Browse Health A-Z

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Personality disorder

 

Personality disorders are mental health conditions that affect how people manage their feelings and how they relate to other people.

Disturbances of feeling and distorted beliefs about other people can lead to odd behaviour, which can be distressing and which other people may find upsetting.

The main symptoms are:

  • being overwhelmed by negative feelings such as distress, anxiety, worthlessness or anger
  • avoiding other people and feeling empty and emotionally disconnected
  • difficulty managing negative feelings without self-harming (for example, abusing drugs and alcohol or taking overdoses) or, in rare cases, threatening other people 
  • odd behaviour
  • difficulty maintaining stable and close relationships, especially with partners, children and professional carers 
  • sometimes, periods of losing contact with reality

Symptoms typically get worse with stress.

People with personality disorders often have other mental health conditions, especially depression and substance misuse.

When and why personality disorders occur

Personality disorders typically start in adolescence and continue into adulthood.

They may be mild, moderate or severe, and people may have periods of 'remission' where they can function well.

Personality disorders are caused by a combination of genetic reasons and experiences of distress or fear during childhood, such as neglect or abuse.

Types of personality disorder

There are many different types of personality disorder. They can be broadly grouped into one of three clusters - A, B or C - which are summarised below. For a full list of the main types and signs of personality disorders, see Personality disorders - symptoms.

Cluster A personality disorders

A person with a cluster A personality disorder regards other people as alien and usually shows patterns of behaviour that most people would regard as odd and eccentric. Others may describe them as living in a fantasy world of their own.

An extreme example is paranoid personality disorder, where the person is extremely distrustful and suspicious.

Cluster B personality disorders

A person with a cluster B personality disorder struggles to regulate their feelings and often swings between positive and negative views of others. This can lead to patterns of behaviour that others describe as dramatic, unpredictable and disturbing.

An example is borderline personality disorder, where the person is emotionally unstable, has impulses to self-harm and has very intense and unstable relationships with others. 

Cluster C personality disorders

A person with a cluster C personality disorder struggles with persistent and overwhelming feelings of anxiety and fear. They tend to show patterns of behaviour that most people would regard as antisocial and withdrawn.

An example is avoidant personality disorder, where the person appears painfully shy, is socially inhibited, feels inadequate and is extremely sensitive to rejection. The person may want to be close to others, but lacks the confidence to form a close relationship.

How many people are affected?

Personality disorders are the commonest type of mental condition.

It is estimated that around 1 in every 20 people has a personality disorder. However, many people have only mild conditions so only need help at times of stress (such as bereavement). Other people with more moderate conditions may need specialist help for longer periods.

Outlook

Most people recover from personality disorders with time and proper treatment. This depends on the severity of the disorder and whether there are other ongoing problems.

Most mild to moderate personality disorders can be successfully treated with a long-term course of psychological therapy (at least 12 months).

Different types of psychological therapies have been shown to help people with personality disorders. It is important to get the right therapy. Not all talking therapies are effective and it is essential that they are delivered by a trained therapist. For more information, see Personality disorder - treatment.

How common are the different types of personality disorder?

Mild personality disorders that do not seriously interfere with a person's ability to function socially are common. Severe disorders are rare and affect less than 2% of the population.

In a survey of 8,000 people chosen at random in the UK, the most common personality disorders (PDs) were:

  • obsessive compulsive PD, found in around 2% of people
  • schizoid PD
  • avoidant PD
  • paranoid PD
  • borderline PD
  • antisocial PD, found in less than 1% of people

Many people with mild to moderate personality disorders seek treatment. People with more severe personality disorders, especially borderline and antisocial PD, may be more likely to come into contact with medical services but may be unwilling to seek treatment. This could be because they may not think there is anything wrong with them, or because they fear contact with health professionals.

The different types of personality disorder that might need treatment can be broadly grouped into one of three clusters, called A, B or C.

Cluster A personality disorders

A person with a cluster A personality disorder sees other people as alien and tends to show patterns of behaviour that most people would regard as odd and eccentric.

The main personality disorders in this category are listed below. 

