, or close friends
  • Family-focused therapy (FFT): FFT focuses on improving relationships among family members and helping families develop the communication and problem-solving skills required to function more effectively as a team. FFT includes several types of therapy:
    • Psychoeducation
    • Communication enhancement
    • Problem-solving training

Medications for Treating Personality Disorders

No medications are available specifically to treat personality disorders, but some medications may be helpful in alleviating the anxiety, depression, irritability, and impulsivity associated with some personality disorders:

  • Antidepressants: Several classes of antidepressants are available and may be helpful in alleviating depression and irritability.
  • Mood stabilizers and anti-manic medications: Mood stabilizers, such as lithium and lamotrigine (Lamictal), may help to dial down a revved-up mind while also alleviating depression and irritability. Anti-manic medications may also be helpful in calming the mind.
  • Antipsychotic medications: Antipsychotic medications are used for much more than treating schizophrenia and other conditions that involve psychosis. They are also commonly used for their anti-manic and anti-depressive properties.
  • Anti-anxiety medications: Anti-anxiety medications can help to alleviate anxiety, agitation, and irritability and may also be used as sleep aids. However, they may increase impulsivity in some people.