Personality disorders are enduring patterns of inner experience and behavior that deviate significantly from cultural expectations, causing distress or impairment in personal, social, and occupational functioning. These patterns tend to be fixed and consistent across situations and lead to distress or impairment. While often misunderstood and stigmatized, personality disorders are treatable mental health conditions that affect approximately 9.1% of U.S. adults and 4.1% to 5.2% of the global population.
With appropriate treatment—including evidence-based psychotherapies like dialectical behavior therapy (DBT), schema therapy, and mentalization-based treatment—individuals with personality disorders can learn to manage their symptoms, improve their relationships, and enhance their quality of life. Patients in both DBT and schema therapy treatment groups showed substantial improvements, indicating that even severely affected patients with personality disorders and various comorbid disorders can be treated successfully.
Table of Contents
- Understanding Personality Disorders
- How Do Personality Disorders Develop?
- Stigmatization of Personality Disorders
- Effects of Personality Disorders
- Treatment for Personality Disorders
- Frequently Asked Questions
- How Therapy Can Help / Find a Therapist
- References
Understanding Personality Disorders
To receive a diagnosis of a personality disorder, an individual must display persistent patterns of thinking and behavior that are characteristic of that specific condition across multiple contexts and over an extended period. These disorders can adversely affect multiple aspects of life, including relationships, work, and overall functioning—underscoring the need for early intervention and interdisciplinary care.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) organizes personality disorders into three clusters based on shared characteristics. While these clusters are distinct, it is not uncommon for individuals to have co-occurring personality disorders from different clusters.
Cluster A: Odd or Eccentric Features
Cluster A personality disorders involve patterns of behavior that appear odd or eccentric to others:
- Paranoid personality disorder: Individuals display pervasive distrust and suspicion of others, often perceiving them as hostile and preoccupying themselves with doubts about others' loyalty.
- Schizoid personality disorder: Characterized by detachment from social relationships and restricted emotional expression. Individuals often prefer solitary activities and may seem indifferent to praise or criticism.
- Schizotypal personality disorder: Features include odd beliefs, magical thinking, unusual perceptual experiences, and eccentric behaviors. People may experience discomfort in close relationships and display paranoid ideation.
Cluster B: Dramatic, Emotional, or Erratic Features
Cluster B disorders are characterized by behaviors often perceived as dramatic, overly emotional, and unpredictable:
- Antisocial personality disorder: Characterized by a pervasive and enduring pattern of disregarding and violating the rights of others, typically emerging in childhood or early adolescence. Individuals frequently engage in criminal behavior and struggle to learn from the negative consequences of their actions.
- Borderline personality disorder (BPD): The most extensively researched personality disorder, BPD involves patterns of instability in interpersonal relationships, self-image, emotions, and marked impulsivity. It affects approximately 1.4% of the general population.
- Histrionic personality disorder: Individuals display excessive emotionality and attention-seeking behavior, with rapidly shifting and shallow emotions. They may use physical appearance or dramatic behavior to draw attention.
- Narcissistic personality disorder: Characterized by grandiosity, need for admiration, and lack of empathy. Individuals often have fantasies of unlimited success, power, or ideal love.
Cluster C: Anxious or Fearful Features
Cluster C encompasses personality disorders involving anxious or fearful qualities:
- Avoidant personality disorder: Individuals experience feelings of inadequacy, hypersensitivity to criticism, and social inhibition. Avoidance of awareness of emotions may be employed as a psychological defense strategy to protect against distress.
- Dependent personality disorder: Involves excessive need to be taken care of, leading to submissive and clinging behavior. Individuals struggle with decision-making and fear separation.
- Obsessive-compulsive personality disorder (OCPD): The most prevalent personality disorder in the general population, OCPD is characterized by preoccupation with orderliness, perfectionism, and control. This should not be confused with obsessive-compulsive disorder (OCD).
How Do Personality Disorders Develop?
Personality disorders are psychiatric conditions characterized by enduring patterns of cognition, emotion, and behavior that deviate significantly from cultural norms. The etiology of personality disorders is complex, involving both genetic and environmental factors.
