Introduction to Personality Disorders

The 10 Disorders Described in the DSM-5

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Personality disorders include 10 diagnosable psychiatric conditions that are recognized and described in the fifth and most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Each is a distinct mental illness and not, as the name suggests, a flaw or quirk in someone's personality but rather are defined by personality styles that can be troubling enough to create problems with relating to other people in healthy, normal ways.

Note, though, that there's a much comorbidity between personality disorders, meaning that a person who meets the criteria for one personality disorder will often also meet criteria for one or more additional personality disorders. One recent study funded by the National Institute of Mental Health found that about 85 percent of people with borderline personality disorder also meet diagnostic criteria for at least one other personality or mood disorder.

Personality disorders tend to appear in adolescence or early adulthood, continue over many years, and cause a great deal of distress. During that time they can cause enormous conflict with other people, cause relationships to fail or prevent them from developing in the first place, interfere with someone's ability to function appropriately in social situations and get in the way of reaching life goals.

Clusters

The DSM-5 organizes the ten personality disorders into three groups, or clusters, based on shared key features.

Cluster A

These personality disorders are characterized by odd or eccentric behavior. People with Cluster A personality disorders tend to experience major disruptions in relationships because their behavior may be perceived as peculiar, suspicious, or detached.

Cluster A personality disorders include:

  • Schizotypal Personality Disorder features odd speech, behavior, and appearance, as well as strange beliefs and difficulty forming relationships.
  • Paranoid Personality Disorder affects between 1 percent and 2 percent of adults in the U.S. Symptoms include chronic, pervasive distrust of other people; suspicion of being deceived or exploited by others, including friends, family, and partners; angry outbursts in response to deception; and cold, secretive, or jealous behavior.
  • Schizoid Personality Disorder is characterized by social isolation and indifference toward other people. It affects more men than women. People with this relatively rare disorder often are described as cold or withdrawn, rarely have close relationships with other people and may be preoccupied with introspection and fantasy.

Cluster B

The "Cluster B" personality disorders are characterized by dramatic or erratic behavior. People who have a personality disorder from this cluster tend to either experience very intense emotions or engage in extremely impulsive, theatrical, promiscuous, or law-breaking behaviors.

Cluster B personality disorders include:

  • Borderline Personality Disorder is characterized by emotional instability, intense interpersonal relationships, and impulsive behaviors.
  • Histrionic Personality Disorder features a need to always be the center of attention that often leads to socially inappropriate behavior in order to get attention. People with this disorder may have frequent mood swings as well.
  • Antisocial Personality Disorder tends to show up in childhood, unlike most other personality disorders that don't appear until adolescence or young adulthood. Symptoms include a disregard for rules and social norms and a lack of empathy for other people.
  • Narcissistic Personality Disorder is associated with self-centeredness, exaggerated self-image, and lack of empathy for others.

Cluster C 

Cluster C personality disorders are characterized by anxiety. Individuals with the personality disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.

Cluster C personality disorders include:

  • Dependent Personality Disorder involves fear of being alone and often causes those have the disorder to do things to try to get other people to take care of them.
  • Obsessive-Compulsive Personality Disorder is characterized by a preoccupation with orderliness, perfection, and control of relationships. It's no the same as obsessive-compulsive disorder (OCD).
  • Avoidant Personality Disorder can show up during childhood. It's characterized by a disregard for rules and lack of empathy and remorse.

Treatment 

Unlike with mood disorders such as clinical depression and bipolar disorder, there are remarkably few studies on how to effectively treat personality disorders. And In general, many experts believe that personality disorders are difficult to treat because they are, by definition, long-standing patterns of personality.

The National Alliance on Mental Illness (NAMI) lists several types of psychotherapy that may be useful for treating personality disorders:

  • Dialectical behavior therapy (DBT), which teaches coping skills and strategies for dealing with urges related to self-harm and suicide, regulating emotions, and improving relationships.
  • Cognitive behavior therapy (CBT). The goal of CBT as stated by NAMI is "to recognize negative thoughts and learn effective coping strategies."
  • Mentalization-based therapy (MBT) teaches people to notice internal states and to develop empathy for others.

Medication can be useful to treat depression or anxiety that's caused by a personality disorder.

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