Personality Disorder: Masterpost
What are personality disorders? How many are there? If you need help to self dx or are just curious as I was while researching this, I hope this post helps you.
Personality Disorders: An Overview
Each of us has a unique personality made up of traits that come from both our genetic make-up and our life experiences and is a vital part of what makes us who we are and how we interact with others.
A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving certain things, such as relationships, people in general and emotions. However, that does not make you dumb, broken or worse.
Personality disorders usually become noticeable in adolescence or early
adulthood, but sometimes start in childhood. They can make it difficult
for those affected to start and keep friendships or other relationships, and they may
find it hard to work effectively with others. They may find other people very
scary, and feel very alienated and alone.
In general, individuals with personality disorders may have difficulty sustaining close or intimate
relationships. They may experience chronic interpersonal problems, or have difficulties in
establishing a coherent sense of self or identity. Others may perceive them to be impulsive,
irritable, fearful, demanding, hostile, manipulative, or even violent.
Problem alcohol or drug use, mood disorders, certain anxiety or eating disorders, self-harm,
suicidal thoughts or attempts, and sexual problems often accompany personality disorder.
The diagnosis applies if you have personality difficulties which affect all
aspects of your life, all the time, and make life difficult for you and for
those around you.
The different types of personality disorders
Psychiatrists in the UK tend to use an American system of diagnosis which identifies 10 different types of personality disorder. These types can be grouped into three categories, which are usually called ‘clusters’:
Suspicious ♦ - Cluster A (
odd, eccentric )
The common features of the personality disorders in this cluster are social awkwardness and social withdrawal. These disorders are dominated by distorted thinking.
♦ Emotional and impulsive ♦ - Cluster B ( dramatic, emotional, and erratic )
Disorders in this cluster share problems with impulse control and emotional regulation.
♦ Anxious ♦ - Cluster C
- obsessive compulsive
One person may meet the criteria for several different types of personality disorder, while a wide range of people may fit the criteria for the same disorder, despite having very different personalities.
Quick overview of all the different personality disorders
••Antisocial personality disorder (ASPD)••
This is characterised by a lack of regard for the rights and feelings of others, and a lack of
remorse for actions that may hurt others. People with this diagnosis frequently ignore social
norms of acceptable behaviour; they may disregard rules and break the law. Consequently, if
you have this diagnosis you may also have a criminal record; you may also have problem drug
or alcohol use. Sadly, this kind of behaviour is also likely to result in difficulties in relationships,
with rejection (given or received) a major feature.
Antisocial personality disorder signs and symptoms may include:
- Disregard for right and wrong
- Persistent lying or deceit to exploit others
- Being callous, cynical and disrespectful of others
- Using charm or wit to manipulate others for personal gain or personal pleasure
- Arrogance, a sense of superiority and being extremely opinionated
- Recurring problems with the law, including criminal behavior
- Repeatedly violating the rights of others through intimidation and dishonestyImpulsiveness or failure to plan ahead
- Hostility, significant irritability, agitation, aggression or violence
- Lack of empathy for others and lack of remorse about harming others
- Unnecessary risk-taking or dangerous behavior with no regard for the safety of self or others
- Poor or abusive relationships
- Failure to consider the negative consequences of behavior or learn from them
- Being consistently irresponsible and repeatedly failing to fulfill work or financial obligations
Adults with antisocial personality disorder typically show symptoms of conduct disorder before the age of 15.
Cognitive therapy — first developed to help patients with depression — has recently been applied to ASP.
No medications are routinely used or specifically approved for ASP treatment. Several drugs, however, have been shown to reduce aggression, a common problem for many antisocials.The best-documented medication is lithium carbonate, which has been found to reduce anger, threatening behavior and combativeness among prisoners. More recently, the drug was shown to reduce behaviors such as bullying, fighting and temper outbursts in aggressive children.Phenytoin (Dilantin), an anticonvulsant, has also been shown to reduce impulsive aggression in prison settings.Other drugs have been used to treat aggression primarily in brain-injured or mentally retarded patients. These include carbamazepine, valproate, propranolol, buspirone and trazodone. Antipsychotic medications also have been studied in similar populations. They may deter aggression, but potentially induce irreversible side effects. Tranquilizers from the benzodiazepine class should not be used to treat people with ASP because they are potentially addictive and may lead to loss of behavioral control.
