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What is a Personality Disorder?
Personality is the unique set of characteristic traits that defines a person in terms of:
- Their way of thinking
- Their perception of themselves, other people, and the world around them
- Their relationships with other people
- Their habitual patterns of behavior
These individual traits combine with one another in countless creative ways, and they naturally evolve, shift, or soften over time in response to age, family influences, and social and professional circumstances. Together, this ever-evolving constellation of behaviors and thought patterns is what makes each of us unique as human beings.
However, when certain personality traits become rigid and maladaptive, and when they cause significant functional impairment or genuine subjective distress, this is when clinicians begin to speak of personality disorders.
There are 10 distinct personality disorders currently recognized in psychiatric classification systems. Despite their differences, all share a common underlying feature: a persistent, enduring pattern of inner experience, thinking, and behavior that deviates markedly from the expectations of the individual’s culture and from commonly shared ways of feeling and acting.
These disorders typically emerge during adolescence or early adulthood and tend to persist over long periods of time, often throughout much of a person’s life without appropriate treatment.
Personality disorders are organized into three clusters based on shared characteristics and behavioral patterns:
Cluster A: Odd or Eccentric Disorders
People with these disorders appear odd or eccentric in their thinking and behavior.
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Cluster B: Dramatic, Emotional, or Erratic Disorders
People with these disorders appear dramatic, overly emotional, or unpredictable in their thinking and behavior.
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Cluster C: Anxious or Fearful Disorders
People with these disorders tend to be anxious and fearful.
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder, which is distinct and different from obsessive-compulsive disorder (OCD)
Personality disorders are chronic conditions that, without appropriate treatment, can persist for many years, causing serious and far-reaching disruption across virtually every area of daily life, affecting not only the person diagnosed but also their family members and loved ones. The areas most commonly affected include family relationships, romantic and emotional relationships, work performance, and academic functioning, and these difficulties can ultimately lead to social isolation and increased risk of alcohol and drug abuse as maladaptive coping strategies.
In some cases, the condition can become so severe that the affected person is unable to adequately care for themselves, or is at genuine risk of harming themselves or others. In these more serious situations, hospitalization becomes necessary to ensure safety and provide intensive, stabilizing care.
Finally, it is important to recognize that individuals do not always come to the attention of a doctor or mental health specialist at the very onset of their first symptoms. In fact, it is quite common for a considerable amount of time to pass between when symptoms first begin, when the person seeks consultation, when an accurate diagnosis is finally made, and when effective treatment ultimately begins, a delay that can unfortunately allow the condition to become more entrenched over time.
Causes
It is worth noting that personality disorders frequently present with overlapping characteristics from more than one cluster simultaneously, making clean, clear-cut categorization somewhat challenging in real-world clinical practice. The estimated prevalence (the percentage of the general population affected at any given point in time) for each cluster is approximately:
- 5.7% for Cluster A disorders
- 1.5% for Cluster B disorders
- 6% for Cluster C disorders
As with a great many psychiatric conditions, the precise underlying cause of personality disorders remains unknown. However, researchers have identified several factors that appear to meaningfully increase a person’s risk of developing symptoms:
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Traumatic events. Symptoms of a personality disorder can be triggered or worsened following stressful or traumatic experiences, such as the loss of a loved one, or as a result of complex, destabilizing social circumstances and life transitions.
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Genetic factors. There is growing evidence that genes play a meaningful role in the development of personality disorders, with certain inherited traits potentially predisposing individuals to specific patterns of thinking and behavior.
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Family history. Having a family history of personality disorders or other mental illnesses appears to increase an individual’s own risk of developing a similar condition.
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Abusive or unstable family environments during childhood, including experiences of neglect, inconsistent caregiving, or exposure to chaotic household dynamics.
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Childhood diagnosis of conduct disorder (CD), a behavioral condition in children characterized by persistent patterns of aggressive or rule-violating behavior, which has been associated with increased risk of certain adult personality disorders, particularly antisocial personality disorder.
