Personality disorders involve unhealthy, inflexible behaviors and patterns of thought. Personality disorder traits can vary drastically, but most people with personality disorders have impairments in daily functioning that significantly affect their ability to live healthy, happy and productive lives. 

These disorders typically start in childhood, and they often co-occur with substance use disorders. Understanding the types of personality disorders, how they’re caused and how they’re treated can contribute to better outcomes for people struggling with these disorders.

Causes of Personality Disorders

There can be many different causes of personality disorders, including environmental and genetic factors. Childhood trauma and adversity have been strongly associated with many personality disorders, including schizotypal, antisocial, borderline and narcissistic personality disorders. One analysis revealed that emotional abuse and physical neglect were highly associated with the development of personality disorders in adulthood.

Genetic causes can be seen particularly in studies on twins, which show a strong genetic component in the development of personality disorders. In addition, other studies point toward genes that are known to be dysregulated in people with personality disorders. These include genes related to neurochemicals like dopamine, serotonin, norepinephrine and dopamine.

Symptoms of Personality Disorders

Personality disorder symptoms vary greatly from disorder to disorder, but there are several characteristics that are universal. Some of these signs include:

  • Symptoms of Personality Disorders

    Unhealthy patterns of thinking, functioning and behaving

    Trouble perceiving and relating to various situations and people

    Significant problems and limitations in relationships, social situations, work and school

Different Types of Personality Disorders

There are three clusters of personality disorders in the DSM-5, the handbook used by health professionals to diagnose mental disorders. These are referred to as Cluster A, Cluster B, and Cluster C. 

Cluster A includes paranoid, schizoid and schizotypal personality disorders, and people with these disorders often appear “odd” or “eccentric.” Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders, and people with these disorders tend to appear dramatic, emotional or erratic. Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders, and people within this cluster usually appear anxious or fearful.

Cluster A Personality Disorders

Many medical professionals believe this category includes the most severe personality disorders. Cluster A tends to involve odd, eccentric personality disorders.

Paranoid Personality Disorder

Paranoid personality disorder manifests as chronic and widespread interpersonal distrust, and a person with this disorder typically interprets the actions of others as malevolent and malicious. Paranoid personality disorder symptoms include:

  • Paranoid Personality Disorder Symptoms

    Exaggerated sensitivity to perceived rejection

    Persistently bearing grudges

    Paranoia 

    Sustained vigilance about potential “threat signals”

This disorder does not include hallucinations, delusions or psychosis. Instead, it refers to a state of mind that is consumed by constant suspicion of others. Effects of paranoid personality disorder include increased risk for depression and anxiety, violent and criminal behavior, suicide attempts and poor quality of life due to social withdrawal and isolation. Cognitive analytical therapy has been shown to reduce some symptoms of this disorder.

Schizoid Personality Disorder

Schizoid personality disorder involves detachment from social relationships and restricted expression of emotions with other people. Other schizoid personality disorder symptoms listed in the DSM-5 include:

  • Schizoid Personality Disorder Symptoms

    Not desiring or enjoying close relationships

    Nearly always choosing solitary activities 

    Little to no interest in sexual experiences with others

    Taking pleasure in very few activities

    Lack of close friends

    Indifference to praise or criticism 

    Emotional coldness or detachment

Living with schizoid personality disorder is very difficult and is linked to both unbearable and inescapable loneliness.

Schizotypal Personality Disorder

Schizotypal personality disorder is another debilitating disorder characterized by odd and eccentric behaviors. Schizotypal personality disorder symptoms include:

  • Schizotypal Personality Disorder Symptoms

    Believing coincidences or innocuous events have strong personal significance

    Odd beliefs and ways of thinking

    Unusual perceptual experiences and bodily illusions

    Disorganized speech

    Inappropriate or constricted emotional responses

    Suspiciousness or paranoia

    Appearance that is odd, eccentric or peculiar

    Lack of close friends 

    Excessive social anxiety that does not go away with familiarity and also tends to be associated with paranoid fears

Though this disorder is similar to schizoid personality disorder, people with schizotypal personality disorder avoid social interaction because of a deep-seated fear of people. Meanwhile, people with schizoid personality disorder feel no desire to form relationships in the first place.

Cluster B Personality Disorders

Cluster B personality disorder traits include dramatic, emotional or erratic thoughts and behaviors. Cluster B is sometimes referred to as the dramatic cluster of personality disorders, and it is also characterized by emotional and impulsive personality disorders.

