Personality disorders

What are personality disorders?

A personality disorder is a mental health condition that involves long-lasting patterns of thinking, feeling, and relating to others that differ from what is expected and cause real distress or difficulty functioning. These patterns are steady over time and show up across many areas of life, from work to relationships.

There are 10 types, grouped into three clusters. Cluster A involves unusual or eccentric thinking, Cluster B involves dramatic and unstable emotions and behavior, and Cluster C involves strong anxiety and fear. Borderline and antisocial personality disorders are among the most commonly diagnosed.

About 9% of U.S. adults have some type of personality disorder. Having a distinct personality style, like being shy or private, is not the same as a personality disorder; the difference is whether the patterns cause genuine distress or disruption. Many people with a personality disorder do not realize their patterns are causing problems.

What are the symptoms of personality disorders?

Each of the 10 types has its own specific signs, but personality disorders generally share problems in two areas, how a person sees themselves and how they relate to others. The signs below are broad patterns rather than a checklist.

Signs in identity and thinking affect how a person sees themselves and the world.

• An unstable or unclear sense of self, or self-esteem that swings high or low
• Rigid or distorted beliefs about yourself, others, or the world
• Difficulty seeing how your own behavior affects others
• Trouble with impulse control or managing emotions

Signs in relationships and behavior affect how a person connects with others day to day.

• Ongoing difficulty forming close, stable relationships
• Patterns others find confusing, frustrating, or hurtful
• Being emotionally detached, or overly needy of attention and care
• Problems at work or in social situations because of these patterns

A key feature is that many people with a personality disorder have little awareness that their patterns are causing difficulty, which is part of why loved ones often notice first.

Who is at increased risk for personality disorders?

Personality disorders are among the least understood mental health conditions, and their exact cause is still being studied. Researchers point to a mix of genetics, brain differences, and early life experiences. Knowing the common factors can help you make sense of a diagnosis, even though having them does not mean a personality disorder will develop.

Biological factors

• A family history, since genetics appear to play a role
• Subtle differences in brain areas that process emotion and fear

Life and environmental factors

• Childhood trauma, including abuse or neglect
• Verbal abuse in childhood
• Cultural and family environment

Personality disorders usually emerge in the teen years, as personality develops. Because the causes are still being studied, these factors describe risk rather than certainty.

How are personality disorders treated?

Personality disorders can be challenging to treat, partly because a person may not see their patterns as a problem, but psychotherapy helps and many people improve when they stay engaged with it. There are no medications approved specifically for personality disorders, though some can ease related symptoms.

Psychotherapy is the main treatment. It helps you recognize troubling patterns, understand that difficulties come from within rather than only from others, and build healthier ways of thinking and relating.

Dialectical behavior therapy (DBT) is effective for borderline personality disorder, teaching skills for managing intense emotions, while cognitive behavioral therapy (CBT) helps with several other personality disorders. The right approach depends on the specific type.

Medication for related symptoms can help even though none treats a personality disorder directly. Antidepressants or anti-anxiety medications can ease the depression and anxiety that often come alongside it.

Progress takes time and commitment, and studies show outcomes improve a great deal when people stay engaged with treatment.

When should you seek help?

Because personality disorders can be hard to recognize from the inside, people often seek help for related problems like anxiety, depression, or difficulties at work or in relationships. If patterns of thinking or relating are repeatedly causing distress or conflict, that is a good reason to talk to a mental health professional.

Personality disorders can raise the risk of suicide, so any thoughts of self-harm deserve urgent attention; call or text 988, the Suicide and Crisis Lifeline, or call 911. If you recognize these patterns in yourself or a loved one, know that treatment can help a great deal. Whenever you feel ready, support is available.