An Overview of Mixed Personality Disorder

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Mixed personality disorder refers to a type of personality disorder that does not fall into the 10 recognized personality disorders. It is possible for people to have traits or symptoms of more than one personality disorder at the same time, while not meeting the criteria for any single one of them.

In DSM-IV, this was referred to as "Personality Disorder Not Otherwise Specified (NOS)." This terminology has been replaced in the DSM-5 by "Other Specified Personality Disorder."

This is not a surprising category as there is a significant overlap between the symptoms of several of the personality disorders. Since this is in a way a "catch-all" category for people with some symptoms of many different personality disorders, there is a wide range of symptoms among people who receive this diagnosis.

Symptoms of Mixed Personality Disorder

Most people have a fairly flexible personality that allows them to adapt to a variety of circumstances, people, and events. People with personality disorders, on the other hand, tend to get stuck in rigid ways of relating to people and events.

These rigid thoughts may affect how they think about themselves and the world around them, how they experience emotion, how they function socially, and how well they can control their impulses.

Mixed personality disorder is one of the most commonly diagnosed personality disorders. In one study looking at patients referred for psychotherapy, 18.4% met the diagnostic criteria for a mixed personality disorder.

Types of Personality Disorders

A personality disorder is defined as a chronic and pervasive mental disorder that affects thoughts, behaviors, and interpersonal functioning. The DSM-5 recognizes 10 distinct personality disorders, which are arranged into three clusters.

Cluster A: Odd-Eccentric

  • Paranoid personality disorder: Paranoid personality disorder is marked by a chronic fear and distrust of other people combined with a belief that others are deceiving or exploiting them. It occurs in 1% to 2% of the population and overlaps in some ways with schizophrenia.
  • Schizoid personality disorder: Schizoid personality disorder is marked by an indifference to other people. Those with this disorder often have very little interest in forming close relationships with other people.
  • Schizotypal personality disorder: Schizotypal personality disorder, a condition that affects around 3% of the population, is marked by eccentric thoughts and behaviors. People with the disorder often engage in magical thinking, for example, believing they can read the future. They often experience tremendous social anxiety as well.

Cluster B: Dramatic-Emotional

  • Antisocial personality disorder: About 7.6 million Americans live with antisocial personality disorder, in which people may intentionally harm others and are indifferent to the pain experienced by others. A lack of empathy (lack of concern for others) combined with a lack of remorse (little conscience about their actions) contributes to the tendency toward criminal behaviors.
  • Borderline personality disorder: Borderline personality disorder (BPD) often leads to unstable and intense relationships due to anger and aggression towards others combined with a deep fear of abandonment. People with BPD often engage in risky behaviors and may engage in self-harming behaviors.
  • Histrionic personality disorder: Histrionic personality disorder affects 1.8% of the population and involves a combination of shallow emotions and attention-seeking/manipulative behaviors. Suicide gestures may be used to manipulate others (rather than as a sign of depression). Never ignore warning signs of suicide, even if you believe they are disingenuous.
  • Narcissistic personality disorder: Narcissistic personality disorder (NPD) is characterized by extreme self-centeredness, an exaggerated sense of self-importance, and a lack of empathy or concern for others. The disorder is often recognized first through the emotional damage that occurs to those people with whom the person with NPD interacts.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Cluster C: Anxious-Fearful

  • Avoidant personality disorder: Avoidant personality disorder is characterized by extreme shyness and sensitivity to criticism from others. It is often associated with other mental health conditions such as anxiety disorders and social phobia.
  • Dependent personality disorder: Dependent personality disorder is characterized by intense fear and inability to make decisions. This disorder is the ultimate in the need to be a "people pleaser" and can result in near paralysis and inability to make the daily decisions (without the input of others) necessary for functioning well in the outside world.
  • Obsessive-compulsive personality disorder: Around 2.5% of the population is expected to live with obsessive-compulsive personality disorder at some point in their life. It is characterized by a preoccupation with orderliness, perfectionism, and control.

