Personality Disorders

Understanding Personality Disorders

A personality disorder involves lasting patterns of thinking, feeling, and relating to other people that cause serious distress or problems in daily life. The patterns can make it difficult to adapt when circumstances change. They may affect relationships, work, school, or the way someone understands themselves.^[1]

Being quiet, emotional, particular about details, or difficult to get along with does not establish a diagnosis. An assessment looks at the whole pattern, its effects, and the person’s background. These are mental health conditions, and help can address specific difficulties without treating someone’s entire personality as a problem.^[2][1]

When a Personality Pattern Becomes a Problem

Everyone has familiar ways of responding to stress and relationships. With a personality disorder, those responses can become hard to change even when they repeatedly cause problems. Symptoms often begin in the teenage years or early adulthood. A clinician considers how persistent the difficulties are and how they affect different parts of life.^[1][3]

Possible difficulties include an unstable sense of who you are, trouble managing emotions, repeated relationship problems, or acting on urges in ways that cause harm. Different disorders involve different combinations. A person does not need to recognize every difficulty themselves before they can ask for support.^[1]

Consider seeking an assessment when these patterns keep interfering with the life you want. You can ask for help with a concrete problem, such as repeated conflict or fear of rejection, without arriving with a diagnosis. The first appointment can be about understanding what is happening.^[4]

Types of Personality Disorders

The ten types below are grouped by some shared features. A cluster is a way of organizing diagnoses, not a description of everything about a person. People can meet criteria for more than one personality disorder. A short description cannot establish which diagnosis, if any, fits.^[1][4]

Cluster A

Cluster A includes patterns involving strong mistrust, distance from other people, or unusual ways of thinking and interpreting experiences.^[1]

• Paranoid personality disorder involves persistent distrust and suspicion of other people’s intentions. Someone may believe others intend harm even when that interpretation is not supported by the situation.^[1]
• Schizoid personality disorder involves a longstanding lack of interest in close relationships and a preference for being alone. It is more than simply enjoying quiet time or needing a break from social activity.^[1]
• Schizotypal personality disorder involves unusual beliefs, perceptions, speech, or behavior together with difficulty forming close relationships. It is distinct from schizophrenia, although the conditions have some related features.^[1][4]

These diagnoses do not all mean that someone has hallucinations or cannot distinguish reality from their thoughts. If that is happening, it needs its own assessment. Our schizophrenia guide explains symptoms such as hearing voices and strongly held beliefs that do not match reality.^[4]

Cluster B

Cluster B includes patterns involving difficulty with emotions, impulses, self-image, or relationships. The diagnoses differ substantially, so their names should not be used interchangeably.^[1]

• Antisocial personality disorder involves a persistent pattern of disregarding or violating other people’s rights. Here, “antisocial” does not mean shy or uninterested in a party.^[1]
• Borderline personality disorder (BPD) involves difficulty managing intense emotions, an unstable sense of self, and relationship difficulties. Fear of abandonment, impulsive behavior, and self-harm can occur, but the experience differs from person to person.^[5]
• Histrionic personality disorder involves a persistent pattern of seeking attention and expressing emotions intensely. Being outgoing or enjoying attention on its own is not enough for a diagnosis.^[1]
• Narcissistic personality disorder involves an inflated sense of importance, a strong need for admiration, and difficulty recognizing other people’s feelings and needs. Calling someone a “narcissist” after a conflict is not a clinical assessment.^[1]

Cluster C

Cluster C includes patterns shaped by anxiety or fear, such as fear of rejection, fear of being unable to cope alone, or a strong need for order and control.^[1]

• Avoidant personality disorder involves feeling inadequate and avoiding social contact because criticism or rejection feels threatening. A person may want connection but find it hard to risk being judged.^[1]
• Dependent personality disorder involves a strong need to be cared for and difficulty making decisions without reassurance. Fear of losing support can make it hard to disagree or leave an unhealthy relationship.^[1]
• Obsessive-compulsive personality disorder (OCPD) involves a rigid need for perfection, order, and control. The pattern can interfere with completing tasks or being flexible with other people.^[1]

OCPD and obsessive-compulsive disorder (OCD) are different conditions. In OCD, unwanted recurring thoughts or repetitive actions can cause distress or take up substantial time. OCPD centers on a broader pattern of perfectionism and control. A clinician can assess concerns that overlap rather than deciding from the similar names.^[1][6]

What Causes Personality Disorders?

There is no single established cause. Inherited characteristics and experiences while growing up may both contribute. Research connects some personality disorders with childhood adversity, but that does not mean every person has the same history or that one experience explains a diagnosis.^[1][5]

For BPD specifically, the National Institute of Mental Health describes family history, brain function, and environmental experiences as possible influences. It also cautions that risk factors do not make the condition inevitable. Researchers are still working out how these influences relate to one another.^[5]

An assessment should leave room for your actual experiences. You do not have to fit a particular story about childhood or family relationships to deserve help with present difficulties.

How Common Are Personality Disorders?

