There are ten types of personality disorders, broadly grouped into three categories: suspicious (Cluster A), emotional and impulsive (Cluster B), and anxious (Cluster C).
There are some grey areas in this class of mental health conditions, with some being controversial. There is an overlap in the diagnostic criteria, and many people are diagnosed with more than one personality disorder. This overlap is called mixed personality disorder.
According to the MSD Manual, a personality disorder in patients 18 years and older may be present if they have exhibited a “persistent, inflexible, pervasive pattern of maladaptive traits” and “significant distress or impaired functioning resulting from the maladaptive pattern” for at least a year or longer.
Let’s explore the ten types of personality disorders, what causes them, the signs of the different conditions, and how they are treated.
What are personality disorders?
Personality disorders affect how people think about themselves and others, how they respond emotionally, how they relate to other people, and their ability to control their behaviour based on social norms.
Your personality is the way you think, feel and behave that makes you different from other people. It is influenced by inherited characteristics, life experiences, and environmental factors such as your home, school, work and social background.
Your personality should stay the same, more or less, as you grow older. Personality disorders change you in a way that causes distress to yourself and others and creates problems with how you function in daily life.
The pattern of maladjusted personality traits tends to appear in the late teenage years or early adulthood. There is no straightforward cure for each recognised personality disorder, but it is a treatable mental health condition. People with personality disorders respond well to an integrated treatment programme that includes medication, psychotherapy, holistic therapies, regular exercise and a healthy, balanced diet.
What causes personality disorders?
People living with personality disorders have unique situations, and there is no single cause. Usually, a complex combination of factors underpins the risk of developing one or more personality disorders.
Three key factors trigger these conditions:
- genetics (passed down from one or more relatives)
- early exposure to trauma or abuse
- environmental and social situations
How are personality disorders diagnosed?
Personality disorders are difficult to isolate and people are often misdiagnosed, mainly because of considerable overlap between personality disorders and other mental health illnesses. Chronic depression and anxiety run across the three Clusters, and this makes it more challenging to separate mood and anxiety disorders from personality disorders.
If a personality disorder is suspected, your doctor will use comprehensive diagnostic tools to assess your mental, emotional, social and behavioural traits. Other medical-related mental disorders have to be ruled out, such as trauma, head injury or a terminal illness.
One or more personality disorders are present if you meet the following DSM-5 criteria:
- the continuing, rigid, invasive pattern of maladaptive personality characteristics involving two or more of the following: poor cognitive abilities, lack of impulse control, disturbed emotional state and impaired social functioning
- major distress or compromised function caused by maladaptive traits
- maladaptive behaviour can be traced back to late adolescence and early adulthood
What are the different types of personality disorders?
The different types of personality disorders are grouped into three categories: suspicious (Cluster A), emotional and impulsive (Cluster B) and anxious (Cluster C).
Personality disorder not otherwise specified (PD-NOS) and personality disorder trait specified (PD-TS) are diagnosed if the patient does not fully meet the criteria for a specific type of personality disorder.
What are suspicious personality disorders?
Suspicious personality disorders are classified as Cluster A disorders characterised by paranoid, erratic and eccentric behaviour. This behaviour affects how you function in daily life and your ability to maintain stable, healthy relationships.
Schizoid personality disorder
Someone with schizoid personality disorder (SPD) is a longer and doesn’t rely on others to make them happy. Their behaviour doesn’t impair how they function in everyday life and doesn’t negatively affect other people, except those who would like a closer relationship or friendship. Often, people don’t know the person has schizoid personality disorder; they just come across as cold, aloof or withdrawn.
Signs of schizoid personality disorder include:
- struggle or have no interest in developing close relationships with family, friends or colleagues
- prefer their own company, live alone and keep to themselves
- are not easy to talk to, disinterested in two-way conversations
- low sex drive, avoid intimacy
- appear coldhearted, emotionally frigid, distant
Schizotypal personality disorder
Someone with schizotypal personality disorder (SPD) is often described as peculiar, odd, eccentric or different. Their behaviour doesn’t necessarily affect how they function in daily life, but it does make it difficult for them to develop close relationships with people and enjoy social interactions. If the condition is not treated and worsens, they can develop paranoia.
