Mental health issues grow less stigmatized every year, yet personality disorders remain confusing to many people. However, because roughly 10 percent of the adult U.S. population is afflicted with a personality disorder, it is wise to educate oneself on some of the most common personality disorders and their symptoms, as well as options for treatment.
What is a Personality Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), commonly referred to as the "bible of psychiatry," a personality disorder is "a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time." In other words, personality disorders are abnormal behaviors, thoughts, or feelings that cause chronic distress or dysfunction. A personality disorder must exhibit many types of these behaviors for a long history, and some people may experience several types of personality disorders simultaneously.
Personality disorders are difficult to define and therefore easily misunderstood. They differ from the five major categories of mental illness (anxiety disorders, mood disorders, schizophrenia and psychotic disorders, dementia, and eating disorders), which often begin at a young age; can be caused by genetics, brain chemistry and environmental toxins; and number over 200 in all. Personality disorders are considered a type of mental illness or mental disorder, which typically present in teenage years or early adulthood; can be caused by genetics and environmental influences; and are generally categorized in three different "clusters," or categories, with a total of 10 in all. The three "clusters" of emotional types that organize these 10 personality disorders are:
- Cluster A: Odd, eccentric, bizarre. The personality disorders in this cluster (Paranoid, Schizoid, and Schizotypal) are characterized by strange or eccentric behaviors. People with these types of personality disorders are usually high-functioning, and therefore can often be mistaken for simply quirky or odd.
- Cluster B: Dramatic, emotional, erratic. The personality disorders in this cluster (Antisocial, Borderline, Histrionic, and Narcissistic) are characterized by highly dramatic responses to everyday situations, unpredictable behavior, and overly emotional thinking and reactions.
- Cluster C: Anxious, fearful. The personality disorders in this cluster (Avoidant, Dependant, and Obsessive-Compulsive Personality Disorder) are characterized by overwhelmingly anxious behavior and inflexible paralysis by fear.
Signs of a Personality Disorder
Despite their high occurrence rate, personality disorders can still be difficult to diagnose; even seasoned psychiatrists may struggle to identify them since their symptoms vary so widely from person to person. Furthermore, pinpointing personality disorders can be especially confusing because they are often simply umbrellaed under the term "mental illness." Although they do fall under the category of mental illness as outlined in the DSM-5, one main distinction is that personality disorders are often first treated with various forms of talk therapy rather than medication, while most other mental illnesses are treated first with medication and later with therapy.
Ultimately, both personality disorders and other forms of mental illness can only be properly diagnosed by a qualified professional.
4 Common Personality Disorders and Their Symptoms
When taken individually, some symptoms of personality disorders don't seem too worrisome. For example, many of us have occasional days where we selfishly disregard others' feelings, feel unmotivated or overwhelmed, or tolerate poor treatment from friends or colleagues. However, when a number of symptoms occur for a long period of time and (this is important) hinder a person's ability or desire to function normally, that should be cause for concern. Below are the symptoms of four common personality disorders; if you suspect you or a loved one suffers from one or more of these disorders please seek medical attention from a qualified mental health professional.