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Chemical and structural abnormalities in the brain, which ongoing neuroscience research continues to investigate as a potential biological contributor to these conditions.
Additional Risk Factors Worth Noting
Beyond the factors listed above, researchers have also identified several additional considerations that may contribute to the development of personality disorders:
- Early attachment difficulties, meaning disruptions in the crucial early emotional bond between an infant and their primary caregiver, which some researchers believe may lay important groundwork for later personality development
- Chronic invalidation during childhood, referring to environments where a child’s emotions and experiences are repeatedly dismissed, minimized, or punished, which has been particularly studied in relation to borderline personality disorder
- Cultural and societal factors, since what is considered a deviation from expected norms can vary somewhat between different cultural contexts, making cross-cultural diagnostic consistency an ongoing area of research interest
Symptoms, Development, and Course
Symptoms of personality disorders typically become clearly apparent during adolescence or early adulthood, though depending on the specific type of disorder and the person’s age, there are notable differences in how these conditions tend to unfold over time.
For example, antisocial personality disorder and borderline personality disorder tend to become less pronounced or even enter remission as a person ages, often improving noticeably by midlife. In contrast, obsessive-compulsive personality disorder and schizotypal personality disorder tend to follow a different, generally more stable and persistent course over the lifespan.
Core Diagnostic Features
Regardless of which specific cluster they belong to, all personality disorders are characterized by an enduring pattern of thinking, feeling, and behaving that deviates markedly from the expectations of the individual’s surrounding social and cultural environment.
These deviations manifest in two or more of the following areas:
- Cognitive functioning: meaning the person’s characteristic way of thinking about and interpreting themselves, other people, and life events
- Affective functioning: meaning the person’s typical emotional responses to different situations
- Interpersonal functioning: encompassing social relationships and functioning in work or academic settings
- Impulse control: the ability to regulate emotional responses and behavioral impulses appropriately
Additionally, the behaviors associated with a personality disorder share several important characteristics:
- They are notably rigid and inflexible, showing little adaptability across different situations and contexts
- They affect multiple broad areas of the person’s life, including personal identity, social relationships, work, academic performance, and romantic or emotional relationships
- They cause clear, significant distress in the person’s day-to-day functioning and quality of life
The onset of symptoms typically dates back to at least adolescence or early adulthood, and the pattern persists over an extended period of time, often many years or even decades.
It is also critically important to establish that these symptoms are not attributable to another medical condition (such as traumatic brain injury or temporal lobe epilepsy), to substance abuse or alcohol use, or to another underlying mental illness, since these conditions can sometimes produce symptoms that superficially resemble a personality disorder.
The 10 Personality Disorders in Detail
Paranoid personality disorder. This disorder is characterized by pervasive suspiciousness and distrust toward other people, who are perceived as malicious, exploitative, or deceptive, even in the absence of any clear evidence supporting these beliefs.
Schizoid personality disorder. People with this disorder display a notably detached pattern of behavior in interpersonal relationships, along with a flattened, restricted range of emotional expression. They generally do not seek out close, intimate relationships and tend to genuinely prefer solitude over social interaction.
Schizotypal personality disorder. This condition is characterized by significant discomfort in close relationships, alongside distortions in thinking and perception, and notably eccentric behavior. A person with this disorder may hold unusual ideas or beliefs, display excessive suspiciousness, exhibit atypical emotional responses, or experience significant social anxiety.
Antisocial personality disorder. This disorder is characterized by a repeated pattern of disregard for, and violation of, the rights of others. A person with this condition may fail to conform to social norms regarding lawful behavior, may repeatedly lie, deceive, or defraud others for personal profit or pleasure, or may act impulsively, aggressively, and irresponsibly, all typically without displaying any genuine remorse for the harm caused.
Borderline personality disorder. This condition is characterized by marked instability in interpersonal relationships, self-image, and mood, alongside significant impulsivity. A person with this disorder may make frantic efforts to avoid real or imagined abandonment, experience a pattern of unstable and intense relationships, make repeated suicide attempts, display inappropriate and intense anger, or experience chronic, recurring feelings of emptiness.
