We all have that one friend, co-worker, or even family member that has always seemed a little…off. Sometimes, it’s how they speak or a particular eccentric behavior. Maybe it’s because they don’t seem to have the same emotional response as other people. Whatever the case, chances are pretty good you’ve encountered multiple people with a personality disorder in your life.
Or, maybe, you feel like you’ve been a little off. Maybe loved ones have told you they don’t quite understand how you act or think. Maybe you’ve been having a hard time connecting with others, and you’re not sure why.
All these could signify that a personality disorder is getting in the way of life and happiness. Let’s talk about it.
How Common are Personality Disorders?
Surprisingly, personality disorders affect 9.1% of adults in the U.S. which makes them the second most common mental health concern (right after anxiety disorders at 19.1%).
Can children or teens be diagnosed with a personality disorder?
This is a complicated topic and professional opinions vary. Kasen et al.[2] found that a diagnosis of disruptive, anxiety, or depressive disorders in childhood or adolescence translated to a much higher chance of being diagnosed with a personality disorder in adulthood. Their theory is that kids learn maladaptive behaviors they don’t unlearn before becoming adults, leading to worse problems later.
The bottom line is that about 1 out of every 11 people have some kind of personality disorder, so if you feel like things don’t add up, that’s okay! Many other people feel the same, and you can talk to someone about it.
Are There Different Kinds of Personality Disorders? What are the Symptoms?
Yes, there are ten currently recognized and they can be complicated to diagnose. Any specific disorder has to show dysfunction (i.e. clinically significant problems) in one of four specific areas: (1) emotional control, (2) relating to others, (3) thinking about self/others, or (4) self-control. Disorders are grouped into Clusters based on the combination of these areas.
Cluster A personality disorders all show symptoms of odd, eccentric thinking or behavior. The three in this cluster are:
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Paranoid PD symptoms include extreme mistrust of others, their intentions, and their actions, coupled with the perception that innocent comments/actions are personally insulting, and hostility towards those who have “wronged” them.
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Schizoid PD presents as a lack of interest in personal/social relationships including sex, limited emotional range, inability to take pleasure in most activities, inability to read most social cues, and appearing cold/indifferent to others.
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Schizotypal PD symptoms focus on peculiar dress, beliefs, thoughts, speech, and behavior including hearing voices, inappropriate emotional responses, social anxiety, inappropriate responses to others, and the unfounded belief that one has special powers/status.
Cluster B personality disorders all include symptoms of dramatic, overly emotional, or unpredictable thinking or behavior. They are:
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Antisocial PD presents as disregard for others (lying, stealing, conning, harming), recurring illegal activity, repeated violation of others’ rights, aggressive/violent behavior, impulsiveness, irresponsibility, and lack of remorse.
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Borderline PD includes impulsive/risky behavior (unsafe sex, gambling, binge eating), unstable self-image/relationships, mood swings, suicidality/self-harm, ongoing feelings of emptiness, frequent displays of intense anger, and stress-related paranoia.
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Histrionic PD sufferers constantly seek attention through excessive emotional displays, dramatic opinions (high emotion, low facts), or sexual provocation. They are often easily influenced by others, experience shallow/shifting emotions, are overly concerned with physical appearance, and think relationships are more intimate than they are.
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Narcissistic PD looks like a persistent belief of increased personal importance over others, fantastical thinking about/exaggeration of personal qualities (power, success, attractiveness), arrogance, failure to recognize the needs of others, unreasonable expectations of others, and unreasonable feelings of envy (either of others or expected from others).
Cluster C personality disorders show symptoms of anxious, fearful thinking or behavior.
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Avoidant PD is an extreme sensitivity to criticism/rejection, dysfunctional feelings of inadequacy/inferiority, social isolation/avoidance of new activities/people, extreme shyness, and clinically significant fear of embarrassment.
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Dependent PD is characterized by excessive dependence on others, fear of needing to care for oneself, difficulty starting/doing projects alone, fear of disapproval, tolerance of poor/abusive treatment (even with other options), and an urgent need to always be in a relationship.
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Obsessive-Compulsive PD shows as extreme preoccupation with orderliness/rules, distress from dysfunctional perfectionism, the desire to be in control of everything (people, tasks, situations), excessive commitment to work leading to neglect of other areas (friends, family), hoarding, inflexible morality/values, and miserly budgeting.
