Personality disorder covers a variety of maladaptive personality traits that cause significant psychosocial distress and interfere with functioning. These traits remain relatively persistent in the person over time and impact their life and relationships.
Personality disorders are characterised by patterns of thought, behaviour and emotion that differ from what is normally expected. It leads to difficult relationships, reduced quality of life and poor physical health.
Personality disorders are thought to result from a combination of genetic and environmental factors. Patients often have a history of early childhood trauma and difficult circumstances.
Presentation
A wide range of symptoms and behaviours occur with personality disorders. The symptoms typically emerge during the teenage or early adult years. Symptoms vary depending on the type and individual.
For example, possible symptoms in someone with borderline personality disorder include:
- Strong and intense emotions (e.g., anger)
- Emotional instability (rapidly changing emotions)
- Difficulty managing emotions
- Difficulty maintaining relationships
- Poor sense of identity
- Feelings of emptiness
- Fear of abandonment
- Impulsive and risky behaviour
- Recurrent self-harm
- Recurrent suicidal behaviours
Types
There are many different types of personality disorders based on the dominant features. In the DSM-5, they fall into three categories:
- Cluster A – Suspicious
- Cluster B – Emotional or impulsive
- Cluster C – Anxious
Suspicious Personality Disorders
Paranoid personality disorder features difficulty in trusting or revealing personal information to others.
Schizoid personality disorder features a lack of interest or desire to form relationships with others and feelings that this is of no benefit to them.
Schizotypal personality disorder features unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.
Emotional and Impulsive Personality Disorders
Antisocial personality disorder features reckless and harmful behaviour, with a lack of concern for the consequences or the impact of their behaviour on other people. It often involves criminal misconduct.
Borderline personality disorder features fluctuating strong emotions and difficulties with identity and maintaining healthy relationships.
Histrionic personality disorder involves the need to be the centre of attention and performing for others to maintain that attention.
Narcissistic personality disorder features feelings that they are special and need others to recognise this, or else they get upset. They put themselves first.
Anxious Personality Disorders
Avoidant personality disorder features severe anxiety about rejection or disapproval and avoidance of social situations or relationships.
Dependent personality disorder features a heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach.
Obsessive-compulsive personality disorder features unrealistic expectations of how things should be done by themselves and others and catastrophising about what will happen if these expectations are not met.
Management
Management of personality disorder can be challenging. The patterns of thinking and behaviours are deeply ingrained and are difficult to change. Patient and carer education is very important to help them understand the condition.
Risk management is important, considering short and long-term risks (e.g., ongoing self-harm, suicide and harm to others). Risks are reviewed regularly and managed across the multidisciplinary team. Supportive care is provided during crises to help keep the patient safe.
Psychological treatment is the main treatment (e.g., cognitive behavioural therapy or dialectical behaviour therapy).
Medications are not recommended for the long-term treatment of personality disorders. Sedative medications (e.g., sedative antihistamines) are sometimes used short-term (e.g., for less than one week) in a crisis. Personality disorders can co-exist with other psychiatric problems (e.g., depression), where medications may be beneficial.
Last updated June 2024
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