Histrionic personality disorder. This disorder is marked by a pervasive pattern of excessive attention-seeking and heightened emotionality. People with this condition may feel genuinely uncomfortable when they are not the center of attention, may use physical appearance as a manipulative tool to draw attention, communicate in an overly dramatic or theatrical manner, and display emotions that shift rapidly but tend to feel shallow or superficial.
Narcissistic personality disorder. People with this disorder have a persistent need for admiration from others, combined with a notable lack of empathy toward other people’s feelings and needs. A characteristic feature is grandiosity, meaning the person may exaggerate their own achievements and talents, and may genuinely believe themselves to be special or superior compared to others.
Avoidant personality disorder. The person with this disorder is excessively shy, feels persistently inadequate, and is extremely sensitive to any form of criticism from others. Because of these symptoms, they may avoid, for example, work activities that require regular contact with the public, and may avoid interpersonal relationships altogether out of fear of being criticized or ridiculed. They also tend to be reluctant to take on personal risks or engage in new activities, driven by pervasive feelings of inadequacy.
Dependent personality disorder. In people with this disorder, there is a clear, pathological need to be cared for and continuously reassured by others. They display submissive, clingy behaviors driven by a fear of separation and being left alone, often struggle to make even everyday decisions independently, and feel a strong need for others to take responsibility for major areas of their life.
Obsessive-compulsive personality disorder. The primary characteristic of this disorder is an excessive preoccupation with orderliness, rules, perfectionism, detailed organization, and control. Because of these traits, a person may be reluctant to delegate tasks to others, may work excessively at the expense of personal relationships, and may be rigidly inflexible when it comes to matters of morality and personal values. It is important to reiterate that this disorder is entirely distinct from obsessive-compulsive disorder (OCD), despite the similarity in name.
Diagnosis
Given the early age of onset and the characteristically long-lasting course of personality disorders, establishing an accurate diagnosis requires a long-term medical evaluation process, specifically designed to rule out any underlying medical conditions, or substance and alcohol abuse, that could potentially mimic or explain the observed symptoms.
In particular, if a clear and marked change in personality is observed in adulthood, or especially later in life, it becomes essential to investigate for a possible underlying medical condition (such as a brain tumor) or an unrecognized substance abuse disorder, since a genuine personality disorder, by definition, has roots dating back to adolescence or early adulthood rather than appearing suddenly later in life.
For specialist evaluation, in some cases a single interview with a physician or mental health professional may be sufficient, though more commonly, multiple sessions are needed to properly assess the person’s characteristic thoughts, feelings, and behavioral patterns over time. The overall medical evaluation may also include structured questionnaires and interviews with family members and other people close to the individual, who can often provide valuable additional perspective on long-standing patterns of behavior.
Age Considerations in Diagnosis
Diagnosis is typically only made once a person has reached at least 18 years of age. This is because, at younger ages, personality traits are still actively developing and evolving, making it potentially difficult, and even counterproductive, to formally classify certain traits as pathological before personality has had the opportunity to fully mature.
To diagnose a personality disorder in a younger individual, symptoms must have been consistently present for at least one year. The sole exception to this rule is antisocial personality disorder, which, under diagnostic guidelines, cannot be diagnosed in individuals under 18 years of age under any circumstances, given the significant overlap with normal developmental behaviors in younger individuals.
Distinguishing From Other Psychiatric Conditions
The clinical features of personality disorders must be carefully distinguished from symptoms that can arise during the course of another psychiatric illness, such as bipolar disorder, depressive disorders, or anxiety disorders, all of which can sometimes produce symptoms that superficially resemble a personality disorder but which typically have a different course, different triggers, and different treatment approaches.