Signs of schizotypal personality disorder include:
- struggle to make friends, maintain close relationships
- thoughts and beliefs are distorted, biased, one-sided
- opinionated, unfiltered thoughts
- slow to trust, wary of people
- anxious, depressed, tense
- lonely, isolated, antisocial
- paranoid, worry excessively
- behave bizarrely, irrationally
Paranoid personality disorder
Someone with paranoid personality disorder (PPD) lives in constant fear that someone or something will harm them, even if there is justification for their fear and paranoia. Their beliefs are often bizarre, unfounded and unrealistic. They are deeply distrustful of others and always on guard that they will be betrayed, manipulated or hurt. This paranoia makes it difficult for them to make friends and form close relationships with other people.
Signs of paranoid personality disorder include:
- avoid confiding in people, deeply mistrusting
- overly sensitive to criticism or feedback
- feel physically or emotionally threatened for no reason
- misinterpret what others say, read negative things in innocent comments
- quick to anger, lash out
- struggle to maintain healthy relationships, resist getting too close
- controlling, jealous, possessive
- restless, agitated
- argumentative, hostile
- stubborn, inflexible
- lack of self-awareness, blame others
What are emotional and impulsive personality disorders?
Emotional and impulsive personality disorders are classified as Cluster B disorders and are associated with highly spirited, dramatic, erratic and impulsive personality traits.
Borderline personality disorder
Borderline personality disorder (BPD) is the most common personality disorder characterised by highly emotional and impulsive traits. It is also known as an emotionally unstable personality disorder (EUPD). Someone with BPD has a low self-image, finds it difficult to regulate their emotions, and struggles to maintain healthy relationships.
Signs of borderline personality disorder include:
- fear abandonment, constantly worry about being rejected
- extreme mood swings, high-highs and low-lows
- struggle to maintain stable relationships with family and friends
- low self-confidence and self-esteem, feel worthless or hopeless
- participate in risky behaviour, act without thinking
- have low self-control
- self-harm, suicidal thoughts or attempts
- depression, anxiety, PTSD
- eating disorder
- paranoid, worry excessively
- see or hear things that others don’t
- disassociated from reality, out of touch
- poor concentration and memory
Antisocial personality disorder
Someone with antisocial personality disorder (ASPD) is focused on themselves to the detriment of other people. They put their needs, priorities and personal gain before others. They struggle to maintain healthy and stable relationships, lack self-control and act impulsively to satisfy their own needs.
Signs of antisocial personality disorder include:
- participate in risky, reckless behaviour that is dangerous or illegal
- act impulsively without considering the consequences or how it affects other people
- their behaviour makes other people feel uncomfortable, annoyed or irritated
- get bored quickly, restless
- struggle to hold down a job or keep up good grades at school
- aggressive, quick to anger, get into fights
- lack of empathy, not concerned with how they treat or hurt others
- poor self-awareness, don’t see their behaviour is a problem
Narcissistic personality disorder (NPD)
Someone with narcissistic personality disorder (NPD) is self-centred, lacks empathy, doesn’t consider other peoples’ feelings and has an insatiable need for attention and admiration. Narcissistic behaviour comes across as arrogant, selfish, manipulative, cruel, patronising and condescending.
Signs of narcissistic personality disorder include:
- self-esteem reliant on how others perceive them
- put their needs before others
- believe they are unique and more deserving than others
- exaggerated sense of self-worth
- unsympathetic towards other people’s situations and emotions
- selfish, make themselves a top priority
- can be cruel, verbally abusive
- manipulative, coerce people to do what suits their needs
- lack self-awareness, don’t feel guilty about their attitude and behaviour
Histrionic personality disorder
Someone with histrionic personality disorder (HPD) relies on positive feedback and compliments to boost their sense of self-worth. They are attention seekers and behave impulsively or erratically to get noticed. They are overdramatic and have strong opinions, forcing others to feed their need to be centre stage in conversations.