Antisocial Personality Disorder

This disorder involves a pattern of disregard for the rights of others. According to the DSM-5, antisocial personality disorder symptoms and traits include:

  • Antisocial Personality Disorder Symptoms

    Failure to conform to social norms with respect to lawful behaviors (repeatedly performing acts that are grounds for arrest)

    Deceitfulness (repeated lying, use of aliases or conning others for personal profit or pleasure)

    Impulsivity

    Irritability 

    Aggressiveness

    Reckless disregard for the safety of oneself and others

    Consistent irresponsibility 

    Lack of remorse

People who have this disorder tend to experience higher rates of incarceration. Unfortunately, research suggests that psychological interventions for adults with this disorder are not very effective. 

Narcissistic Personality Disorder

Narcissistic personality disorder signs include pervasive patterns of grandiosity, need for admiration and a lack of empathy. The relationships of people with narcissistic personality disorder are often fraught with problems, which are likely caused by lack of empathy and preoccupation with personal desires. Diagnostic criteria for narcissistic personality disorder include:

  • Narcissistic Personality Disorder Symptoms

    Grandiose sense of self-importance

    Preoccupation with fantasies (unlimited success, power, brilliance, beauty or love)

    Belief that one is “special” and unique

    A need for excessive admiration

    Sense of entitlement

    Taking advantage of others

    Lack of empathy

    Envy of others

    Believing that others are envious of oneself

    Arrogant behaviors or attitudes

Although it is a relatively rare condition, the DSM-5 indicates that approximately 50% to 75% of those characterized with this disorder are men.

Borderline Personality Disorder

Some professionals consider borderline personality disorder to be a part of the bipolar disorder spectrum. According to the DSM-5, signs of borderline personality disorder include impulsivity and a pattern of instability in interpersonal relationships, self-image and mood. People with borderline personality disorder also show signs such as:

  • Borderline Personality Disorder Symptoms

    Frantic efforts to avoid real or imagined abandonment

    Patterns of unstable and intense relationships

    Unstable self-image or sense of self

    Impulsivity in at least two self-damaging behaviors, such as in spending, sex, substance misuse, reckless driving or binge eating 

    Recurrent suicidal behavior, gestures, or threats 

    Intense, rapid mood swings

    Chronic feelings of emptiness

    Inappropriate, intense anger or difficulty controlling anger

    Stress-related paranoid ideation or severe dissociative symptoms

Clinical studies show that people with borderline personality disorder respond best to structured and specifically designed forms of psychotherapy, such as dialectical behavior therapy.

Histrionic Personality Disorder

Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention-seeking. It is sometimes referred to as the attention-seeking disorder, and it has also been called a disorder of hysteria. According to the DSM-5, histrionic personality disorder symptoms include:

  • Histrionic Personality Disorder Symptoms

    Discomfort when not being the center of attention

    Interactions with others often include inappropriate seductive or provocative behaviors

    Rapid shifts and shallow expression of emotions

    Using physical appearance to draw attention to oneself

    Excessively impressionistic style of speech that is lacking in detail

    Self-dramatization, theatricality and exaggerated expression of emotion

    Being easily influenced by others

    Believing relationships to be more intimate than they actually are

Cluster C Personality Disorders

Cluster C personality disorders cause people to appear fearful or anxious. Research has shown that inpatient psychotherapeutic treatment is particularly helpful for treating Cluster C personality disorders.

Avoidant Personality Disorder

People with avoidant personality disorder experience social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation. According to the DSM-5, avoidant personality disorder symptoms include:

  • Avoidant Personality Disorder Symptoms

    Avoiding activities involving others because of a fear of criticism, disapproval or rejection

    Preoccupation with being criticized or rejected in social situations

    Unwillingness to get involved with people unless they are certain of being liked

    Showing restraint in intimate relationships because of the fear of being shamed or ridiculed

    Inhibition in personal situations with others because of feelings of inadequacy

    Viewing oneself as socially inept, unappealing or inferior to others 

    Reluctance to take personal risks or engage in any new activities

This disorder has a high degree of overlap with generalized anxiety disorder, but there are some differences. People with social anxiety disorder typically know that their fears are irrational, but people with avoidant personality disorder believe that they are inferior and that rejection and humiliation are inevitable and deserved.