Paranoid personality disorder

A person with a paranoid personality disorder is extremely distrustful and suspicious. Other symptoms include:

  • thinking other people are lying to them or trying to manipulate them
  • feeling they cannot really trust their friends and associates
  • worrying that any confidential information shared with others will be used against them
  • often thinking there are hidden meanings in remarks most people would regard as innocent
  • worrying that their spouse or partner is unfaithful, despite a lack of evidence

Schizoid personality disorder 

A person with a schizoid personality disorder may appear cold and detached and may avoid making close social contact with other people. Other symptoms include:

  • preferring to take part in activities that do not require interaction with others
  • having little desire to form close relationships, including sexual relationships
  • being uninterested when receiving criticism or praise
  • having a limited ability to experience pleasure or joy

Schizotypal personality disorder

A person with a schizotypal personality disorder is likely to have poor social skills and delusional thoughts and behave in unusual ways. Other symptoms include:

  • attaching undue and misguided significance to everyday events, such as thinking newspaper headlines are secret messages to them
  • believing in special powers, such as telepathy or the ability to influence other people's emotions and actions
  • having unusual ways of speaking, such as long, rambling vague sentences or going off on a tangent
  • experiencing excessive anxiety in social situations, even if they have known a particular person or group of people for a long time

Cluster B personality disorders

A person with a cluster B personality disorder struggles to relate to other people. As a result, they show patterns of behaviour that most people would regard as dramatic, erratic and threatening or disturbing.

The main personality disorders in this category are listed below.

Antisocial personality disorder

A person with an antisocial personality disorder sees other people as vulnerable and may enjoy intimidating or bullying others. They lack concern about the consequences that their actions may have.

Symptoms include:

  • mistrust and deceit (including lying to people)
  • feeling agitated, depressed and bored most of the time
  • manipulating and exploiting other people
  • lack of concern, regret or remorse about other people's distress
  • blaming others for problems in their lives

.

Borderline personality disorder

A person with a borderline personality disorder is emotionally unstable, has impulses to self-harm and has very intense and unstable relationships with others.

For more information, see the Health A-Z topic on borderline personality disorder.

Histrionic personality disorder

A person with a histrionic personality disorder is anxious about being ignored. As a result, they feel a compulsion (overwhelming urge) to be noticed and to be the centre of everybody's attention. Symptoms and behaviours include:

  • displaying excessive emotion yet appearing to lack real emotional sincerity
  • dressing provocatively and engaging in inappropriate flirting or sexually seductive behaviour
  • moving quickly from one emotional state to another
  • being self-centred and caring little about other people
  • constantly seeking reassurance and approval from other people

Symptoms and signs may co-exist with borderline and narcissistic personality disorders.

Narcissistic personality disorder

A person with a narcissistic personality disorder swings between seeing themselves as special and fearing they are worthless. They may act as if they have an inflated sense of their own importance and show an intense need for other people to look up to them.

Other symptoms include:

  • exaggerating their own achievements and abilities
  • thinking they are entitled to be treated better than other people
  • exploiting other people for their own personal gain
  • lacking empathy for other people's weaknesses 
  • looking down on people they feel are 'beneath' them, while feeling deeply envious of people they see as being 'above' them

Cluster C personality disorders

A person with a cluster C personality disorder fears personal relationships and shows patterns of anxious and fearful behaviour around other people. Others may comment that they are withdrawn and reluctant to socialise.

The main personality disorders in this category are listed below.

Avoidant personality disorder

A person with an avoidant personality disorder appears painfully shy, is socially inhibited, feels inadequate and is extremely sensitive to rejection.

Unlike people with schizoid personality disorders, they desire close relationships with others but lack the confidence and ability to form them.

Dependent personality disorder

A person with a dependent personality disorder feels they have no ability to be independent. They may show an excessive need for other people to look after them and are very 'clingy'. Other symptoms include:

  • finding it difficult to make decisions without other people's guidance
  • needing others to take responsibility over what should be their own important life choices
  • not being able to express disagreement with other people
  • finding it difficult to start new activities due to a lack of confidence
  • going to extremes to obtain support and comfort
  • feeling helpless and uncomfortable when alone
  • urgently needing to start a new relationship once a previous relationship comes to an end
  • having an unrealistic and constant fear they will be left alone to fend for themselves

Obsessive compulsive personality disorder

A person with an obsessive compulsive personality disorder is anxious about issues that seem out of control or 'messy'. They are preoccupied with orderliness and ways to control their environment and may come across to others as a 'control freak'.