Signs of histrionic personality disorder include:
- like to be the centre of attention
- flip-flop between ideas to please others
- easily influenced out of fear of rejection
- fear abandonment, people pleasers
- prone to hysteria, overdramatic, overemotional
- obsessed with their appearance and status
- struggle to maintain healthy boundaries in relationships and friendships
- behave erratically or impulsively to get attention, inappropriate or promiscuous behaviour
- moody, rapid shift from good to bad moods
- come across as fake and flighty
What are anxious personality disorders?
Anxious personality disorders are classified as Cluster C disorders and are characterised by extreme anxiety and fear that affects behaviour and daily functioning.
Obsessive-compulsive personality disorder (OCPD)
Someone with obsessive-compulsive personality disorder (OCPD) finds it difficult to control their need for perfectionism, and they struggle to be flexible and adapt to situations they cannot control. They have an overly nervous and fearful personality, which impairs their ability to function daily and maintain stable relationships.
OCPD is different to obsessive-compulsive disorder (OCD), which is an anxiety disorder. OCPD relates to personality rather than behaviour.
Signs of OCPD include:
- set impossibly high standards for yourself and others
- get very anxious when things are not perfect
- hyper-focused on keeping everything under control and in order
- obsess over what other people think of your imperfections and mistakes
Dependent personality disorder
Someone with dependent personality disorder (DPD) develops an unhealthy dependence on certain people and constantly seek their attention, support and reassurance. This overriding dependency is overwhelming for the other person and negatively impacts relationships and everyday life.
Signs of dependent personality disorder include:
- needy, clingy, insecure
- keep in constant touch, paranoia when out of contact
- low self-esteem and self-confidence
- self-worth connected to the state of the relationship
- cannot function without their support
- cannot make decisions on your own
- easily manipulated out of fear of rejection
- fear of abandonment
- stalk, pester, hound the person
Avoidant personality disorder
Someone with avoidant personality disorder experiences such extreme anxiety over people, places or objects, they will avoid what they fear at all costs. The anxiety negatively affects how they cope with daily life and their relationships, often leading to isolation and depression. Avoidant personality disorder is also known as anxious personality disorder.
Signs of avoidant personality disorder include:
- avoid people, places and things that cause extreme anxiety
- struggle to develop healthy relationships
- low self-esteem and self-confidence, feel inferior
- fear rejection or abandonment
- depressed, anxious, panic attacks
- isolated, antisocial, social phobia
How are personality disorders treated?
Personality disorders are life-long conditions, and there are no straightforward cures for the different types. They are more challenging to treat than other mental health disorders, purely because people with these disorders resist treatment due to maladaptive traits such as deep distrust, paranoia, inflexible thoughts and feelings, and lack of self-awareness.
Prescription drugs and psychotherapy is used as part of a comprehensive treatment programme to treat symptoms of personality disorders and to help people function daily.
Medication for personality disorders:
- mood stabilisers (Lithium carbonate or citrate)
- antidepressants (tricyclics, SSRIs, SNRIs, MAOIs)
- antianxiety drugs (Zoloft, Prozac, Paxil)
- antipsychotic drugs (Risperdal, Zyprexa, Atrolak)
- anticonvulsant drugs (Tegretol, Epilim, Lamictal)
Psychotherapy for personality disorders:
- cognitive behavioural therapy (CBT)
- cognitive analytic therapy (CAT)
- dialectical behaviour therapy (DBT)
- mentalisation-based therapy (MBT)
- interpersonal therapy (IPT)
- holistic therapies; equine, dance, music, drama and art therapy
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