Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. Many gradually become less severe with age, but certain traits may persist to some degree after the acute symptoms that prompted the diagnosis of a disorder abate. Diagnosis is clinical. Treatment is with psychosocial therapies and sometimes drug therapy.
Personality traits represent patterns of thinking, perceiving, reacting, and relating that are relatively stable over time.
Personality disorders exist when these traits become so pronounced, rigid, and maladaptive that they impair work and/or interpersonal functioning. These social maladaptations can cause significant distress in people with personality disorders and in those around them. For people with personality disorders [unlike many others who seek counseling], the distress caused by the consequences of their socially maladaptive behaviors is usually the reason they seek treatment, rather than any discomfort with their own thoughts and feelings. Thus, clinicians must initially help patients see that their personality traits are the root of the problem.
Personality disorders usually start to become evident during late adolescence or early adulthood, although sometimes signs are apparent earlier [during childhood]. Traits and symptoms vary considerably in how long they persist; many resolve with time.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] lists 10 types of personality disorders Types of Personality Disorders Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders... read more , although most patients who meet criteria for one type also meet criteria for one or more others. Some types [eg, antisocial Antisocial Personality Disorder [ASPD] Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others. Diagnosis is by clinical criteria. Treatment may include cognitive-behavioral... read more , borderline Borderline Personality Disorder [BPD] Borderline personality disorder is characterized by a pervasive pattern of instability and hypersensitivity in interpersonal relationships, instability in self-image, extreme mood fluctuations... read more ] tend to lessen or resolve as people age; others [eg, obsessive-compulsive Obsessive-Compulsive Personality Disorder [OCPD] Obsessive-compulsive personality disorder is characterized by a pervasive preoccupation with orderliness, perfectionism, and control [with no room for flexibility] that ultimately slows or interferes... read more , schizotypal Schizotypal Personality Disorder [STPD] Schizotypal personality disorder is characterized by a pervasive pattern of intense discomfort with and reduced capacity for close relationships, by distorted cognition and perceptions, and... read more ] are less likely to do so.
About 10% of the general population and up to half of psychiatric patients in hospital units and clinics have a personality disorder. Overall, there are no clear distinctions in terms of sex, socioeconomic class, and race. However, in antisocial personality disorder, men outnumber women 6:1. In borderline personality disorder, women outnumber men 3:1 [but only in clinical settings, not in the general population].
For most personality disorders, levels of heritability are about 50%, which is similar to or higher than that of many other major psychiatric disorders. This degree of heritability argues against the common assumption that personality disorders are character flaws primarily shaped by an adverse environment.
DSM-5 groups the 10 types of personality disorders into 3 clusters [A, B, and C], based on similar characteristics. However, the clinical usefulness of these clusters has not been established.
Cluster A is characterized by appearing odd or eccentric. It includes the following personality disorders with their distinguishing features:
Cluster B is characterized by appearing dramatic, emotional, or erratic. It includes the following personality disorders with their distinguishing features:
Cluster C is characterized by appearing anxious or fearful. It includes the following personality disorders with their distinguishing features:
Symptoms and Signs of Personality Disorders
According to DSM-5, personality disorders are primarily problems with
Self-identity
Interpersonal functioning
Self-identity problems may manifest as an unstable self-image [eg, people fluctuate between seeing themselves as kind or cruel] or as inconsistencies in values, goals, and appearance [eg, people are deeply religious while in church but profane and disrespectful elsewhere].
Interpersonal functioning problems typically manifest as failing to develop or sustain close relationships and/or being insensitive to others [eg, unable to empathize].
People with personality disorders often seem inconsistent, confusing, and frustrating to people around them [including clinicians]. These people may have difficulty knowing the boundaries between themselves and others. Their self-esteem may be inappropriately high or low. They may have inconsistent, detached, overemotional, abusive, or irresponsible styles of parenting, which can lead to physical and mental problems in their spouse and/or children.
People with personality disorders may not recognize that they have problems.
Clinical criteria [DSM-5]
Personality disorders are underdiagnosed. When people with personality disorders seek treatment, their chief complaints are often of depression or anxiety rather than of the manifestations of their personality disorder. Once clinicians suspect a personality disorder, they evaluate cognitive, affective, interpersonal, and behavioral tendencies using specific diagnostic criteria. More sophisticated and empirically rigorous diagnostic tools are available for more specialized and academic clinicians.
Diagnosis of a personality disorder requires the following:
A persistent, inflexible, pervasive pattern of maladaptive traits involving ≥ 2 of the following: cognition [ways or perceiving and interpreting self, others, and events], affectivity, interpersonal functioning, and impulse control
Significant distress or impaired functioning resulting from the maladaptive pattern
Relative stability and early onset [traced back to at least adolescence or early adulthood] of the pattern
For a personality disorder to be diagnosed in patients