Personality Disorders: Frequently asked questions

What is a personality disorder? How does having a personality disorder such as obsessive-compulsive disorder, antisocial personality disorder, or paranoid personality disorder impact the brain? What are the causes? Risks? How is a personality disorder diagnosed? Read more to find the answers to your most frequently asked questions.

Personality Disorders: Frequently asked questions
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What Is A Personality Disorder?

Personality is defined as the qualities, emotions, and behaviors that make up a person’s character. When personality patterns deviate from social expectations and are considered unhealthy, it may be indicative of a personality disorder.

Personality disorders are a group of mental disorders characterized by rigid thinking and behavior. Someone with a personality disorder is unable to adequately cope with stress and relate to others. As a result, symptoms that can range from mild to severe interfere with work, relationships, and the tasks of daily functioning.

Causes and Risk Factors For Personality Disorders

A definitive cause for personality disorders has yet to be identified. However, genetics and environmental risk factors associated with the development of a number of these mental disorders.

  • Age—A personality disorder can develop at any age, but the majority of personality disorders begin during the teenage years or early adulthood.
  • Genetics and Family History— Researchers recently identified a potential genetic connection. For example, the American Psychological Association has located a mutated gene common in those with obsessive-compulsive disorder. Regardless of the type, having a family member with a personality disorder increases risk.
  • Childhood Trauma—Children who have endured parental neglect, violence, verbal or sexual abuse during childhood more often develop personality disorders, as evidenced by studies (Berenz et al., 2013)
  • Conduct Disorders—Signs of a conduct disorder are aggression, destructive behavior, and repeated lying. If untreated, children with conduct disorders are prone to other mental conditions in adulthood.

Types of Personality Disorders

Because the symptoms of personality disorders differ, experts classify the 10 personality disorders into clusters based on the behavioral patterns for easier recognition. There are 3 clusters of personality disorders: cluster A, cluster B, and cluster C. It is not uncommon to present with characteristics from multiple clusters.

Cluster A

Cluster A is the odd, eccentric cluster and affects 3-4% of the population. Paranoid premonitions, odd beliefs, and paranoia-associated social anxiety are the main signs and symptoms. These abnormal thinking and behavior patterns are typically evident even by a total stranger. Schizoid personality disorder, schizotypal personality disorder, and paranoid personality disorder belong to cluster A.

Schizoid Personality Disorder

Schizoid personality disorder is not to be confused with schizophrenia. The condition includes little emotional expression and antisocial patterns of behavior. People with schizoid personality disorder are “loners.” They do not seek close relationships or display significant emotion. Others may see them as dull, superficial, and detached because they fail to respond to social cues like facial expressions (i.e. smiles, gestures) or return efforts at conversation.  

Schizotypal Personality Disorder

Eccentricity and a reduced capacity for maintaining relationships are hallmark signs of schizotypal personality disorder. Like schizoid personality disorder, those with schizotypal personality disorder are also “loners” and experience acute anxiety in social settings. What separates schizotypal personality disorder from the other disorders in cluster A are the cognitive distortions such as seeing objects that are not there, as well as “magical thinking”—the belief that one’s thoughts or actions can influence the world. Anxiety and depression are also common manifestations.

Paranoid Personality Disorder

Paranoid personality disorder is characterized by a strong sense of paranoia or distrust of other people. Someone with the disorder assumes others are “out to get them.” They may be perceived as antisocial because they distance themselves from others out of fear of malintent. Rarely do they develop close relationships, as they hold intense grudges, are jealous, and easily threatened.

Cluster B

Cluster B is the dramatic, overly emotional cluster. The behavior of someone with a cluster B personality disorder is seen as erratic and they struggle to regulate their emotions. This causes relationship problems. Cluster B is comprised of antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Antisocial Personality Disorder

Deceit, manipulation, and a disregard for people are the predominant characteristics of antisocial personality disorder. These patients are highly aggressive and their behaviors seek to bully others. They lack impulse control, placing themselves in risky situations, and do not follow appropriate conduct. Actions such as theft, arson, and tormenting animals are common. However, they blame others for their wrong behavior. This personality disorder tends to present in childhood as a conduct disorder.

Borderline Personality Disorder

Borderline personality disorder is recognized for its white-or-black, all or nothing thinking patterns and emotional dysregulation. Those with borderline personality disorder experience rapid shifts in intense emotions. The inconsistency of their mood changes interferes with their relationships, goals, and occupations. As an effort to cope, they engage in risky, impulsive behaviors like binge eating, sexual liaisons, self-harm, and substance abuse.

Histrionic Personality Disorder

The term “histrionic” means dramatic or theatrical, which are the defining characteristics of histrionic personality disorder. People with the disorder crave attention and will go to great lengths to secure it. Their distorted self-image drives their intense desire to be noticed. To others, they are flirtatious and flamboyant—expressing exaggerated emotions that seem insincere. Their relationships are dysfunctional and they frequently behave as if their relationships are more intimate than they are because they fear to be alone. When they are not the center of attention, they become uncomfortably depressed.

Narcissistic Personality Disorder

Narcissistic personality disorder first appears as a case of extreme overconfidence. The condition is characterized by an inflated sense of self-worth, attention-seeking behavior, and superficial relationships. Someone with narcissistic personality disorder believes that they stand out from other individuals. They fantasize that they are the most talented, attractive, and successful. As they realize they possess the same limitations as everyone else, they become severely depressed. Although they display arrogance, they rely on outside admiration and judgments to boost their self-esteem, yet, their relationships are devoid of empathy, which leads to shallow, superficial relationships.