Additionally, several personality disorders show meaningful symptom overlap with other recognized psychiatric conditions, which can complicate accurate diagnosis. For example, the symptoms of schizotypal personality disorder can overlap considerably with those of schizophrenia, while the symptoms of avoidant personality disorder can overlap significantly with social anxiety disorder (social phobia). Careful, experienced clinical assessment is essential to accurately distinguish between these related but distinct conditions.
Treatment
The specific approach to treatment depends heavily on the particular type of personality disorder diagnosed, its overall severity, and the specific symptoms a person is experiencing.
Given the inherent complexity of these conditions, effective management often requires a broad, multidisciplinary approach sustained over a period of several years, typically involving a range of different healthcare professionals, including:
- Primary care physicians
- Psychiatrists
- Psychotherapists
- Social workers
- Nurses
Psychotherapy
Psychotherapy represents the primary and most important treatment tool for addressing personality disorders. Through the therapeutic process, a person has the opportunity to deeply explore the various aspects of their condition, openly share the thoughts, feelings, and behaviors that are causing them distress, and carefully analyze the specific situations and triggers that tend to provoke or worsen their symptoms.
Through consistent psychotherapy, individuals can learn genuinely new behavioral strategies to better manage their symptoms and maintain meaningful, long-term control over their condition.
Several different psychotherapy approaches exist and may be used depending on the individual’s specific needs, including:
- Individual therapy, working one-on-one with a therapist
- Group therapy, which allows individuals to practice interpersonal skills and receive feedback within a supportive group setting
- Family or couples therapy, involving family members or close partners in the therapeutic process, which can be particularly valuable given how significantly these conditions can affect close relationships
Certain specialized forms of psychotherapy have demonstrated particularly strong evidence for specific personality disorders. For example, Dialectical Behavior Therapy (DBT) was specifically developed for, and has shown considerable effectiveness in treating, borderline personality disorder, helping individuals develop skills in emotional regulation, distress tolerance, and interpersonal effectiveness. Mentalization-Based Therapy (MBT) and Transference-Focused Psychotherapy (TFP) are additional specialized approaches that have also shown meaningful benefit, particularly for borderline personality disorder.
Medications
Regarding pharmacological treatment, it is important to understand that no medications currently exist that are specifically designed and approved to treat personality disorders themselves. However, medications are widely and effectively used to manage the various associated symptoms that frequently accompany these conditions:
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Antidepressants, used to address feelings of sadness, hopelessness, and other depressive symptoms that commonly co-occur with personality disorders
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Mood stabilizers, used to help manage sudden mood shifts, irritability, aggression, and impulsivity, symptoms that are particularly prominent in certain Cluster B disorders
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Antipsychotic medications, used to address psychotic symptoms or difficulties distinguishing reality from fantasy, which can occur in certain more severe presentations, particularly within Cluster A disorders
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Sedatives, used to help manage anxiety, psychomotor agitation, or insomnia, typically used cautiously and for shorter durations given the potential for dependence
Lifestyle
Finally, there are several practical lifestyle measures that can be implemented alongside a formal medical treatment plan to help prevent symptoms from worsening. These generally involve adopting habits centered on physical and mental well-being, along with effective self-care strategies:
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Taking an active and responsible role in one’s own treatment plan, for example, by consistently attending scheduled medical appointments and psychotherapy sessions rather than skipping them, since consistency is often key to long-term improvement
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Learning more about one’s own condition, which helps build greater awareness and understanding of personal symptoms, and improves the ability to recognize and address warning signs early, before they escalate into a full crisis
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Regular physical activity, which can meaningfully help with depressive symptoms, stress, and anxiety, and can also help counterbalance certain undesirable side effects of some medications, such as weight gain
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Avoiding alcohol and recreational drugs, since substance use tends to significantly worsen symptoms and can dangerously interact with prescribed medications, undermining the overall effectiveness of treatment
Living With a Personality Disorder
Receiving a diagnosis of a personality disorder, whether for yourself or for a loved one, can feel overwhelming at first. However, it is important to know that with sustained, appropriate treatment, many people with personality disorders experience meaningful and lasting improvement in their symptoms and overall quality of life. A few additional considerations can help support long-term management:
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Be patient with the treatment process. Personality disorders, by their very nature, involve deeply ingrained patterns of thinking and behavior that have often developed over many years. Meaningful change through psychotherapy typically takes considerable time and sustained effort, and setbacks along the way are a normal part of the recovery process rather than a sign of failure.
