Personality Disorder: Signs, Diagnosis and Treatment

What a personality disorder is

Everyone has personality traits: ways of thinking, feeling and behaving that make us who we are. A personality disorder is diagnosed when traits are so extreme, rigid and persistent that they cause ongoing suffering or harm, in many areas of life, for a long time. The key features are:

• thinking: how you see yourself, others and events
• emotions: range, intensity and stability of feelings
• relationships: how you relate to and trust others
• impulse control: how you manage urges

Personality disorders are not a character flaw or a choice. They are mental health conditions with recognized treatments.

There are 10 specific personality disorders, grouped into three clusters. See types of personality disorders for each type explained.

Common signs

Signs vary with type, but common patterns include:

• intense, unstable relationships with fear of abandonment
• rapid mood swings, intense anger or chronic emptiness
• impulsive or self-destructive behavior, including self-harm
• extreme distrust or suspicion of others
• difficulty empathizing or disregard for others' rights
• extreme shyness, fear of rejection and avoidance of social contact
• excessive need to be cared for, or difficulty making decisions alone
• rigid perfectionism and need for control
• odd beliefs, unusual thinking or eccentric behavior

Causes and risk factors

• genetics: personality disorders and related traits run in families
• temperament: emotional sensitivity or impulsivity present from childhood
• childhood adversity: abuse, neglect, trauma, unstable family environments
• brain differences in areas involved in emotion regulation and impulse control

Many people with these risk factors never develop a personality disorder.

Conditions that often occur alongside

• depression and anxiety
• post-traumatic stress disorder
• substance use disorders
• eating disorders
• ADHD

Personality disorders can be confused with bipolar disorder, because both involve mood changes. In bipolar disorder, mood episodes last days to weeks; in borderline personality disorder, emotions shift within hours in response to events, especially in relationships.

Diagnosis

A psychiatrist, psychologist or other mental health professional makes the diagnosis after:

• a detailed interview about long-term patterns, relationships, work and emotions
• input from family or friends when appropriate
• questionnaires and structured interviews
• ruling out other conditions, substance effects and medical causes

Diagnosis is usually made in adults, but it can be made in teenagers when patterns are persistent. Clinicians are careful, because personality is still developing in young people.

Treatment

Psychotherapy

Talking therapy is the main treatment. Evidence-based approaches include:

• Dialectical behavior therapy (DBT): teaches skills for managing emotions, distress, relationships and mindfulness; strong evidence for borderline personality disorder and self-harm
• Mentalization-based therapy (MBT): helps understand one's own and others' thoughts and feelings
• Schema therapy: addresses deep-rooted patterns from childhood
• Transference-focused psychotherapy
• Cognitive behavioral therapy (CBT) adapted for personality disorders
• Group therapy and family education

Treatment usually lasts months to years.

Medicines

No medicine is approved specifically for personality disorders. Medicines may help co-occurring depression, anxiety or specific symptoms such as impulsivity or mood instability, as part of a broader plan.

Crisis planning

A written crisis plan lists warning signs, coping strategies, people to contact and emergency numbers.

Outlook

Personality disorders were once thought to be lifelong and untreatable. Research now shows that many people, especially with borderline personality disorder, improve substantially over time, with many no longer meeting criteria after several years, particularly with treatment.

Supporting someone with a personality disorder

• learn about the condition
• encourage treatment without forcing it
• set clear, consistent boundaries
• validate feelings while not accepting harmful behavior
• look after your own mental health; family programs and support groups can help

Frequently asked questions

What is a personality disorder?

It is a long-lasting, inflexible pattern of thinking, feeling and behaving that differs from what is expected and causes distress or problems in relationships, work or daily life. It usually becomes clear by early adulthood and is treatable.

What are the signs of a personality disorder?

Signs depend on the type, but often include unstable relationships, intense or rapidly changing emotions, impulsivity, self-harm, deep distrust, extreme social avoidance, excessive dependence on others, or rigid perfectionism, persisting over years.

Can personality disorders be cured?

Many people improve significantly, especially with specialized psychotherapy such as DBT or mentalization-based therapy. Symptoms often lessen with age and treatment, and many people go on to have stable relationships and fulfilling lives.

How is a personality disorder diagnosed?

A mental health professional diagnoses it through detailed interviews about long-term patterns in thinking, emotions, relationships and behavior, sometimes using questionnaires and information from family, after ruling out other conditions.