Personality Disorders

The American Psychiatric Association (APA) defines a personality disorder as “a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” People with personality disorders have chronic dysfunctional behaviors that cause problems in personal relationships and impair functioning in society. In order to make a diagnosis of a personality disorder, the APA says a person must have significant and long-lasting difficulties in at least two of these four areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

Although everyone may exhibit some of the personality traits associated with the various disorders at times, a diagnosis of a personality disorder isn’t made unless the behaviors are long-lasting and cause significant impairment in functioning.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), recognizes 10 types of personality disorders and divides them into three clusters: Cluster A, Cluster B and Cluster C.

Cluster A – Odd and eccentric behavior; distorted thinking, social withdrawal
Disorders included: Paranoid, Schizoid and Schizotypal Personality Disorders

• Paranoid Personality Disorder – People with this disorder don’t trust others and are always suspicious of other people’s behaviors. They have difficulty getting close to others for fear they will be harmed in some way.
• Schizoid Personality Disorder – A person with this disorder is viewed as a “loner.” Characteristics include avoiding relationships, difficulty expressing emotions, poor social skills and difficulty responding appropriately to various life events.
• Schizotypal Personality Disorder – Individuals are often superstitious and demonstrate odd behaviors, beliefs, speech patterns and may dress in strange clothes. They experience extreme discomfort in social settings and have few close relationships.

Cluster B – Dramatic, emotional, and erratic; difficulty regulating emotions and have poor impulse control
Disorders included: Borderline, Narcissistic, Histrionic and Antisocial Personality Disorder

• Borderline Personality Disorder – Borderline personality disorder (BPD) is characterized by impulsivity and instability in mood, self-image, and personal relationships. This instability often disrupts family and work, long-term planning and the individual’s sense of self-identity. Many people with BPD also have a co-occurring disorder such as depression, anxiety, substance abuse or eating disorders. Although it’s often viewed as a disorder that’s difficult to treat, BPD can be treated effectively and quality of life can improve over time.
• Narcissistic Personality Disorder – One of the classic signs of this disorder is a grandiose sense of self-importance. People are described as very arrogant and lack empathy. They may exploit others to benefit themselves.
• Histrionic Personality Disorder – People with this disorder have good social skills, but they use them to manipulate others in order to become the center of attention. They are typically very dramatic, preoccupied with physical appearance and often portray seductive and provocative behavior. They are also very sensitive to criticism and constantly seek approval and reassurance from others.
• Antisocial Personality Disorder – The American Psychiatric Association describes this disorder as “a pervasive pattern of disregard for, and violation of, the rights of others.” It typically begins in childhood or adolescence and continues into adulthood. People with this disorder are self destructive, aggressive, disregard laws and boundaries, lie and show no remorse when they cause harm to others. This disorder is common among the prison population.

Cluster C – Anxious and fearful
Disorders include: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders

• Avoidant Personality Disorder – People with this disorder are extremely concerned about what others think of them. They fear rejection and criticism. Due to feeling inadequate in social situations, the person tries to avoid any interaction with others; even missing school and work.
• Dependent Personality Disorder – People with this disorder have a strong need to be taken care of by others. They fear being abandoned by people in their life and have difficulty making the smallest decisions without approval and reassurance. Others may describe the person as “clingy” or “needy.”
• Obsessive Compulsive Personality Disorder (OCPD) – Perfection, order and control are the main characteristics of this disorder. People have trouble completing tasks due to the extreme perfectionism; nothing is ever good enough. They also have difficulty delegating tasks to others for fear it won’t be done “right.” OCPD is different from Obsessive Compulsive Disorder (OCD) because obsessions and compulsions aren’t present in OCPD. For example, a person with OCD might make lists to relieve anxiety or out of fear that something bad will happen if they don’t. A person with OCPD might also make lists, but they don’t do so out of fear; it helps them achieve a more perfect outcome. Lastly, people with OCD view their thoughts and behaviors as problematic, whereas those with OCPD don’t think there is anything wrong with their behavior.

Treatment for personality disorders varies based on the disorder and the symptoms. Each case is unique, but a combination of psychotherapy and medication are often used. Depending on the severity of symptoms, some people may benefit most from a long-term residential treatment program.

Silver Hill Hospital specializes in treating personality disorders with dialectical behavior therapy (DBT). In fact, it is one of the only residential DBT treatment programs in the country. It is a highly structured, intensive program for patients who do not need close inpatient supervision but are not able to manage successfully in an outpatient setting. Learn more about the program