••Avoidant (anxious) personality disorder••
Typically, a person with this diagnosis fears being judged negatively by others, leading to
feelings of discomfort in group or social settings. You may come across as being socially
withdrawn, a ‘loner’. Fear and anxiety may mean that you have difficulty in holding down a job,
as well as experiencing difficulties in relationships.
This can be very painful for you as you can feel lonely and isolated, while at the same time,
fearful of those relationships and situations that might make you feel more included and
engaged with a community or circle of family or friends.
You are likely to:
- avoid work or social activities that mean you must be with others
- expect disapproval and criticism and be very sensitive to it
- worry constantly about being ‘found out’ and rejected
- worry about being ridiculed or shamed by others
- avoid relationships, friendships and intimacy because you fear rejection
- feel lonely and isolated, and inferior to others
- be reluctant to try new activities in case you embarrass yourself.
People with avoidant personality disorder experience long-standing feelings of inadequacy and are extremely sensitive to what others think about them. These feelings of inadequacy leads to the person to be socially inhibited and feel socially inept. Because of these feelings of inadequacy and inhibition, the person with avoidant personality disorder will seek to avoid work, school and any activities that involve socializing or interacting with others.
Treatment of avoidant personality disorder typically involves psychotherapy with a therapist that has experience in treating this kind of personality disorder.
Anti-anxiety agents and antidepressants should be prescribed for avoidant PD only when another psychiatric problem co-occurs (e.g., anxiety or depression).
••Borderline personality disorder (BPD)••
This is the most commonly diagnosed personality disorder. The term borderline originally
referred to symptoms being on the borderline between psychosis and neurosis. Typically, with a
diagnosis of BPD, you are likely to have a poor self-image and unstable personal relationships,
which are likely to result from mood swings that may involve angry outbursts, which tend to drive
people away. Conversely, you may find it difficult to break away from damaging relationships as
you are frightened of being alone.
Others may find it difficult to relate to you, as your response tends to be unpredictable, or people
may be afraid of your anger. While seeking contact and support with others, you may also be
quite rejecting of this, which makes it hard for people to engage with, or relate to you.
While in some ways inviting rejection, you also find it hard to be rejected and may act impulsively
in reaction to this, sometimes threatening, or carrying out self-destructive behaviour such as selfharm
or suicide attempts.
Life can be very difficult and painful, both for you, and for those who care about you. You may
have feelings of emptiness and fear abandonment by friends or partners.
A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationshipscharacterized by alternating between extremes of idealization and devaluation
- Identity disturbance, such as a significant and persistent unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid thoughts or severe dissociative symptoms
Types of psychotherapy used to treat BPD include:
- Cognitive Behavioral Therapy (CBT): CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
- Dialectical Behavior Therapy (DBT): This type of therapy utilizes the concept of mindfulness, or being aware of and attentive to the current situation and moods. DBT also teaches skills to control intense emotions, reduce self-destructive behaviors, and improve relationships. DBT differs from CBT in that it integrates traditional CBT elements with mindfulness, acceptance, and techniques to improve a person’s ability to tolerate stress and control his or her emotions. DBT recognizes the dialectical tension between the need for acceptance and the need for change.
- Schema-Focused Therapy: This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.
- Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a type of group therapy that aims to educate family members, significant others, and health care professionals about BPD and gives them guidance on how to interact consistently with the person with the disorder using the STEPPS approach and terminology. STEPPS is designed to supplement other treatments the patient may be receiving, such as medication or individual psychotherapy.
There are no known medications that can treat BPD as a whole. A mental health professional may recommend medications to treat specific symptoms, such as mood swings, depression, or other disorders that may occur with BPD.
••Dependent personality disorder (DPD)••
With this diagnosis you are likely to take a passive position with regard to your own life, allowing
others to assume responsibility for many areas of your life. You are likely to lack selfconfidence,
assuming that the needs of others take precedence to yours. You may find it very
hard to even recognise that you have rights and needs.
This can leave you in a very vulnerable position as you are reliant on others looking out for your
needs and not abusing the position you take within relationships. Other people are more likely
to identify this vulnerability as they recgonise your passivity and submissiveness .