Other symptoms include:

  • having an excessive interest in lists, timetables and rules
  • being so concerned with completing a task perfectly that they have problems completing it (perfectionism)
  • being a workaholic
  • having very rigid views about issues such as morality, ethics and how a person should behave in daily life
  • hoarding items that seem to have no monetary or sentimental value
  • being unable to delegate tasks to other people
  • disliking spending money, as they think it is always better to save for a 'rainy day'

This personality disorder differs from obsessive compulsive disorder (OCD), a related mental health condition, in several important ways:

  • People with OCD are aware that their behaviour is abnormal and are anxious about it. Most people with obsessive compulsive personality disorder think their behaviour is perfectly acceptable and have no desire to change it.
  • Most people with OCD are compelled to carry out rituals, such as having to touch every second lamppost as they walk down the street. This is not usually the case with people with obsessive compulsive personality disorder.
  • People with OCD may feel compelled to make lists or organise items in their house but feel anxious about doing so. People with obsessive compulsive personality disorder find relief from anxiety when doing such tasks and may become irritated when they are prevented from doing so.

For more information, see the Health A-Z topic on Obsessive compulsive disorder.

Treatment for most personality disorders usually involves a long-term course of psychological therapy. This normally lasts 6-12 months, depending on the severity of the condition and other co-existing problems.

Psychological therapies are treatments that involve discussion of thoughts, feelings and emotions with a trained professional. The aim of all psychological therapies is to improve people's ability to regulate their thoughts and emotions.

Some therapies focus on dysfunctional thoughts, while others focus on self-reflection and being aware of how your own mind works. Some therapies, especially group therapies, help people understand social relationships better.

Psychological therapies can be highly effective for many personality disorders. However, they should only be delivered by a trained professional who has experience of working with personality disorders and other clinical conditions. This is because personality disorders are serious conditions that can be associated with high-risk behaviours, such as self-harm.

As well as listening and discussing important issues with you, the psychotherapist can suggest strategies to resolve problems and, if necessary, can help you change your attitudes and behaviour.

A range of different psychotherapies is used to treat personality disorders. They can be broadly classified into three types of therapy, which are outlined below.

Psychodynamic (reflective) psychotherapy

Psychodynamic psychotherapy is based on evidence that many adult patterns of behaviour are the result of negative early childhood experiences. These experiences cause patterns of distorted thinking and beliefs that may have been understandable in childhood but do not work in adult life. The goal of therapy is to explore these distortions, understand how they arose, and find effective ways to overcome their influence on your thinking and behaviour.

Both individual and group dynamic therapy has been shown to be helpful for personality disorders, especially borderline personality disorder (BPD). A particular form, called mentalisation-based therapy, is recommended for BPD.

Cognitive behavioural therapy

Cognitive behavioural therapy(CBT) is based on the theory that how we think about a situation affects how we act. In turn, our actions can affect how we think and feel. Therefore, it is necessary to change both the act of thinking (cognition) and behaviour at the same time.

A type of CBT called dialectical behaviour therapy (DBT) has proved successful in helping people reduce impulsive self-harming behaviours, especially in borderline personality disorder. DBT is designed to help you cope better with emotional instability, while at the same time encouraging you to behave in a more positive way.

For more information on DBT, see Borderline personality disorder - treatment.

Interpersonal therapy

Interpersonal therapy (IPT) is based on the theory that our relationships with other people and the outside world in general have a powerful effect on our mental health.

Several personality disorders may be associated with feelings of low self-esteem, anxiety and self-doubt caused by problems interacting with people.

During IPT, the therapist will explore any negative issues associated with your interpersonal relationships and how these issues can be resolved.

Medication

Currently, no medication has been licensed for the treatment of any personality disorder. However, medications may be prescribed to help people engage in therapy and think about their problems. For example, if you have moderate to severe symptoms of depression that make it difficult to approach your therapy with confidence or enthusiasm, you may be prescribed a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). Some people, especially those with borderline personality disorder, have found mood-stabilising medication helpful.

Therapeutic communities

Therapeutic communities (TCs) are a form of group therapy in which the experience of having a personality disorder is explored in depth. TCs are an intensive form of therapy. The minimum type of TC is one day a week, but others are 9-5pm, five days a week. They have been shown to be effective for mild to moderate personality disorders, but require a high level of commitment.


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.