Diagnosis of Personality Disorder

In order to be diagnosed with a personality disorder, a person must exhibit symptoms that meet the diagnostic criteria established in the DSM-5, including:

  • The patterns of behavior must be chronic and pervasive, affecting many different aspects of the individual’s life, including social functioning, work, school, and close relationships.
  • The person must exhibit symptoms that affect two or more of the following four areas: thoughts, emotions, interpersonal functioning, impulse control.
  • The pattern of behaviors must be stable across time and have an onset that can be traced back to adolescence or early adulthood.
  • These behaviors cannot be explained by any other mental disorders, substance use, or medical conditions.

While the DSM-5 retained the DSM-IV's categorical approach to diagnosing personality disorders, it developed an alternate model, which it suggests could be an area for future study.

Using this alternate hybrid model, clinicians would assess personality and diagnose a personality disorder based on a combination of specific difficulties in personality functioning, as well as the general patterns of pathological personality traits.

Differential Diagnosis

Before a clinician can diagnose a personality disorder, they must make a differential diagnosis to rule out other disorders or medical conditions that may be causing the symptoms. This is very important but can be difficult as the symptoms that characterize personality disorders are often similar to those of other psychiatric disorders and medical illnesses.

Personality disorders also commonly co-occur with other illnesses.

Causes of Personality Disorders

Though experts don't understand all of the causes of personality disorders, there are believed to be causes that likely underlie more than one of these disorders. Personality disorders are thought to be caused by a combination of both genetic and environmental factors. Some people may be predisposed to these disorders due to genetics and family history.

Genetic vulnerabilities may make people more susceptible to these conditions, while experiences and other environmental factors may act as a trigger in the development of a personality disorder.

Personality Disorder Treatment

Since the symptoms and characteristics of mixed personality disorder span a wide range, there is not one specific treatment that is helpful to all people with the diagnosis. The particular symptoms present are often treated as if the person does meet the criteria of one of the personality disorders described above.

For example, if a person meets some, but not all of the criteria for borderline personality disorder, one of the empirically validated psychotherapy treatments for borderline personality disorder may be pursued. In general, the treatment of personality disorders also requires that the person with the disorder wishing to pursue therapy.

Psychotherapy

Your treatment plan will depend largely upon your symptoms but may involve the use of cognitive-behavioral therapy (CBT) or a subtype known as dialectical-behavioral therapy (DBT).

  • Cognitive-behavioral therapy: Traditional CBT focuses on identifying negative thinking patterns that contribute to maladaptive behaviors and replacing these patterns with healthier, more realistic ones.
  • Dialectical-behavioral therapy: DBT can be particularly effective at treating borderline symptoms and involves learning skills related to emotional regulation, interpersonal communication, mindfulness, and tolerating distress.

Medications

Psychotherapy is often more effective than medications, but medications may be prescribed to address certain symptoms. Antidepressants and anti-anxiety medications may be used to treat symptoms of depression and anxiety. Antipsychotic medications may be prescribed when people have Cluster A symptoms such as eccentric thoughts or behaviors.

How to Cope With a Personality Disorder

While personality disorders are fairly common, many people do not realize that they have one of these conditions. One of the best ways to improve your quality of life is to recognize the signs and find effective ways to cope with symptoms that lead to distress and impairment.

Professional support from a therapist combined with self-care can help people learn to manage their condition.

Recognize Your Symptoms

If you have mixed traits such as avoidance or dependence, consider the impact these might have on different aspects of your life including work and relationships. By better understanding these traits, you'll have a clearer idea of what you can do to work around them.

Have a Plan

Some traits can make it hard to take care of your health and home. You might do well some of the time, only to have periods where you struggle to keep up. Come up with a self-care plan that works for you and enlist the help of friends and family who can help keep you on track.

A Word From Verywell

While research suggests that personality disorders with mixed symptoms are quite common, people often go underdiagnosed and undertreated. With appropriate treatment, you can learn to manage symptoms that may be having a negative impact on multiple areas of your life. Talk to your doctor if you suspect that you may be experiencing symptoms of some type of personality disorder.

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  1. Verheul R, Bartak A, Widiger T. Prevalence and construct validity of Personality Disorder Not Otherwise Specified (PDNOS). J Pers Disord. 2007;21(4):359-70. doi:10.1521/pedi.2007.21.4.359

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