Personality disorders

Overview

People have unique personalities made up of a complex combination of different traits. Personality traits affect how people understand and relate to the world around them, as well as how they see themselves.

Ideally, people's personality traits allow them to flexibly adapt to their changing environment in ways that lead to more healthy relationships with others and better coping strategies. When people have personality traits that are less adaptive, this leads to inflexibility and unhealthy coping. For example, they may manage stress by drinking or misusing drugs, have a hard time managing their anger, and find it hard to trust and connect with others.

Personality forms early in life. It is shaped through a blend of your:

• Genes — Your parents may pass down some personality traits to you. Sometimes these traits are called your temperament.
• Environment — This includes your surroundings, events that have happened to you and around you, and relationships and patterns of interactions with family members and others.

A personality disorder is a mental health condition where people have a lifelong pattern of seeing themselves and reacting to others in ways that cause problems. People with personality disorders often have a hard time understanding emotions and tolerating distress. And they act impulsively. This makes it hard for them to relate to others, causing serious issues, and affecting their family life, social activities, work and school performance, and overall quality of life.

Symptoms

In some cases, you may not know that you have a personality disorder. That's because how you think and behave seems natural to you. You also may think others are responsible for your challenges.

There are many types of personality disorders, each with important differences. These disorders are organized into three groups, or clusters, with shared features and symptoms:

Group A personality disorders

Group A personality disorders have a consistently dysfunctional pattern of thinking and behavior that reflects suspicion or lack of interest in others. They include:

Paranoid personality disorder

• Lacks trust and is suspicious of others and the reasons for their actions.
• Believes that others are trying to do harm with no reason to feel this way.
• Doubts the loyalty of others.
• Is not willing to trust others.
• Hesitates to confide in others for fear that others will use that information against them.
• Takes innocent remarks or situations that are not threatening as personal insults or attacks.
• Becomes angry or hostile to what are believed to be slights or insults.
• Has a habit of holding grudges.
• Often suspects that a spouse or sexual partner is unfaithful with no reason to feel this way.

Schizoid personality disorder

• Appears to be cold to or not interested in others.
• Almost always chooses to be alone.
• Is limited in how emotions are expressed.
• Cannot take pleasure in most activities.
• Cannot pick up typical social cues.
• Has little to no interest in having sex with another person.

Schizotypal personality disorder

• Has unusual thinking, beliefs, speech or behavior.
• Feels or thinks strange things, such as hearing a voice whisper their name.
• Has flat emotions or emotional responses that are socially unusual.
• Has social anxiety, including not being comfortable making close connections with others or not having close relationships.
• Responds to others in ways that are not proper or shows suspicion or lack of interest.
• Has "magical thinking"— the belief that their thoughts can affect other people and events.
• Believes that some casual incidents or events have hidden messages.

Group B personality disorders

Group B personality disorders have a consistently dysfunctional pattern of dramatic, overly emotional thinking or unpredictable behavior. They include:

Borderline personality disorder

• Has a strong fear of being alone or abandoned.
• Has ongoing feelings of emptiness.
• Sees self as being unstable or weak.
• Has deep relationships that are not stable.
• Has up and down moods, often due to stress when interacting with others.
• Threatens self-harm or behaves in ways that could lead to suicide.
• Is often very angry.
• Shows impulsive and risky behavior, such as having unsafe sex, gambling or binge eating.
• Has stress-related paranoia that comes and goes.

Histrionic personality disorder

• Always seeks attention.
• Is overly emotional or dramatic or stirs up sexual feelings to get attention.
• Speaks dramatically with strong opinions but has few facts or details to back them up.
• Is easily led by others.
• Has shallow emotions that change quickly.
• Is very concerned with physical appearance.
• Thinks relationships with others are closer than they are.

Narcissistic personality disorder

• Has beliefs about being special and more important than others.
• Has fantasies about power, success and being attractive to others.
• Does not understand the needs and feelings of others.
• Stretches the truth about achievements or talents.
• Expects constant praise and wants to be admired.
• Feels superior to others and brags about it.
• Expects favors and advantages without a good reason.
• Often takes advantage of others.
• Is jealous of others or believes that others are jealous of them.

Antisocial personality disorder

• Has little, if any, concern for the needs or feelings of others.
• Often lies, steals, uses false names and cons others.
• Has repeated run-ins with the law.
• Often violates the rights of others.
• Is aggressive and often violent.
• Has little, if any, concern for personal safety or the safety of others.
• Behaves impulsively.
• Is often reckless.
• Has little, if any, regret for how their behavior negatively affects others.

Group C personality disorders

Group C personality disorders have a consistently dysfunctional pattern of anxious thinking or behavior. They include:

Avoidant personality disorder

• Is very sensitive to criticism or rejection.
• Does not feel good enough, important or attractive.
• Does not take part in work activities that include contact with others.
• Is isolated.
• Does not try new activities and does not like meeting new people.
• Is extremely shy in social settings and in dealing with others.
• Fears disapproval, embarrassment or being made fun of.

Dependent personality disorder

• Relies on others too much and feels the need to be taken care of.
• Is submissive or clingy toward others.
• Fears having to take care of self if left alone.
• Lacks confidence in abilities.
• Needs a lot of advice and comforting from others to make even small decisions.
• Finds it hard to start or do projects due to lack of self-confidence.
• Finds it hard to disagree with others, fearing they will not approve.
• Endures poor treatment or abuse, even when other options are available.
• Has an urgent need to start a new relationship when a close one ends.

Obsessive-compulsive personality disorder

• Focuses too much on details, orderliness and rules.
• Thinks everything needs to be perfect and gets upset when perfection is not achieved.
• Cannot finish a project because reaching perfection is not possible.
• Needs to be in control of people, tasks and situations.
• Cannot assign tasks to others.
• Ignores friends and enjoyable activities because of too much focus on work or a project.
• Cannot throw away broken or worthless objects.
• Is rigid and stubborn.
• Is not flexible about morality, ethics or values.
• Holds very tight control over budgeting and spending money.

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, which is an anxiety disorder.

Many people with one type of personality disorder also have symptoms of at least one other type. The number of symptoms a person has may vary.

When to see a doctor

If you have any symptoms of a personality disorder, see your doctor or a mental health professional. When personality disorders are not treated, they can cause serious issues in relationships and mood. Also, the ability to function and pursue personal goals may get worse without treatment.

Causes

It's believed that personality disorders are caused by a blend of how genetics and your environment affect you. Your genes may make it more likely that you develop a personality disorder, and what happens to you in life may set a personality disorder into motion.

Risk factors

Although the specific causes of personality disorders are not known, some factors seem to increase the risk of having one:

• Specific personality traits. This includes always trying to stay away from harm, or the opposite — a strong need to seek out new activities that get the adrenaline pumping. It also includes poor impulse control.
• Early life experiences. This includes a home environment that is not stable, predictable or supportive. It also includes a history of trauma — physical neglect or abuse, emotional neglect or abuse, or sexual abuse.

Complications

Personality disorders can seriously disrupt your life and the lives of those who care about you. They may cause issues in relationships, work or school. And they can lead to social isolation, other mental health issues with addictions, as well as occupational and legal issues.