Genetic and Neurobiological Factors
Recent evidence shows that personality disorders are influenced by thousands of genetic variants acting together. Most of these variants are commonly occurring, meaning that every individual has a genetic risk to each psychiatric disorder, from low to high. Research has identified specific neurobiological mechanisms:
Network analysis on dysregulated genes revealed two pathways, centered on p38 MAPK and ubiquitin, that might be implicated in aggression associated with personality disorders
The role of fatty acid amide hydrolase (FAAH) in aggression in borderline personality disorder, excitation/inhibition imbalances in antisocial personality disorder
Serotonergic and dopaminergic pathway dysfunction, microglial activation, and proinflammatory cytokines implicated in aggression
Environmental and Developmental Factors
Adverse childhood experiences are significantly associated with personality disorder development, as shown in a prospective, longitudinal study. Key environmental risk factors include:
- Childhood trauma: Children exposed to verbal abuse from their parents were three times more likely to be diagnosed with borderline, narcissistic, obsessive-compulsive, or paranoid personality disorders
- Early attachment disruptions: Problems in early caregiver relationships can affect emotional regulation and interpersonal functioning
- Chronic stress: Emerging evidence supports the role of mTOR signaling pathway in stress-induced psychopathology, with elevation of mTOR levels shown to confer stress-resilience
- Gene-environment interactions: Preclinical evidence shows synergistic or antagonistic effects of genetic mutations (e.g., serotonin transporter genes) and environmental factors (e.g., stress, enrichment)
Stigmatization of Personality Disorders
Stigma and discrimination toward those with a mental disorder are prevalent. This is especially true of those with a personality disorder. Understanding and addressing stigma is crucial for improving treatment access and outcomes.
Forms of Stigma
Three main types of mental health stigma exist: Public stigma involves negative or discriminatory attitudes that others have about mental illness; self-stigma refers to the negative attitudes, including internalized shame, that people with mental illness have about their condition; and institutional stigma involves policies that intentionally or unintentionally limit opportunities for people with mental illness.
Impact on Treatment
Individuals with personality disorders endorsed several factors of internalized stigma including alienation, social withdrawal, stereotype endorsement, and reported significant discriminatory experiences. This stigma creates significant barriers:
More than half of people with mental illnesses do not receive help for their disorders, or they delay seeking help, due to concerns about being treated differently or fearing the loss of a job or livelihood
- Healthcare providers themselves may hold negative attitudes toward patients with personality disorders- A systematic review found widespread experiences of stigma and discrimination in healthcare settings for those with borderline personality disorder
Reducing Stigma
Treating those living with a mental health condition with understanding, empathy, and acceptance is crucial. Having personal, direct contact with people living with mental health conditions has been shown to combat negative stereotypes and reduce stigma. Key strategies include:
Using non-stigmatizing language when talking about mental health
Focusing away from catch-all categories and pointing toward the causal attributions and treatment of specific mental disorders, while educating yourself and others
Implementing supportive policies and practices that reduce barriers in settings like workplaces and healthcare
Effects of Personality Disorders
Personality disorders can significantly impact multiple areas of life:
Interpersonal Relationships-
Personality disorders significantly impact interpersonal and occupational functioning, often leading to profound impairments in overall quality of life
- Difficulty maintaining stable relationships due to patterns of mistrust, emotional dysregulation, or fear of abandonment- Challenges with treatment engagement, as factors related to dropout include interpersonal difficulties inherent to the disorder
Occupational Functioning
- Challenges in workplace settings due to interpersonal difficulties or perfectionism- 6.9% of U.S. adults with mental illness are unemployed compared to 4.3% of U.S. adults without mental illness
- Avoidant personality may lead to missed opportunities due to fear of rejection
Physical and Mental Health-
Coexisting psychiatric conditions and substance use disorders are common among those affected
Personality disorder is associated with substantial distress, disability, and excess mortality
Increased risk of suicide, unemployment, social isolation, and reduced life expectancy
Quality of Life-
Studies show significant impairments in global psychiatric symptoms, depression, and anxiety
- Social isolation and loneliness
- Difficulty achieving personal goals and maintaining independence
Treatment for Personality Disorders
While personality disorders present treatment challenges due to their pervasive nature, research demonstrates that effective treatments are available. A meta-analysis of 54 trials (n=3,716 participants) found a large effect size (g=0.78) favoring interventions for borderline personality disorder symptoms over treatment as usual.