Dependent Personality Disorder

Dependent personality disorder traits include an excessive need to be taken care of, which leads to clinging behavior and a fear of separation. According to the DSM-5, dependent personality disorder symptoms include:

  • Dependent Personality Disorder Symptoms

    Difficulty making simple, everyday decisions without an excessive amount of advice and reassurance from others

    Needing others to assume responsibility for most major areas of life

    Going to excessive lengths to obtain support from others

    Urgently seeking another relationship as a source of care and support when a close relationship ends

    Difficulty expressing when they disagree with others because of a fear of losing support

    Difficulty initiating projects or doing things alone

    Feeling uncomfortable or helpless when alone 

    Fears of being left to take care of oneself

Dependent personality disorder causes may include chronic physical illness or separation anxiety disorder during youth.

Obsessive-Compulsive Personality Disorder (OCPD)

Obsessive-compulsive disorder symptoms are characterized by preoccupation with orderliness, perfectionism and control. According to the DSM-5, symptoms include:

  • Obsessive-Compulsive Personality Disorder (OCPD) Symptoms

    Preoccupation with details, lists, organization, schedules and more

    Perfectionism to the point that it interferes with completing tasks

    Being overconscientious and inflexible about matters of morality, ethics or values

    Excessive devotion to work, which negatively affects other activities

    Inability to discard worthless objects

    Reluctance to delegate tasks or work with others

    View money as something to be hoarded 

    Rigidity and stubbornness

Relationships are particularly affected by obsessive-compulsive personality disorder, and the condition is most common among men. People with obsessive-compulsive personality disorder experience an excessive capacity to delay rewards, which makes it different from obsessive-compulsive disorder.

Diagnosing Personality Disorders

Personality disorder diagnosis must be done by a medical professional, such as a psychiatrist or clinical psychologist. Doctors typically use personality disorder assessment tools, such as the DSM-5 and structured clinical interviews

Personality disorders typically stem from childhood events and are also influenced by genetic predispositions. Personality disorders generally develop in the late teen years, when a person’s brain and personality finish developing.

Personality Disorder Statistics

The prevalence of personality disorders is rather low, especially when compared to mood and anxiety disorders like depression or generalized anxiety disorder. The most common personality disorder is obsessive-compulsive personality disorder, followed by narcissistic and borderline personality disorders. Personality disorder statistics indicate that the prevalence of these disorders ranges from approximately 6% to 9% in the United States.

Personality Disorders in Childhood and Adolescence

Personality disorders in childhood and adolescence are not unheard of, but they are more often found in adults. Diagnosing personality disorders in adolescence is more difficult because the personality is still maturing as the brain’s cortex finishes developing. 

Borderline personality disorder is perhaps the most commonly diagnosed personality disorder in the teenage years. In fact, teenage personality disorder symptoms are very similar to those that are observed in adulthood.

Co-Occurring Substance Abuse and Personality Disorders

A co-occurring disorder is when two disorders present themselves at the same time. In this context, co-occurring disorders include substance misuse and personality disorders. Personality disorders and drug addiction are linked, especially in the case of borderline personality disorder. Nearly 80% of adults with borderline personality disorder develop a substance use disorder or experience addiction at some time in their lives. 

Other research has shown that alcoholism and personality disorders are also linked. One study found that people with Cluster B personality disorders met certain alcohol milestones at a younger age. These people have higher levels of impulsivity during alcohol intake, greater likelihood of early treatment dropout and a quicker time to first relapse.

Personality Disorder Treatment

Personality disorder treatment is not simple, and many people are unresponsive to different forms of therapy and medications. The most effective forms of personality disorder therapy are often methods of cognitive behavioral therapy, such as dialectical behavioral therapy. 

Additionally, there are personality disorder medications that work for some people. For example, mood stabilizers such as lamotrigine are sometimes used to treat borderline personality disorder symptoms. Each person responds differently to medication based on their personal history, diagnosis and other factors.

Key Points: Personality Disorders

Personality disorders include conditions that can impact day-to-day functioning. Some examples include schizotypal personality disorder, borderline personality disorder, narcissistic personality disorder and obsessive-compulsive personality disorder. Based on the traits and symptoms of these disorders, they have been categorized into three clusters in the DSM-5.

If you or a loved one may be suffering from a personality disorder, reach out to our expert mental health care team at Baptist Health to begin treatment today. If you believe you or a loved one are struggling with a co-occurring personality disorder and addiction contact us at The Recovery Village Palm Beach at Baptist Health to begin your road to recovery.