Personality Disorders

What are personality disorders?

A personality disorder is a long-lasting pattern of thinking, feeling and behaving that differs significantly from what is expected in a person’s culture, is inflexible, and leads to distress or problems in relationships, work or other areas of life. These patterns usually become noticeable in adolescence or early adulthood.

Types

Clinicians describe several personality disorders, often grouped into three clusters:

• Cluster A (odd or eccentric patterns), such as paranoid and schizoid personality disorders.
• Cluster B (dramatic, emotional or erratic patterns), such as borderline, narcissistic and antisocial personality disorders.
• Cluster C (anxious or fearful patterns), such as avoidant, dependent and obsessive-compulsive personality disorders. (Obsessive-compulsive personality disorder is different from OCD.)

Borderline personality disorder

BPD is characterized by intense and unstable emotions, a fragile sense of self, fear of abandonment, impulsive behavior and difficulties in relationships. Self-harm and suicidal thoughts can occur, so access to support is important.

These symptoms can occur with personality disorders, but only a qualified professional can provide a diagnosis.

Causes

Personality disorders likely result from a combination of genetic factors and life experiences, particularly childhood adversity or trauma.

Treatment

Psychotherapy is the main treatment. For BPD, approaches with good evidence include dialectical behavior therapy (DBT), mentalization-based treatment, schema therapy and transference-focused psychotherapy. Medications are not a primary treatment for personality disorders but may be used for co-occurring symptoms such as depression or anxiety.

Some therapists on online platforms such as BetterHelp and Sesame offer DBT-informed therapy; for borderline personality disorder, ask whether a full DBT program with skills training is available.

Understanding personality disorders without stigma

Personality disorders are conditions in which long-standing patterns of thinking, feeling and relating to others differ markedly from cultural expectations, cause distress or difficulty in functioning and are inflexible across many situations. They typically emerge in adolescence or early adulthood. The term can sound judgmental, but these are recognized health conditions, often linked to difficult early experiences, and many people improve substantially with the right treatment. Using respectful language, such as “a person with borderline personality disorder,” matters because these conditions are heavily stigmatized, even among clinicians, which can delay care.

How the types are grouped

Clinicians usually group personality disorders into three clusters:

• Cluster A (odd or eccentric): paranoid, schizoid and schizotypal personality disorders.
• Cluster B (dramatic, emotional or erratic): antisocial, borderline, histrionic and narcissistic personality disorders.
• Cluster C (anxious or fearful): avoidant, dependent and obsessive-compulsive personality disorders.

Many people don’t fit neatly into one type, and diagnosis requires careful assessment by an experienced clinician. These descriptions can occur with personality disorders, but only a qualified healthcare professional can provide a diagnosis.

Borderline personality disorder in more detail

Borderline personality disorder (BPD) involves intense, rapidly shifting emotions, a fragile sense of identity, fear of abandonment, unstable relationships, impulsive behavior and, for some, self-harm or suicidal thoughts. People with BPD often feel emotions more intensely and take longer to recover from them, and describe feeling “emotionally sunburned.” Many have a history of trauma, though not everyone does. BPD is frequently mistaken for bipolar disorder, because both involve mood changes, but mood shifts in BPD are usually shorter and driven by interpersonal triggers, and treatment differs. BPD often occurs with depression, anxiety, PTSD, eating disorders and substance use.

The outlook is better than many people assume. Long-term studies suggest that a majority of people with BPD no longer meet the criteria after several years, particularly with specialized treatment.

Treatment that works

Psychological therapy is the main treatment, and several specialized approaches have research support:

• Dialectical behavior therapy (DBT) teaches skills in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, and is one of the best-studied treatments for BPD.
• Mentalization-based treatment (MBT) helps people understand their own and others’ thoughts and feelings.
• Schema therapy and transference-focused psychotherapy explore long-standing patterns and relationships.
• Other approaches, including cognitive therapies adapted to specific personality difficulties.
• Medication doesn’t treat personality disorders directly, but may help with co-occurring depression, anxiety or other symptoms, and is chosen with a prescriber.

Treatment generally takes months to years. Finding a therapist with specific training is important. See psychotherapy and our comparison of CBT vs. DBT.

Supporting someone you care about

• Learn about the condition and try to understand that strong reactions often reflect real distress.
• Stay calm and validate feelings, even when you disagree with behavior.
• Set clear, consistent and compassionate boundaries, which help both of you; see how to set healthy boundaries.
• Take self-harm and suicidal statements seriously, and encourage professional help.
• Look after yourself, and consider family support programs.

When to seek urgent help

If you or someone you care about is thinking of self-harm or suicide, or is in immediate danger, call your local emergency number or a crisis line; see Get Help Now. Reaching out during a crisis is a sign of strength, not weakness. Longer term, speaking with a mental health professional experienced in personality disorders can open the door to effective treatment, and many people go on to build stable relationships and rewarding lives.