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Build a strong support system. Whether through supportive family members, close friends, or peer support groups specifically for individuals with personality disorders, having people who understand and support the recovery journey can make a substantial difference in long-term outcomes.
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Educate family members when appropriate. Because personality disorders significantly affect close relationships, involving family members in understanding the condition, sometimes through family therapy or educational resources, can help reduce conflict and improve the overall support the person receives at home.
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Watch for co-occurring conditions. Depression, anxiety disorders, and substance use disorders frequently occur alongside personality disorders. Addressing these co-occurring conditions as part of a comprehensive treatment plan is essential for achieving the best possible overall outcome.
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Recognize crisis warning signs. For certain personality disorders, particularly borderline personality disorder, having a clear, well-rehearsed safety plan in place for managing moments of intense emotional crisis or suicidal thoughts is an essential component of comprehensive care, and should be developed together with a treating clinician.
Frequently Asked Questions
Can personality disorders be cured completely?
While personality disorders are generally considered chronic conditions, this does not mean they cannot improve substantially. With sustained, appropriate treatment, particularly specialized forms of psychotherapy, many individuals experience significant, lasting reduction in symptoms and meaningful improvement in relationships, work functioning, and overall quality of life, even if some underlying personality traits persist to some degree.
Is it possible to have more than one personality disorder at the same time?
Yes, this is actually quite common. Many individuals display overlapping traits from multiple personality disorders, or even from different clusters simultaneously, which can make diagnosis and treatment planning more complex and typically requires careful, individualized clinical assessment.
What is the difference between a personality trait and a personality disorder?
Everyone has personality traits, characteristic ways of thinking, feeling, and behaving that make them unique. These traits only become classified as a personality disorder when they are notably rigid, inflexible, and maladaptive, causing significant distress or impairment across multiple important areas of a person’s life, and when this pattern has persisted since adolescence or early adulthood.
Can children be diagnosed with a personality disorder?
Generally, no. Diagnosis is typically reserved for individuals who are at least 18 years old, since personality is still actively developing during childhood and adolescence. The one notable exception in diagnostic criteria involves certain precursor patterns, such as conduct disorder, which may later be associated with antisocial personality disorder in adulthood, though antisocial personality disorder itself cannot be diagnosed before age 18.
Are personality disorders more common in men or women?
The prevalence of specific personality disorders can differ somewhat between men and women. For example, antisocial personality disorder is diagnosed more frequently in men, while borderline personality disorder has historically been diagnosed more frequently in women, though some researchers believe this may partly reflect differences in diagnostic patterns and healthcare-seeking behavior rather than true differences in underlying prevalence.
Is borderline personality disorder the most severe personality disorder?
Severity can vary considerably among all personality disorders and depends heavily on the individual case, the specific symptoms present, and the presence of co-occurring conditions. Borderline personality disorder is often associated with higher rates of self-harm and suicide risk compared to some other personality disorders, which is why it frequently receives significant clinical attention and has well-developed, specialized treatment approaches such as Dialectical Behavior Therapy.
Sources and Bibliography
- American Psychiatric Association (APA), What Are Personality Disorders?
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
- Mayo Clinic, Personality Disorders: Symptoms and Causes
- National Institute of Mental Health (NIMH), Personality Disorders
- National Education Alliance for Borderline Personality Disorder (NEABPD), About BPD
- Cleveland Clinic, Personality Disorders Overview
- MedlinePlus, Personality Disorders Information
- World Health Organization (WHO), International Classification of Diseases, 11th Revision (ICD-11), Personality Disorders Section