Evidence-Based Psychotherapies
Dialectical Behavior Therapy (DBT)- Studies revealed that both short-term DBT and standard DBT improved suicidality in BPD patients with small or moderate effect sizes, lasting up to 24 months after treatment. DBT can significantly improve general psychopathology and depressive symptoms
DBT integrates individual therapy, skills training, telephone coaching, and therapist consultation. It follows a biosocial model and teaches four core skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance
Research shows DBT may be particularly effective for patients with higher functioning, less emotional neglect and sexual abuse, more anxiety, and more pronounced schema 'failure to achieve'
Schema Therapy- Research consistently shows moderate to large effect sizes (g=0.359 to 0.859) across studies, with benefits lasting 3-5 years post-treatment
A randomized clinical trial demonstrated schema therapy's effectiveness for violent personality disorder offenders
In direct comparisons with DBT, both treatments showed substantial improvements for severely affected patients with BPD and various comorbid disorders
Mentalization-Based Treatment (MBT)- A recent randomized controlled trial showed MBT's effectiveness for antisocial personality disorder in community probation settings
- Focuses on improving the capacity to understand mental states in oneself and others
- Shows promise for reducing self-harm and improving interpersonal functioning
Other Effective Approaches
- Cognitive Behavioral Therapy (CBT): Effective for various personality disorders, particularly when adapted for specific symptoms
- Transference-Focused Psychotherapy: Psychodynamic approach showing effectiveness for BPD
- Systems Training for Emotional Predictability and Problem Solving (STEPPS): Group treatment showing benefits as adjunct therapy
Medication Management
While no medications are specifically approved for personality disorders, psychiatrists may prescribe medications to target specific symptoms:- Pharmacotherapy options exist for symptom management, though no medication is FDA-approved specifically for personality disorders
A network meta-analysis evaluated pharmacological treatments for BPD symptoms, though psychotherapy remains the first-line treatment
- Common medications include antidepressants for mood symptoms, mood stabilizers for emotional dysregulation, and antipsychotics for severe symptoms
Treatment Duration and Intensity
Research comparing 8-week and 12-week DBT interventions found both durations effective, with treatment adapted for routine inpatient settings
Studies suggest that detecting a medium effect size (d=0.5) for group differences requires significant sample sizes, indicating the importance of adequate treatment duration
Treatment effects were maintained at follow-up periods, suggesting lasting benefits
Integrated and Specialized Care
Future research needs to test the efficiency of various models of integrated treatments over time to help support patients and improve quality of life
Early diagnosis and treatment are crucial in managing symptoms and improving quality of life for those affected
- Residential and intensive outpatient programs for severe cases
- Integration of trauma-informed approaches given high rates of childhood adversity
Frequently Asked Questions
What is the most common personality disorder?
Obsessive-compulsive personality disorder (OCPD) is the most prevalent personality disorder in the general population. OCPD is different from obsessive-compulsive disorder (OCD) and is characterized by preoccupation with orderliness, perfectionism, and control.
Can personality disorders be cured?
While personality disorders involve enduring patterns of behavior, research shows that even severely affected patients can be treated successfully with evidence-based therapies like DBT and schema therapy. Treatment focuses on symptom management and improving quality of life rather than "cure."
How long does treatment for personality disorders typically take?
Treatment duration varies by individual and severity. Research shows benefits from schema therapy can last 3-5 years post-treatment, while DBT improvements in suicidality can last up to 24 months after treatment. Most evidence-based treatments involve at least 6-12 months of regular therapy.
Are personality disorders genetic?
Personality disorders are influenced by thousands of genetic variants acting together, with every individual having some genetic risk ranging from low to high. However, environmental factors like childhood trauma also play a significant role.
What's the difference between BPD and bipolar disorder?
While both involve mood instability, BPD is characterized by patterns of instability in interpersonal relationships, self-image, emotions, and marked impulsivity, with rapid mood changes often triggered by interpersonal events. Bipolar disorder involves distinct episodes of mania/hypomania and depression lasting days to weeks.
Can someone have more than one personality disorder?
Yes, a large proportion of people with personality disorders also have one or more other mental disorders (84.5%). It's also possible to have personality disorders from different clusters simultaneously.
How Therapy Can Help / Find a Therapist
If you or someone you know is struggling with symptoms of a personality disorder, professional help is available and effective. Psychological and psychosocial interventions delivered in community and outpatient settings are highly effective in treating personality disorder symptoms and can improve a wide range of psychiatric symptoms, with considerable maintenance across time.
Working with a qualified mental health professional who has experience treating personality disorders is crucial. Look for therapists trained in evidence-based approaches like DBT, schema therapy, or MBT. The therapeutic relationship itself is an important factor in treatment success.
GoodTherapy.org can help you find a therapist who specializes in personality disorders and uses evidence-based treatment approaches. Our directory includes mental health professionals who understand the unique challenges of personality disorders and are committed to providing compassionate, effective care.
Remember: Having personal, direct contact with people living with mental health conditions has been shown to combat negative stereotypes and reduce stigma. Seeking help is a sign of strength, not weakness.
Find a therapist near you who specializes in personality disorders →
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