Personality disorders: Causes, symptoms and treatment

You probably know someone you call dramatic. Or have a friend who is spontaneous and impulsive. Do you have a family member who is a little clingy or someone who struggles to make a decision on their own? How can you tell when a personality trait has strayed too far from normal and may be a personality disorder? Read on to learn more about the causes, symptoms and treatment of personality disorders.

What is a personality disorder?

A personality disorder is a long-term condition that can negatively impact your behavior and impulse control, feelings and emotions, relationships, sense of reality, sense of identity and work. According to the American Psychiatric Association, a personality disorder is a way of thinking, feeling and behaving that differs from what our culture expects. A personality disorder can cause you or your loved ones distress or it can lead to problems functioning well in your daily life.

How common is a personality disorder?

A personality disorder can happen to anyone. However, most begin in the teen years. About 9% of adults in the US,
and 6% worldwide, have a personality disorder.

Borderline personality disorder and antisocial personality disorder are the most frequently diagnosed personality disorders. People diagnosed with antisocial personality disorder were first diagnosed with a conduct disorder as a child or teen.

Types and symptoms of personality disorders

There are 10 types of personality disorders, grouped into three clusters.  In general, they involve challenges with relationships, self-worth and identity.

Cluster A. People with these disorders have odd or eccentric behaviors. The specific conditions include:

• ­Paranoid personality disorder. People distrust and suspect others of trying to harm them with no good reason for these feelings.
• ­Schizoid personality disorder. People show few emotions and care little about interacting with others.
• Schizotypal personality disorder. People are uncomfortable with close relationships. They may be overly superstitious and have a distorted sense of reality.

Cluster B. Impulsive, erratic and dramatic describes people with these personality disorders. They include:

• ­Antisocial personality disorder (ASPD). People often break the law, refuse to accept responsibility for their actions, and can cause physical and emotional harm to others. ASPD is more likely to be diagnosed in people assigned male at birth.
• ­Borderline personality disorder (BPD). People can struggle to control their emotions, have low self-esteem, mood swings and impulsive behaviors. BPD is more likely to be diagnosed in people assigned female at birth.
• ­Histrionic personality disorder. The self-worth of a person who has this condition depends on the approval of other people. Dramatic behaviors and an overwhelming desire to be noticed by others is common. This disorder is more likely to be diagnosed in people assigned female at birth.
• ­Narcissistic personality disorder. Low self-esteem and a lack of self-confidence often are part of narcissistic personality disorder. While people with this condition act superior, they also have an overwhelming need for praise and admiration, and lack empathy for others.

Cluster C. People with these personality disorders are overly anxious and fearful, to the point that it impacts their daily lives. The disorders in this cluster include:

• Avoidant personality disorder. A chronic fear of rejection is common with this disorder. People feel inadequate and are highly sensitive about others who they feel may be judging them.
• ­Dependent personality disorder. Being overly submissive and clinging to one person with a constant need to be reassured, and an inability to make decisions on your own are some of the signs you may have this condition. This disorder is more likely to be diagnosed in people assigned female at birth.

Obsessive-compulsive personality disorder (OCPD). A need for control, order and perfection are common signs of OCPD. This condition is different from the more commonly known obsessive-compulsive disorder (OCD), in which people have distressing, intrusive thoughts and then take steps to negate or control them. These steps, such as compulsive hand washing, can impact your ability to function in your daily life. 

Causes of personality disorders

While there is no one cause for personality disorders, these factors could contribute to developing one:

Genetics. While less clearly genetic than schizophrenia, bipolar disorder and ADHD, disorders such as borderline personality disorder have a substantial genetic contribution. Research is also evaluating whether there is a link to symptoms such as anxiety, fear and aggression, which are common in a number of personality disorders.

• Brain changes. Changes in the functioning of the brain’s amygdala were found in some people with paranoid personality disorder. This part of the brain deals with processing threatening and fearful stimuli. Changes in the emotion processing areas of the brain, like the amygdala, and their connection to the planning areas of the brain, like the cortex, are seen in many personality disorders.
• Childhood trauma and verbal abuse. Childhood trauma, particularly sexual trauma, is over-represented in borderline personality disorder. One study showed a correlation between verbal abuse as a child and borderline, narcissistic, obsessive-compulsive and paranoid personality disorders in adulthood
• Culture. Where you grow up and live may have a role in the development of personality disorders.

Diagnosing a personality disorder

A psychiatric evaluation can help diagnose a personality disorder. Your health care provider will base their diagnosis on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine a diagnosis.

To schedule a psychiatric evaluation, call Allina Health Mental Health Services at 888-603-0016 or visit our mental health and addition services page to learn more.

Treatment of a personality disorder

Symptoms such as anxiety and depression may overshadow a personality disorder. Often, the person with a personality disorder doesn’t think they have a problem. Other people who are close to them may need to convince them to seek treatment and help the provider identify symptoms and challenges.

At this time, there is no medication approved to treat any specific personality disorder. Medication for anxiety and depression, symptoms of several personality disorders, can be used along with talk therapy to manage symptoms.

The goals of talk therapy include:

• Managing anxiety and depression.
• Building skills to identify and manage emotions effectively.
• Decreasing unhealthy and socially undesirable behavior.
• Modifying the personality traits that are causing difficulties.

Each personality disorder responds to a different type of psychotherapy. For example, dialectical behavior therapy (DBT) is one effective treatment for borderline personality disorder.

Visit our mental health and addition services page to learn more about the care we provide and to find qualified providers near you.