Cluster C

Cluster C is the fearful, anxious cluster. High levels of anxiety lead to excessive caution and avoidant behaviors. Avoidant personality disorder, dependent personality disorder, and obsessive-compulsive disorder make up cluster C.

Avoidant Personality Disorder

Shyness is a common personality trait that is not necessarily indicative of a mental disorder. But if shyness progresses to severe social inhibition, that is avoidant personality disorder. Avoidant personality disorder is an intense fear of social situations. People with avoidant personality disorder feel inadequate. They avoid social situations due to the anxiety that they aren’t good enough or that they will be rejected. With underdeveloped social skills, they do not have an active social life. Their relationships and professional life both suffer from the opportunities lost out of fear.

Dependent Personality Disorder

Dependent personality disorder emphasizes a strong need to be cared for by other people. Those with the condition are seen as “clingy,” constantly seeking support from others. They are especially vulnerable to abuse and manipulation, as disagreements interfere with their ever-present need for support. Rarely do they make independent decisions. They search for reassurance to quell their anxiety, panic attacks, and hopelessness when not surrounded by people. When relationships end, they immediately seek new sources of support.

Obsessive-Compulsive Personality Disorder

The features of obsessive-compulsive personality disorder are perfectionism, order, and preoccupation with rule-following to the point of neglecting social relationships. It differs from obsessive-compulsive disorder (OCD) because individuals with obsessive-compulsive personality disorder are oblivious to the flaws in their behavior and thinking. Behavior becomes so rigid that it prevents the completion of simple tasks. Someone with an obsessive-compulsive personality disorder has such a strong devotion to work that interferes with their relationships. They feel they must be responsible because if they delegate or share a task, it will not be done correctly.

Diagnosing Personality Disorders

After performing a complete medical evaluation to access symptoms and physical causes are ruled out, a physician suspecting a personality disorder refers the patient to a psychologist further evaluation. Although the symptoms of each personality disorder vary, and the disorders have their own set of diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does outline a general criterion for all personality disorders:

  1. Impairments in self-identity and interpersonal functioning
  2. One or more pathological trait domains (i.e Negative Affectivity, Detachment, Psychoticism, Antagonism, and Disinhibition) or trait facets
  3. The impairments in personality function and the individuals’ personality trait expression are stable across time and consistent across situations
  4. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental cultural environment
  5. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (i.e. drug abuse, medication) or a general medical condition (i.e. head trauma)

Personality Disorder Treatment

Personality disorders have no cure. There is no standard treatment plan. Treatment focuses on symptom management. The interventions are tailored to the type of personality disorder, the symptom severity, and any pre-existing or comorbid conditions.

Personality Disorders: Frequently asked questions
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Psychotherapy

The main treatment for personality disorders is psychotherapy, which is referred to as talk therapy. The goal of psychotherapy is to overcome problematic behaviors and to instill healthy coping skills. The patient works with a professional therapist to “talk” about unproductive thoughts, feelings, and behaviors. While psychotherapy is often just the individual and therapist, it can include a group setting with others enduring similar circumstances, family members, or a partner.

There are 4 types of psychotherapy used in the treatment of personality disorders:

  • Cognitive-behavioral therapy (CBT)—In cognitive behavioral therapy, the therapist helps the patient identify ineffective patterns of thinking that lead to problems. Cognitive restructuring, behavior modification, exposure, psychoeducation, and skills training are CBT techniques that teach patients to replace maladaptive behaviors with productive ones.
  • Dialectical behavior therapy (DBT)—Borderline personality disorder has the best outcomes with dialectical behavior therapy because it focuses on regulating emotions. The therapist assures the patient their emotions are valid to convey acceptance, but procedures such as reinforcers, cognitive modification, exposure strategies, and mindfulness trigger a change in dysfunctional behaviors.
  • Interpersonal therapy (IPT)—Interpersonal therapy concentrates on interactions between the patient and their social relationships. It targets interpersonal issues (i.e. social roles, grief, etc.) contributing to depression and is based on the idea that communication with others affects mood. Only the patient and therapist are involved in interpersonal therapy. Family members are not present in the session.
  • Family-focused therapy—Family-focused therapy is similar to interpersonal therapy, yet with family members or loved ones present. In family-focused therapy, the family received education regarding the patient’s condition and learns effective coping strategies to handle the challenges of the disorder.

Medications

No specific medications are approved to treat personality disorders. While pharmaceuticals are not the first go-to treatment, secondary mental disorders such as anxiety and depression often co-occur with personality disorders. Medications can be used to treat those symptoms.

  • Antidepressants—Antidepressants target symptoms of anger, impulsivity, and depressed mood.
  • Antipsychotics—For those out of touch with reality, antipsychotics manage the cognitive distortions and hallucinations, like in schizotypal personality disorder.
  • Antianxiety medications—Antianxiety medication relieves the anxiety felt from fear of social situations. Symptoms such as insomnia and agitation also respond to this class of medication.
  • Mood stabilizers—Mood stabilizers prevent rapid shifts in mood and emotional reactivity.

Few patients manage their symptoms with just therapy or medication alone. Medication as an adjunct therapy is proven to be the optimal treatment for personality disorders.

References

Berenz, E. C., Amstadter, A. B., Aggen, S. H., Knudsen, G. P., Reichborn-Kjennerud, T., Gardner, C. O., & Kendler, K. S. (2013). Childhood trauma and personality disorder criterion counts: a co-twin control analysis. Journal of abnormal psychology122(4), 1070–1076. https://doi.org/10.1037/a0034238

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.