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Personality Disorder

A person with a personality disorder thinks, feels, behaves or relates to others very differently to the average person.

There are several different types of personality disorder. This page gives some information about personality disorders in general, linking out to other sources for more detail.

Symptoms of a personality disorder

Symptoms vary depending on the type of personality disorder.

A person with borderline personality disorder (one of the most common types) tends to have disturbed ways of thinking, impulsive behaviour and problems controlling their emotions. They may have intense but unstable relationships and worry about people abandoning them. Read more about borderline personality disorder.

A person with antisocial personality disorder will typically get easily frustrated and have difficulty controlling their anger. They may blame other people for problems in their life, and be aggressive and violent, upsetting others with their behaviour. Read more about antisocial personality disorder.

You can also read about the other types of personality disorder on the Royal College of Psychiatrists website.

Someone with a personality disorder may also have other mental health problems, such as depression and substance abuse.

Treatment for a personality disorder

Treatment for a personality disorder usually involves a talking therapy. This is where the person talks to a therapist to get a better understanding of their own thoughts, feelings and behaviours.

It will last for at least three months but can often last longer depending on the severity of the condition and other problems the person may have.

As well as listening and discussing important issues with the person, the therapist may identify strategies to resolve problems and, if necessary, help them change their attitudes and behaviour.

Therapeutic communities

Therapeutic communities (TCs) are an intensive form of group therapy in which the experience of having a personality disorder is explored in depth.

The person attends at least one day a week and sometimes even five full days a week. TCs have been shown to be effective for mild to moderate personality disorders but require a high level of commitment.

Medication

Medication may be prescribed to treat problems associated with a personality disorder, such as depression, anxiety or psychotic symptoms.

For example, moderate to severe symptoms of depression might be treated with a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).

You can read more about the treatment for borderline personality disorder and antisocial personality disorder.

You can also visit the Royal College of Psychiatrists website, and charity websites Mind and Rethink Mental Illness for their patient information on treatment for other types of personality disorder.

Recovery

Many people with a personality disorder recover over time. Psychological or medical treatment is often helpful, but support is sometimes all that's needed. There's no single approach that suits everyone – treatment should be tailored to the individual.

Causes

It's not clear exactly what causes personality disorders, but they are thought to result from a combination of the genes a person inherits and early environmental influences – for example, a distressing childhood experience (such as abuse or neglect).

Support for people living with a personality disorder

Having a personality disorder can have a big effect on the person's life, as well as their family and friends, but support is available.

If you would like support for yourself or someone you know, you may find the following links useful:

Ask your GP about support groups for personality disorders near you. Or find out what mental health services exist and how to access them.


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 tends to have difficulty relating to others and usually shows patterns of behaviour 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 features 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
  • thinking there are hidden meanings in remarks most would regard as innocent
  • worrying that their spouse or partner is unfaithful, despite a lack of evidence

Schizoid personality disorder 

Someone with a schizoid personality disorder may appear cold and detached, and avoid making close social contact with others. Other features 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 features 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 a long time

Cluster B personality disorders

Someone with a cluster B personality disorder struggles to relate to others. As a result, they show patterns of behaviour most 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 intimidate or bully others without remorse. They lack concern about the consequences of their actions.

Symptoms include:

  • lack of concern, regret or remorse about other people's distress
  • irresponsibility and disregard for normal social behaviour
  • difficulty in sustaining long-term relationships
  • little ability to tolerate frustration and to control their anger
  • lack of guilt, or not learning from their mistakes
  • blaming others for problems in their lives

The National Institute for Health and Care Excellence (NICE) has published guidelines on how people with antisocial personality disorders should be treated. For more information, see NICE: antisocial personality disorder (PDF, 250kb).

Borderline personality disorder

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

Read more about borderline personality disorder.

Histrionic personality disorder

A person with histrionic personality disorder is anxious about being ignored. As a result, they feel a compulsion (overwhelming urge) to be noticed and the centre of everyone’s attention. Features 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 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

Someone with a cluster C personality disorder fears personal relationships and shows patterns of anxious and fearful behaviour around other people. Others may be withdrawn and reluctant to socialise.

The main personality disorders in this category are listed below.

Avoidant personality disorder

A person with 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 dependent personality disorder feels they have no ability to be independent. They may show an excessive need for others to look after them and are "clingy". Other features 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 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 features 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.
  • Some 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 prevented from doing so.

Treatment for most personality disorders usually involves a course of psychological therapy. This normally lasts at least six months, often longer, depending on the severity of the condition and other co-existing problems.

Psychological therapies

Psychotherapy is a treatment that involves discussion of thoughts, emotions and behaviours 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 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 are used to treat personality disorders. They can be broadly classified into three types of therapy, outlined below.

Psychodynamic (reflective) psychotherapy

Psychodynamic psychotherapy is based on the idea that many adult patterns of behaviour are related to 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 psychodynamic therapy may be helpful for personality disorders, especially borderline personality disorder (BPD). A particular form, called mentalisation-based therapy, is recommended for BPD.

Read about treating BPD for more information on mentalisation-based therapy.

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 BPD. 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.

Read about treating BPD for more on DBT.

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.

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 9am-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.

Medication

No medication is currently licensed for the treatment of any personality disorder. However, medications may be prescribed to treat associated problems, such as depression, anxiety or psychotic symptoms.

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 BPD, have found mood-stabilising medication helpful.


 

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