NIMH reports an estimated 9.1% of U.S. adults with a personality disorder in the National Comorbidity Survey Replication.^[7] Those data were collected in 2001–2003 using an earlier diagnostic system.^[7] This is a historical estimate, not a new measurement of how many people have a personality disorder today.^[7]

There is also no dependable, timeless ranking of the “most common” type. A 2011 review found that the leading diagnosis differed across surveys and countries. Differences in the people studied and the way diagnoses were assessed help explain why estimates vary.^[8]

How Personality Disorders Are Diagnosed

A mental health professional looks at symptoms, life experiences, medical and family history, and how the difficulties affect everyday functioning. They may also consider a medical examination to check for other explanations. The assessment is broader than a checklist of traits or the result of an online quiz.^[1]

Useful questions include when the pattern began, whether it appears across different situations, and what was happening when it became worse. Cultural background matters. A difference from someone else’s expectations is not, by itself, a disorder.^[2][3]

These notes support a conversation, not a self-scoring test. For someone being assessed for BPD, the APA recommends considering the person’s goals, other symptoms, physical health, cultural circumstances, previous treatment, and safety needs. The clinician should explain their conclusions and discuss a plan with the person.^[9]

Similar Symptoms Can Have Different Explanations

Depression, anxiety, substance use, and other concerns can occur alongside personality disorders. A clinician needs to consider the whole picture rather than assuming that an existing diagnosis explains every new problem. Tell them about changes in sleep, mood, medication, and substance use.^[1][5]

For example, BPD and bipolar disorder can both involve impulsivity and mood changes. Bipolar assessment considers episodes of depression, mania, or hypomania. BPD also involves patterns affecting relationships and self-image. Timing alone cannot reliably distinguish the conditions, and they can occur together.^[5][4]

Treatment for Personality Disorders

Psychotherapy, or talk therapy, is the main treatment for personality disorders. Therapy can help people understand recurring patterns and practice different ways of responding. The approach and length of care should reflect the person’s difficulties, goals, and other health needs.^[1][10]

In a session, that might mean examining a recent disagreement, noticing the thoughts and feelings that came before a reaction, and considering what to try next time. The work should connect with problems that matter to the person, rather than being only a discussion of diagnostic labels.^[11]

Choosing a Suitable Therapy

For BPD, treatment guidance supports structured psychotherapy designed to address its core difficulties. Dialectical behavior therapy (DBT) teaches skills for managing emotions, tolerating distress, and improving relationships. Cognitive behavioral therapy (CBT) works with patterns of thinking and behavior that contribute to problems.^[5][9]

Other structured approaches can also be appropriate. Discussing the APA’s BPD guideline, psychiatrist George Keepers, M.D., said, “No therapy emerged as a ‘gold standard.’” His point was that several therapies have supporting evidence. It was about BPD, not a claim that every therapy works for every personality disorder.^[12]

Ask the clinician why they recommend a particular approach for your needs. You should be able to discuss the goals, what sessions involve, how progress will be reviewed, and what happens if the plan is not helping.

Where Medication Fits

Medication may help specific symptoms or a coexisting condition, such as depression or anxiety. Its role depends on the problem being treated. A personality disorder diagnosis does not automatically mean that adding medication will make therapy more effective.^[1][10]

For BPD specifically, the APA recommends any medication aimed at its symptoms be used alongside psychotherapy, for a defined target and a limited period. Ask what the medicine is intended to improve and when its benefits and risks will be reviewed. Discuss changes with the prescriber rather than adjusting treatment yourself.^[9][5]

Alcohol or Drug Use Also Deserves Attention

Some people with personality disorders also experience problems with alcohol or other drugs. Both concerns need attention in the treatment plan. Tell your clinician what you use, how often, and what happens before and afterward. Our dual diagnosis guide explains care for substance use and mental health conditions together.^[3][5]

Finding a Therapist Near You or Online

Start by looking for a licensed mental health professional with experience assessing and treating the difficulties you face. A primary care clinician, insurance directory, or local mental health service may help you identify options. Our psychotherapy guide explains the broader process of starting therapy.^[11]

When contacting a service, ask questions that reveal what it actually provides:

• Experience. “Do you regularly treat this diagnosis or these difficulties, and what training supports that work?”
• Program. “Does treatment include individual sessions, a skills group, or both? Who coordinates the plan?”
• Practical access. “What are the fees, insurance arrangements, waiting time, and options if I cannot attend every session?”
• Online suitability. “Can you provide care where I live, and is remote treatment appropriate for my current needs?”
• Support between appointments. “Who should I contact if symptoms worsen, and what help is available outside session times?”

For a specific therapy such as DBT, the name in a provider’s listing is a starting point. Ask how the service is organized and whether the clinician has training in that approach. Compare the answer with your needs, availability, and ability to participate.^[4][11]

Online care can reduce some travel barriers, but it is important to discuss privacy, technology, and what to do during a crisis. A routine therapy appointment is not a substitute for urgent help. Our care access guide covers practical obstacles to finding support.^[11]

Helping Someone You Care About

Starting with a diagnostic label can make a difficult conversation harder. In the APA’s public expert Q&A, psychiatrist Mark Zimmerman, M.D., suggests approaching a person through the pain or frustrations they are experiencing and offering to listen. The immediate goal can be an initial conversation about help.^[4]

With the person’s agreement, practical support might include looking for providers, preparing questions, or attending a family session. Family members can also seek support for themselves. Learning about the condition can help, but it does not make you responsible for providing treatment.^[5]

Compassion and boundaries can coexist. A diagnosis does not mean you must accept threats, abuse, or unsafe behavior. Explain what you can offer and when you need to step away. If a situation becomes dangerous, prioritize safety rather than continuing an argument.^[4]

Getting Help for Personality Disorder Symptoms

Personality disorder symptoms can improve, and a useful plan begins with the difficulties affecting your life now. Whether your first concern is relationships, distress, or substance use, you can ask for an assessment and discuss treatment options. Progress and the amount of support needed differ from person to person.^[10]

In the U.S., call or text 988 if you are in emotional distress or thinking about suicide. Call 911 for immediate danger, a suicide attempt, or another life-threatening emergency.^[5]