Personality Disorder

What is a personality disorder?

With a personality disorder, the way you think, feel and relate to others follows a rigid, long-standing pattern that differs markedly from what's culturally expected, causing real distress or difficulty functioning. It usually takes hold by the late teens or early twenties and, without support, tends to persist.

What are the symptoms of a personality disorder?

Each of the 10 recognised types has its own specific pattern, but most involve difficulty in two broad areas:

• identity and self-image: a shifting or unstable sense of who you are, with self-esteem that swings between unrealistically high and very low
• relationships: trouble forming or keeping close, stable relationships, which might show up as being emotionally distant, needing constant reassurance, or struggling to see things from someone else's point of view.

A defining feature is that most people carrying this diagnosis have little awareness that their own thinking or behaviour is part of the problem, which is part of why loved ones or professionals often notice it before the person themselves does.

What causes a personality disorder, and who is at risk?

Scientists still don't fully understand why personality disorders develop, and no single cause has been identified. Several factors are thought to play a part.

• genetics, which research suggests has a substantial influence on overall risk
• subtle differences in brain structure or function, found in some specific personality disorders
• childhood trauma, including abuse or neglect
• verbal abuse during childhood
• cultural factors, since rates of specific types vary noticeably between countries.

Symptoms typically begin by the late teens or early twenties. Men are diagnosed with antisocial personality disorder more often, while women make up a larger share of borderline, histrionic and dependent diagnoses. 

Meeting the criteria for more than one type at the same time isn't unusual, and having a personality disorder tends to go hand in hand with a higher likelihood of anxiety, low mood, or difficulties with alcohol or drugs.

Are there different types of personality disorder?

There are 10 recognised types, grouped into three clusters based on shared features.

Cluster A: odd or eccentric

• Paranoid: a deep-seated distrust of other people's motives, often reading hidden threats into ordinary comments.
• Schizoid: detachment from relationships and a limited range of emotion, without this being distressing to the person themselves.
• Schizotypal: acute discomfort with close relationships, alongside eccentric beliefs or behaviour.

Cluster B: dramatic, emotional or erratic

• Antisocial: disregard for rules and for other people's welfare, often with impulsive or aggressive behaviour.
• Borderline: intense, hard-to-control emotions, an unstable sense of self, and a strong fear of abandonment; self-harm and impulsive behaviour are common.
• Histrionic: a strong need to be the centre of attention, with dramatic or exaggerated emotional expression.
• Narcissistic: a sense of superiority and entitlement, a deep need for admiration, and difficulty empathising with others.

Cluster C: anxious or fearful

• Avoidant: wanting connection with others but avoiding it out of a strong fear of criticism or rejection.
• Dependent: relying heavily on others for reassurance and support and finding it genuinely hard to make everyday decisions without help.
• Obsessive-compulsive personality disorder (OCPD): rigid perfectionism, stubbornness and a need for control that gets in the way of finishing tasks or relating to others. This is a distinct condition from obsessive-compulsive disorder (OCD): people with OCD usually know their thoughts and habits are excessive, whereas people with OCPD usually see their own standards as entirely reasonable.

How is a personality disorder diagnosed?

There's no blood test or scan for a personality disorder. Diagnosis takes an assessment by a psychiatrist or psychologist, looking at long-term patterns in your relationships, work history, and how you handle emotions and impulses over time.

Diagnosis can be genuinely difficult. Because many people don't recognise their own behaviour as the issue, they don't tend to seek help for the personality disorder directly. Instead, they're often referred after seeking help for something else it's contributed to, such as anxiety, depression, substance use, or a relationship breakdown, and professionals sometimes involve family or friends to build a fuller picture.

How is a personality disorder treated?

Non-surgical treatment

• psychotherapy (talking therapy), which is the main treatment and is tailored to the specific type; dialectical behaviour therapy (DBT) has the strongest evidence base for borderline personality disorder, and cognitive behavioural therapy (CBT) is often used for others
• group therapy or psychoeducation, which can help you and your family understand the condition and build coping strategies
• medicine for related symptoms such as anxiety or depression, since there's currently no medicine approved to treat a personality disorder itself
• self-care measures like regular exercise, avoiding alcohol and drugs, staying connected to family and friends, and joining a support group.

Surgical treatment

There's no surgical treatment for personality disorder. It's managed through psychotherapy and, where needed, medicine for symptoms that occur alongside it.

When should I see a doctor?

• Your relationships, work or daily life are being repeatedly disrupted by patterns you can't seem to change
• a friend or family member has gently raised concerns about how you're relating to others, even if it's hard to see yourself
• you're already getting help for anxiety, low mood or drug or alcohol use, and wonder whether something longer-standing might be behind it
• you feel ashamed or embarrassed about reaching out; this is a genuine health condition like any other, and stigma should not stop you from seeking support.