Personality Disorders: Definition and Treatment

Personality disorders are among the most stubborn and pervasive mental health disorders to be recognized, with the potential to severely harm the individual’s well-being, despite outward appearances. Read on to find out what is a personality disorder, the different types recognized today, and how one can treat them.

The APA’s personality disorder definition stresses how all-encompassing this family of disorders truly is. It describes a personality disorder as a marked deviation from one’s society, when their perspective, behavior, and expectation of others is very different from the culture they grew up in. Cases where the individual’s divergence from their surroundings causes significant distress or impairment and does not allow them to adjust to expected norms to ease their interaction with others, may fall under the definition of a personality disorder. Personality disorders affect a rather large number of individuals, with the APA stating that 15% of the general population face one or more personality disorders.

Though personality disorders (and personality disorder symptoms) can appear in comorbidity with other mental health disorders, they are different from more encapsulated issues, such as phobias or even depression, which focus more on one’s anxiety or mood.

Personality disorders are also separate from disorders that detach the individual from elements of concrete reality, such as psychosis, which hinders their ability to grasp all elements of the world around them, through hallucinations or delusional false beliefs.

Instead, those with personality disorders tend to experience reality around them fairly accurately, while interpreting the effects of their relationships or interaction with said reality in a destabilizing, distressing or erratic manner.

A good way to understand the unique, interpretive aspects of the personality disorders family is by comparing it to psychosis and depression:

• An individual facing psychosis would have a hard time separating their internal, mental and emotional reactions from external reality, believing to see someone standing at the foot of their bed, when there is no one there.
• An individual facing a personality disorder is generally able to differentiate external reality from their internal world. However, their own interpretation of external reality is often rigid, provokes extreme emotions, and tends to create conflict in contexts that most members of their culture would find it easier to de-escalate. For example, an individual with a borderline personality disorder who did not receive a greeting from a fellow coworker upon entering the office might interpret this as a sign they are mad at them or have never truly been their friend. As a result, they may accuse their coworker of being two-faced, causing an unpleasant and public scene.
• An individual with major depression has a firm grasp on external reality, and in somewhat milder cases, still comprehends their loved ones care for them and do not wish them harm. They view their depression as external to their own personality, and long to return to a time when they were not overwhelmed with feelings of sadness and despair.

A Condition that Avoids Detection

Due to varying levels of functioning, those contending with personality disorders may be able to mask their condition, or at least to avoid hospitalization. Individuals with a personality disorder can be found in different walks of life, professions, and social settings. While their condition often causes them or those around them distress, the root of the conflicts it creates may not be traced back to them. This can make acknowledging their disorder, as well as receiving treatment for it, that much more difficult.

The Ten Personality Disorders

The APA’s most recent Diagnostic and Statistical Manual (the DSM-V) lists ten personality disorder types, arranging them into three categories, or clusters:

• Cluster A: The odd cluster, with personality disorders that tend to arouse strikingly unusual or eccentric behavior. It includes:
  • Paranoid Personality Disorder: Significantly distrustful or suspicious of others’ behavior, inclined to believe others are looking to take advantage of them. Paranoid personality disorder is different from psychotic delusions, where the individual fully believes there is a conspiracy out to harm them.
  • Schizoid Personality Disorder: A pattern of social detachment and a limited range of emotional expression. Slightly more common among males.
  • Schizotypal Personality Disorder: Extreme eccentricity, acute discomfort within relationships and a reduced capacity for close relationships, with some distortions of reality. Can include magical thinking or belief in having a “sixth sense.” As with all mental health disorders, a case may warrant a schizotypal personality disorder diagnosis if it significantly hinders the individual’s well-being; as such, merely being quirky does or superstitious do not meet the criteria of this condition. It is slightly more common among males.

• Cluster B: The dramatic cluster, with personality disorders that are decidedly more emotional and erratic. It includes:
  • Antisocial Personality Disorder: Motivated primarily by satisfying their own desires, it is marked by an extreme disregard for rule-abiding or others’ safety, and a tendency to lie and deceive. Antisocial personality disorder is also referred to as psychopathy or sociopathy. The disorder is much more common among males.
  • Borderline Personality Disorder: The most well-researched personality disorder, borderline personality disorder is defined by rocky personal relationships, an unstable self-image, and impulsivity. Borderline personality disorder is reported to exist among 1.6% of the general population but is estimated to actually be as high as 5.9%. This disorder is primarily found among females, who make up 75% of those diagnosed with this condition.
  • Histrionic Personality Disorder: Criticized for its gendered title, histrionic personality disorder is marked by excessive attention-seeking and emotionality. Interestingly, while histrionic personality disorder has been found to be more prevalent among female patients within a clinical setting, certain reports have found the rate of males vs. females in this disorder to be about the same.
  • Narcissistic Personality Disorder: Rather than truly admiring themselves, those with narcissistic personality disorder tend to feel a great deal of loneliness. While they are self-centered and often lack empathy, their focus on themselves stems not from self-love, but from finding it difficult to rely on the caring and stable presence of others. As a result, individuals with narcissistic personality disorder must continuously fuel their (false) sense of admiration, by receiving praise and accolades from those around them. 50%-75% of those with this disorder are male.

• Cluster C: The anxious cluster, with personality disorders that induce fear or trepidation. It includes:
  • Avoidant Personality Disorder: Feelings of significant inadequacy in social settings, a tendency toward social inhibition, and a hypersensitivity to real or perceived criticism.
  • Dependent Personality Disorder: A pattern of clinging, submissive behavior that lacks independence, with a clear preference to be constantly taken care of. Clinical setting studies have found greater prevalence of this disorder among females, while certain studies have found it to appear at similar rates among males and females.
  • Obsessive-compulsive Personality Disorder: Marked by perfectionism, striving toward absolute orderliness, and control (both of themselves and of others). Twice as prevalent among males than females.

Personality Disorder Treatment

Treating personality disorders can be difficult, due to the rigidity commonly displayed by those contending with one. Patients with a personality disorder often balk at changing the way they approach their life, and particularly relationships and social interactions, making it harder to gradually introduce new perspectives, and encourage personal growth.

That said, several treatments have been shown to offer personality disorder symptom relief. The changes they can provide may be local, hard-won, or incremental, but over time, patients with personality disorders who stick with a treatment they find effective and tolerable can experience alleviation and a greater quality of life. Such treatments include:

• Antidepressants, which also act as anti-anxiety medication. With their double-duty appeal, antidepressants can help lift one up from the despair they feel due to the nature of personality disorders, while also calming some of their more chronic anxiety.
• Fast-acting anxiolytics, which can be taken with discretion at moments of extreme distress, for short-term assistance.
• Mood stabilizers, as opposed to antidepressants, work to secure one’s emotional reactivity when faced with either mania or depression. It can offer relief from the instability and fluctuating energy levels that may stem from personality disorders.
• Psychotherapy can offer those with personality disorders a sense of relief in the long-term, through examining some of the defining relationships and experiences in the patient’s life that have contributed to their condition. Psychotherapy, and particularly psychodynamics, can benefit those with a personality disorder over time. Dismantling a detrimental, solid response pattern to the world is far from easy, and it often takes years before the patient is ready to trust their therapist and themselves along the journey toward a more flexible and empathetic approach to life. Yet it can be done, and can benefit different aspects of an individual’s life, both in relation to their condition and beyond it.