1. Obsessive-compulsive Personality Disorder (not to be confused with obsessive-compulsive disorder, or OCD, a type of anxiety disorder), is the most common personality disorder in the United States. It is difficult to spot because not all of the symptoms—high standards and strong work ethic for example—are considered negative by social standards. However, when a person exhibits multiple symptoms to such a degree that their quality of life is hindered, obsessive-compulsive personality disorder might be the cause. Some symptoms of obsessive-compulsive personality disorder include:
- Struggle with overwhelming worry and doubt
- Extreme preoccupation with details, order, and rules
- Extreme perfectionism; real or perceived failure is very distressing
- Dysfunctional desire to control situations; inability or stubborn refusal to delegate tasks for the fear that others might underperform
- Neglect of friends and hobbies for commitment to perfecting work or projects
- Rigid, stubborn, judgmental, inflexible
2. Narcissistic Personality Disorder is the next most common personality disorder among adults in the United States. Narcissists struggle with extreme feelings of self importance—sometimes so much that actual facts become less important than one's own perceived achievements or accomplishments, as well others' perceptions. Narcissistic personality disorder may present symptoms such as:
- Literal belief that you're more special and important than anyone else
- Obsessive fantasies about power and success
- Failure or inability to recognize others' needs and feelings
- Gross exaggeration of personal achievements
- Desire or expectation of constant praise and admiration
- Extreme arrogance
- Envy of others; expectation that others envy you
3. Borderline Personality Disorder is the third most prevalent personality disorder in the United States, and one of the more well-known PDs because of its many portrayals in mainstream films such as Winona Ryder's character in Girl, Interrupted and Glenn Close's character in Fatal Attraction (though neither of these are necessarily accurate representations of the disorder). According to the National Institute of Mental Health, borderline personality disorder is "marked by an ongoing pattern of varying moods, self-image, and behavior." Other symptoms of borderline personality disorder include:
- Tendency toward impulsive, risky actions such as unsafe sex, gambling, reckless driving or spending sprees
- Unstable or fragile self-image; binge eating
- Dysfunctional, unstable relationships
- Suicidal behavior or threats of self-harm
- Intense fear of real or imagined abandonment, even cutting oneself off of personal relationships to avoid being abandoned later
- Feelings of emptiness for extended periods of time
- Frequent, intense outbursts of anger
- Paranoia and difficulty trusting
4. Dependant Personality Disorder, another common personality disorder, is marked by an inability to meet one's own emotional and physical needs, and reliance on others instead. People suffering with dependent personality disorder might exhibit:
- Excessive clinginess or dependence on others; feelings of fear when left alone to care for oneself
- Submissive or passive behavior toward others
- Extreme self-doubt; unable to make even insignificant decisions without excessive advice and reassurance from others; inability to start projects due to paralyzing lack of self-confidence
- Inability to disagree with others, fearing disapproval
- Tolerance of unnecessarily poor or abusive treatment
- Immediate desire to fill a relationship void when a close one has ended
Personality Disorder Treatment
If you have a personality disorder, you aren't "broken," and you aren't doomed to a substandard life: there are treatment options that have been proven to help people suffering from personality disorders. Even though medicine is not commonly used for the immediate treatment of personality disorders (but often helps with alleviating some of the mental health difficulties that accompany personality disorders), that doesn't mean treatment is unimportant. In reality, treatment of personality disorders is crucially important: according to the American Psychiatric Association, "[w]ithout treatment, the [personality disorder] behavior and experience is inflexible and usually long-lasting." Personality disorders do not usually resolve themselves on their own, so getting professional help is highly recommended.
Personality disorder treatments typically consist of individual, group, or family psychotherapy (also called talk therapy), of which there are many types including Mentalization Based Therapy (MBT), Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Schema Focused Therapy, Transference Focused Therapy, Dynamic Psychotherapy, and Cognitive Analytical Therapy. For more severe cases of personality disorders, especially when the patient is at high risk of harming self or others, inpatient treatment options are available.
Treatment for personality disorders can take months or even years because of the longstanding nature of the disorder. It may also require a reliable team of caring professionals, including a primary care provider, psychiatrist, psychologist or other therapist, psychiatric nurse, pharmacist, and social worker. At the San Antonio Behavioral Healthcare hospital we offer all of these medical professionals in one convenient location, so your mental health team can all work together to treat and maintain your personality disorder in the best way possible.
If you or someone you love might be suffering from a debilitating personality disorder, please call our 24/7 toll-free Admission Line at 210.541.5350 to arrange a visit with our qualified professionals. The San Antonio Behavioral Healthcare Hospital offers a private and confidential assessment to help explain the treatment options that will work best for you or your loved one.