People with this disorder do not trust their own ability to make decisions and feel that others have better ideas. They may be devastated by separation and loss, and they may go to great lengths, even suffering abuse, to stay in a relationship. Other symptoms include:
- Difficulty making decisions without reassurance from others
- Extreme passivity
- Problems expressing disagreements with others
- Avoiding personal responsibility
- Avoiding being alone
- Devastation or helplessness when relationships end
- Unable to meet ordinary demands of life
- Preoccupied with fears of being abandoned
- Easily hurt by criticism or disapproval
- Willingness to tolerate mistreatment and abuse from others
Complications of this disorder may include depression, alcohol and drug abuse, and susceptibility to physical, emotional and sexual abuse.
Psychotherapy is the preferred form of treatment for people with dependent personality disorder. Cognitive-behavioral therapy focuses on patterns of thinking that are maladaptive, the beliefs that underlie such thinking and resolving symptoms or traits that are characteristic of the disorder, such as the inability to make important life decisions or the inability to initiate relationships. Improvements are usually seen only with long-term therapy or treatment.
Certain types of drugs such as antidepressants, sedatives and tranquilizers are often prescribed for patients with dependent personality disorder to treat co-occurring conditions.
••Histrionic personality disorder (HPD)••
This disorder is characterised by extreme or over-dramatic behaviour, with a need to be the
centre of attention. If you have this diagnosis, you may form relationships quickly, but be
demanding and attention-seeking. You may also flirt or behave provocatively in order to ensure
you attract or retain the attention of others.
To others you may appear to be self-centred, with shallow emotions. While you crave attention,
this may also be difficult as you may feel you have to entertain others, be the life and soul of the
party and that you are dependent on the approval of other people.
You are likely to:
- feel very uncomfortable if you are not the centre of attention
- feel much more at ease as the ‘life and soul of the party’
- feel that you have to entertain people
- flirt or behave provocatively to ensure that you remain the centre of attention
- get a reputation for being dramatic and overemotional
- feel dependent on the approval of others
- be easily influenced by others
Treatment can be difficult if you have HPD. Like many people with HPD, you might think you don’t need treatment, or you might find the routine of a treatment program to be unappealing. However, therapy — and sometimes medications — can help you cope with HPD.
Psychotherapy is the most common and effective treatment choice for HPD. This kind of therapy involves talking to a therapist about your feelings and experiences. Such talks can help you and your therapist determine the reasoning behind your actions and behaviors. Your therapist may be able to help you learn how to relate with people in a positive manner, instead of continually trying to get attention from them.
If the patient experiences depression or anxiety as a part of their HPD, their primary care provider might put them on antidepressants or antianxiety medication.
••Narcissistic Personality Disorder (NPD)••
People with Narcissistic Personality Disorder have significant problems with their sense of self-worth stemming from a powerful sense of entitlement. This leads them to believe they deserve special treatment, and to assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive. Their sense of entitlement can lead them to act in ways that fundamentally disregard and disrespect the worth of those around them.
You are likely to:
- believe that there are special reasons that make you different, better or more deserving than others
- have fragile self-esteem, so that you rely on others to recognise your worth and your needs
- feel upset if others ignore you and don’t give you what you feel you deserve
- resent other people’s successes
- put your own needs above other people’s, and demand they do too
- be seen as selfish and ‘above yourself’
- take advantage of other people.
Narcissistic personality disorder treatment is centered around talk therapy, also called psychotherapy. Psychotherapy can help you:
- Learn to relate better with others so your relationships are more intimate, enjoyable and rewarding
- Understand the causes of your emotions and what drives you to compete, to distrust others, and perhaps to despise yourself and others
There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety drugs may be helpful.
••Obsessive-compulsive personality disorder (OCPD)••
A person with this disorder tends to have difficulties in expressing warm or tender emotions to others. They are frequently perfectionists, things must be done in their own way. They often lack clarity in seeing other perspectives or ways of doing things, and their rigid attention to detail may prevent them from completing tasks. OCPD is separate from obsessive compulsive disorder (OCD), which describes a form of behaviour rather than a type of personality.
You are likely to:
- need to keep everything in order and under control
- set unrealistically high standards for yourself and others
- think yours is the best way of making things happen
- worry when you or others might make mistakes
- expect catastrophes if things aren’t perfect
- be reluctant to spend money on yourself or others
- have a tendency to hang on to items with no obvious value.
Cognitive behavioral therapy (CBT) is a common type of mental health counseling. During CBT, you meet with a mental health professional on a structured schedule. These regular sessions involve working with your counselor to talk through any anxiety, stress, or depression. A mental health counselor may encourage you to put less emphasis on work and more emphasis on recreation, family, and other interpersonal relationships.