Isn’t Obsessive-Compulsive an anxiety disorder?
There are two different disorders referred to by similar names, which can be confusing, but is related to how the brain is working through dysfunctional thoughts.
Obsessive-Compulsive Anxiety Disorder, what you might know as “OCD”, relates to specific intrusive thoughts or actions that cause fear or anxiety until they’re attended to in some way. An example is feeling compelled to wash one’s hands many times per day with an accompanying anxiousness/fear when they can’t. Typically, people with the anxiety disorder recognize something is wrong, but have trouble controlling it.
Obsessive-Compulsive Personality Disorder is an inflexible mindset and the symptoms are invasive to the person’s entire life. People of OCPD often don’t recognize there’s an issue at all, like many personality disorders, because it’s the way they think things should be.
What Causes Personality Disorders? Who is at Risk for Personality Disorders?
What we call your “personality” is the sum of all the experiences, thoughts, feelings, and behaviors that make you unique. These impact how you think about yourself, and how you understand the world around you. Your personality forms over time from a combination of your Genetics, or what you inherit from your parents, sometimes called your temperament, and Environment, which includes where/when you grew up, events you experienced, and your relationship with others.
Personality disorders are also thought to be caused by these same factors. Genetics might make you more susceptible to developing certain disorders, which (often traumatic) life events can then trigger. The precise cause of personality disorders is unknown, but some risk factors include:
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Childhood diagnoses of disruptive, anxiety, or depressive disorders
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Abuse, neglect, or instability during childhood
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Family history of personality or other mental health disorders
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Variations in brain chemistry and structure
What are the Treatment Options for Personality Disorders?
The appropriate treatment depends on the specific personality disorder, the severity of symptoms, and your life situation. Treatment often needs to be addressed with a care team that includes your primary care physician, a psychiatrist, and a therapist. For some mild cases, counseling with a therapist experienced with your particular disorder might be all you need.
An important point is that personality disorders are long-standing and have a large impact on a person’s life. Effective treatment can take months or years of consistent effort.
Therapy gives you the opportunity to learn about your condition and talk about the symptoms you’re experiencing. You might explore your moods, thoughts, feelings, and behaviors, working towards learning to manage your disorder. Therapy may be individual, group, or family sessions based on your needs and how comfortable you are with these options. Social skills are a common focus with personality disorders since you are, essentially, relearning how to interact with the world in a healthy way.
Medication options are usually geared toward treating specific symptoms, rather than the personality disorder as a whole.
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Anti-anxiety medications are useful for some disorders to treat insomnia, anxiety, or agitation, but they can also increase impulsivity, which is problematic for other disorders.
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Antidepressants can help with depression, anger, impulsivity, irritability, or hopelessness.
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Antipsychotics (aka neuroleptics) may help lessen anger or anxiety and can help treat psychosis (i.e. losing touch with reality).
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Mood stabilizers can help even out mood swings or reduce irritability, impulsivity, and aggression.
Hospital, in-patient & residential programs are an option for severe cases where the sufferer cannot care for themselves or there is an immediate danger of harm to self or others. Typically, the goal is to treat the worst of the symptoms in a timely manner, help the patient stabilize, and then move them to a less intensive program to keep making progress.
Wrapping it Up
Personality disorders are often misunderstood, but they impact about 1 in every 11 adults in the United States to some extent. There are ten specific personality disorders recognized, but all of them involve significant dysfunction or impairment with controlling emotions, relating to others, thinking about self/others, or impulsivity. The root cause of these disorders isn’t known, but experts think that a combination of inherited genetics and environmental triggers leads to the development of a personality disorder. There are no medications specifically for personality disorders, though some may help with specific symptoms. Overcoming the challenges posed by a personality disorder is often a matter of months or years of therapy and effort.
Do you think you might be experiencing the symptoms of a personality disorder? Don’t suffer alone. Get in touch to schedule an appointment with our highly trained therapists.
References
[1] https://www.nimh.nih.gov/health/statistics/personality-disorders
[2] Kasen, S., Cohen, P., Skodol, A. E., Johnson, J. G., & Brook, J. S. (1999). Influence of child and adolescent psychiatric disorders on young adult personality disorder. American Journal of Psychiatry, 156(10), 1529–1535. https://doi.org/10.1176/ajp.156.10.1529