An Overview of Mixed Personality Disorder

psychiatrist and patient
Alain SHRODER/ONOKY/Getty Images
In This Article
Table of Contents

Mixed personality disorder refers to a type of personality disorder that does not fall into the ten 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 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 carrying this diagnosis.

Symptoms

Most people have a fairly flexible personality that allows them to adapt to a variety of circumstances, people and events. People with personality disorders, instead, 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 ten 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 one to two percent 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 which affects around three percent 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. and suffer from tremendous social anxiety as well.

Cluster B: Dramatic-Emotional

  • Antisocial Personality Disorder—It's thought that 7.6 million Americans suffer from antisocial personality disorder, a disorder in which people may intentionally harm others and are indifferent to the pain experienced by anyone other than themselves. A lack of empathy (lack of concern for others) combined with a lack of remorse (little conscience about their cruel activities) often contributes to criminal behaviors.
  • Borderline Personality Disorder—Borderline personality disorder often leads to unstable and intense relationships due to anger and aggression towards others combined with a deep fear of abandonment. These people often engage in risky behaviors and may engage in self-harming behaviors.
  • Histrionic Personality Disorder—Histrionic personality disorder affects around 1.8 percent of the population and involves a combination of shallow emotions combined with attention-seeking and manipulative behaviors. Suicide gestures are commonly not related to depression, but rather as a way to manipulate others.
  • Narcissistic Personality Disorder (NPD)—Narcissistic personality disorder is characterized by extreme self-centeredness, an exaggerated sense of their own importance, and a lack of empathy or concern for others. The disorder is often recognized first not in the person who has the disorder, but through the emotional damage which occurs to those people with whom the person with NPD relates.

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 an 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 percent of the population is expected to suffer from obsessive compulsive personality disorder at some point in their life. It is characterized by a preoccupation with orderliness, perfectionism, and control.

Diagnosis

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

  • These 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 individual 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 abuse 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, she 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

Though we don't understand all of the causes of personality disorders, there are causes as well which 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.

Treatment

Since the symptoms and characteristics of mixed personality disorder span a wide range, there is not one specific treatment which is helpful to all people with this condition. The particular symptoms present are often treated as if a person did 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 requires the person with the disorder wishing very much 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.

Coping

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 functioning 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.

Was this page helpful?

Article Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.