Relaxation training involves specific breathing and relaxation techniques that can help decrease your sense of stress and urgency. These symptoms are common in OCPD. Examples of recommended relaxation practices include yoga, tai chi, and Pilates.
Usually, a SSRI type medication is prescribed to decrease inflexible and detail-oriented thinking.
••Paranoid personality disorder (PPD)••
People with this diagnosis are often emotionally detached and suspicious of other people and
their motives. They may hold longstanding grudges, and believe that other people are not
trustworthy, are deceiving, threatening, or making plans against them.
- People with this disorder assume that others are out to harm them, take advantage of them, or humiliate them in some way.
- They put a lot of effort into protecting themselves and keeping their distance from others.
- They are known to preemptively attack others whom they feel threatened by.
- They tend to hold grudges, are litigious, and display pathological jealously.
- Distorted thinking is evident. Their perception of the environment includes reading malevolent intentions into genuinely harmless, innocuous comments or behavior, and dwelling on past slights.
- Their emotional life tends to be dominated by distrust and hostility.
- For these reasons, they do not confide in others and do not allow themselves to develop close relationships.
talk therapy or psychotherapy are helpful. These methods will:
- help the individual learn how to cope with the disorder
- learn how to communicate with others in social situations
- help reduce feelings of paranoia
Medications may include:
Combining medication with talk therapy or psychotherapy can be very successful.
••Schizoid personality disorder••
People diagnosed with schizoid personality disorder tend to have difficulties in expressing
emotions, particularly around warmth or tenderness. They often feel shy in company, but may
come across as aloof or remote, and have difficulty in developing or maintaining social
- They almost always chose solitary activities, and seem to take little pleasure in life.
- These “loners” often prefer mechanical or abstract activities that involve little human interaction and appear indifferent to both criticism and praise.
- Emotionally, they seem aloof, detached, and cold.
- They may be oblivious to social nuance and social cues causing them to appear socially inept and superficial.
- Their restricted emotional range and failure to reciprocate gestures or facial expressions (such a smiles or nods of agreement) cause them to appear rather dull, bland, or inattentive.
The Schizoid Personality Disorder appears to be rather rare.
Cognitive behavioral therapy is designed to change behavior. It can be successful in treating this condition because you will learn how to act in social situations. This may reduce anxiety and reluctance to pursue social relationships. Group therapy is another option and can help you practice your social skills. This will help you become more comfortable in social situations.
Medication is generally not used unless other treatment methods are not working. Bupropion may be used to increase feelings of pleasure. Antipsychotic medications can be used to treat feelings of indifference. These medications can also help encourage social interactions.
••Schizotypal personality disorder (STPD)••
A person with this disorder typically has problems around developing interpersonal relationships.
The condition is characterised by thought disorders and paranoia. To others they may appear
odd or eccentric; they may dress or behave inappropriately, for example talking to themselves in
- Unlike the Schizoid Personality Disorder, they also experience perceptual and cognitive distortions and/or eccentric behavior.
- People with Schizotypal Personality Disorder have odd beliefs, for instance, they may believe they can read other people’s thoughts, or that that their own thoughts have been stolen from their heads.
- Schizotypal Personality Disorder tends to be found more frequently in families where someone has been diagnosed with Schizophrenia; a severe mental disorder with the defining feature of psychosis (the loss of reality testing). There is some indication that these two distinct disorders share genetic commonalities
- These perceptual abnormalities may include noticing flashes of light no one else can see, or seeing objects or shadows in the corner of their eyes and then realizing that nothing is there.
- These odd or superstitious beliefs and fantasies are inconsistent with cultural norms.
Several types of therapy can help treat STPD. Psychotherapy, or talk therapy, can help you learn how to form relationships. You can get this type of therapy along with social skills training to help you feel more comfortable in social situations.
Cognitive behavioral therapy can help you address some of the behaviors associated with your condition. Your therapist can help you learn how to act in social situations and respond to social cues. They can also help you learn to recognize unusual or harmful thoughts and change them.
Family therapy may be helpful, especially if you live with others. It can help you strengthen your relationships with family members. It may also help you to feel more supported by your family.
No medications are designed to treat STPD specifically. However, some people with this condition benefit from taking antipsychotic or antidepressant drugs if they’re experiencing symptoms that their doctor thinks be improved with these medications.