What Are Personality Disorders?
Personality disorders include 10 diagnosable psychiatric conditions that are recognized and described in the fifth and most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Each is a distinct mental illness defined by personality traits that can be troubling enough to create problems with relating to other people in healthy ways, and can lead to significant distress or impairment in important areas of functioning.
The DSM-5 organizes personality disorders into three groups, or clusters, based on shared key features.
These personality disorders are characterized by odd or eccentric behavior. People with cluster A personality disorders tend to experience major disruptions in relationships because their behavior may be perceived as peculiar, suspicious, or detached.
Cluster A personality disorders include:1
- Paranoid personality disorder, which affects between 2.3% to 4.4% of adults in the U.S. Symptoms include chronic, pervasive distrust of other people; suspicion of being deceived or exploited by others, including friends, family, and partners.
- Schizoid personality disorder, which is characterized by social isolation and indifference toward other people. It affects slightly more men than women. People with this disorder often are described as cold or withdrawn, rarely have close relationships with other people, and may be preoccupied with introspection and fantasy.
- Schizotypal personality disorder, which features odd speech, behavior, and appearance, as well as strange beliefs and difficulty forming relationships.
The cluster B personality disorders are characterized by dramatic or erratic behavior. People who have a personality disorder from this cluster tend to either experience very intense emotions or engage in extremely impulsive, theatrical, promiscuous, or law-breaking behaviors.
Cluster B personality disorders include:
- Antisocial personality disorder, which tends to show up in childhood, unlike most other personality disorders (most don’t become apparent until adolescence or young adulthood). Symptoms include a disregard for rules and social norms and a lack of remorse for other people.
- Borderline personality disorder, which is characterized by instability in interpersonal relationships, emotions, self-image, and impulsive behaviors.
- Histrionic personality disorder, which features excessive emotionality and attention seeking that often leads to socially inappropriate behavior in order to get attention.
- Narcissistic personality disorder, which is associated with self-centeredness, exaggerated self-image, and lack of empathy for others and is often driven by an underlying fragility in the sense of self.
Cluster C personality disorders are characterized by anxiety. People with personality disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.
Cluster C personality disorders include:
- Avoidant personality disorder is a pattern of social inhibition and avoidance fueled by fears of inadequacy and criticism by others.
- Dependent personality disorder, which involves fear of being alone and often causes those who have the disorder to do things to try to get other people to take care of them.
- Obsessive-compulsive personality disorder, which is characterized by a preoccupation with orderliness, perfection, and control of relationships. Though similarly named, it is not the same as obsessive-compulsive disorder (OCD).
Personality disorders tend to appear in adolescence or early adulthood, continue over many years, and can cause a great deal of distress. They can potentially cause enormous conflict with other people, impacting relationships, social situations, and life goals. People with personality disorders often don’t recognize that they have problems and are often confusing and frustrating to people around them (including clinicians).
Certain symptoms of personality disorders can fall into two categories: self-identity and interpersonal functioning.1
Self-identity problems include:
- Unstable self-image
- Inconsistencies in values, goals, and appearance
Interpersonal problems include:
- Being insensitive to others (unable to empathize)
- Difficulty knowing boundaries between themselves and others
- Inconsistent, detached, overemotional, abusive, or irresponsible styles of relating
According to the DMS-5, a person must meet the following criteria to be diagnosed with a personality disorder:2
- Chronic and pervasive patterns of behavior that affect social functioning, work, school, and close relationships
- Symptoms that affect two or more of the following four areas: thoughts, emotions, interpersonal functioning, impulse control
- Onset of patterns of behavior that can be traced back to adolescence or early adulthood
- Patterns of behaviors that cannot be explained by any other mental disorders, substance use, or medical conditions
Before a clinician can diagnose a personality disorder, they must make a differential diagnosis to rule out other disorders or medical conditions that may be causing the symptoms.
A differential diagnosis is very important but can be difficult since personality disorders also commonly co-occur with other mental illnesses. A person who meets the criteria for one personality disorder will often also meet criteria for one or more additional personality disorders.