Personality Disorders: Signs, Symptoms, and Treatment

By Amalia Sirica, LCSW

Personality disorders are mental health conditions that can cause unhealthy and sometimes destructive patterns of thinking. They influence the way that a person relates to and interacts with the world, which can create problems with relationships, social activities and work or school responsibilities. According to the National Institute of Mental Health, around 9.1% of U.S. adults aged 18 or older have a personality disorder.

People with personality disorders generally behave in ways that differ from what society finds normal. However, they might not know they’re experiencing personality disorder symptoms, as their ways of thinking and behaving may feel natural to them. Some research shows that personality disorders may be linked to traumatic childhood events, especially in the case of borderline personality disorder.

The following information provides an overview of the different types of personality disorders, but it should not be used to diagnose yourself or others. Personality disorders are complicated, and symptoms can vary from person to person, so diagnoses should only be made by licensed professionals.

Personality disorders are divided into three clusters:

  • Cluster A: The “odd, eccentric” cluster
  • Cluster B: The “dramatic, impulsive” cluster
  • Cluster C: The “anxious, fearful” cluster

Cluster A: Paranoid, Schizoid and Schizotypal

Paranoid Personality Disorder

  • A person with paranoid personality disorder may have difficulty trusting people, being intimate or maintaining relationships.
  • They may be more sensitive to perceived insults and rejection.
  • Someone with paranoid personality disorder might perceive feedback or suggestions as harsh criticism or a threat. They may also hold onto resentment and anger.
  • Being vulnerable in relationships may feel scary and unsafe, as if shared information might be used to cause them harm at a later date.

Schizoid Personality Disorder

  • A person with schizoid personality disorder might show disinterest in personal relationships and appear aloof or indifferent.
  • They may struggle to pick up on social cues and have a limited range of emotional expression.
  • These symptoms can impact interpersonal relationships and cause the person to experience social isolation. However, they may not be distressed by the lack of social connection because they may prefer to be on their own.

Schizotypal Personality Disorder

  • Someone with schizotypal personality disorder might seem to have odd ways of dressing, speaking or thinking.
  • They might hear voices and experience social anxiety.
  • This disorder is also characterized by distress and suspicion in interpersonal relationships, which may also show up as “magical thinking.” Someone with this disorder might feel that they have the ability to influence people and outcomes just by using their thoughts.
  • As with other personality disorders, schizotypal personality disorder would likely cause a person to display behaviors that are outside of the social norm.

Cluster B: Antisocial, Borderline, Histrionic and Narcissistic

Antisocial Personality Disorder

  • A person with antisocial personality disorder might display reckless behavior and a lack of remorse for how their behavior affects others.
  • Antisocial personality disorder is found in a relatively small portion of the general population, but it is highly prevalent among incarcerated individuals.
  • One study of 320 newly incarcerated offenders found that antisocial personality disorder was present in 113 of the subjects (35.3%).
  • Research suggests that the best treatment for antisocial personality disorder is prevention efforts in youth.

Borderline Personality Disorder

  • People with borderline personality disorder (BPD) symptoms might be perceived as impulsive or likely to engage in risky behaviors. They might also appear to have an unstable and easily influenced sense of self.
  • BPD has been linked to early childhood traumatic experiences.
  • BPD has significant stigma associated with it, even though most BPD-related behaviors are caused by a combination of genetics and early childhood experiences.
  • BPD-related behaviors are often an attempt to get psychological needs met. For example, a person with BPD might express a desire to self-injure as a way to communicate to a loved one that they are feeling scared of abandonment and need care or attention.

 Histrionic Personality Disorder

  • A person with histrionic personality disorder might display attention-seeking behaviors, and their behaviors may seem extreme or exaggerated.
  • They might also be easily influenced by the opinions of others and concerned about what others think.
  • At times, their emotional state may change rapidly and without notice.
  • Someone with histrionic personality disorder might value physical appearance and validation.
  • They may overestimate the level of intimacy in intimate relationships.
  • They may seek to cause dramatic situations for seemingly no reason.

Narcissistic Personality Disorder

  • People with narcissistic personality disorder are primarily identified by an inflated sense of self.
  • They may hold the belief that they are more important than others.
  • They could be self-focused and struggle to recognize the needs of others.
  • They may expect constant praise and attention from others.
  • They might demonstrate paranoia around believing that others are jealous and envious.
  • They are often sensitive to criticism and rejection.
  • They may have an exaggerated sense of self-importance about their achievements, which may be covering up low self-esteem and self-doubt.

Cluster C: Avoidant, Dependent and Obsessive-Compulsive

Avoidant Personality Disorder

  • People with avoidant personality disorder may seem overly sensitive to criticism or rejection.
  • They may describe experiences of self-doubt and feelings of inferiority.
  • They might avoid social situations due to feelings of social anxiety or thinking that they might be rejected or criticized.
  • Their social anxiety usually stems from an extreme fear of being criticized or judged, so much so that they might prefer to isolate themselves than risk rejection.

Dependent Personality Disorder

  • Someone with dependent personality disorder might show excessive dependence on other people and feel the need to be cared for.
  • They may experience feelings of low self-esteem and become reliant on others for making even small decisions.
  • They may fear conflict and choose to agree with people even when an agreement conflicts with their needs.
  • They may have difficulty spending time alone, fearing the thought of having to depend solely on themselves.

Obsessive-Compulsive Personality Disorder

  • This personality disorder is not to be confused with obsessive-compulsive disorder, which is a type of anxiety disorder.
  • Someone with obsessive-compulsive personality disorder might seem intensely preoccupied with cleanliness and rules.
  • They may experience perfectionism that interferes with daily life and getting things done.
  • They might have difficulty understanding that most of life exists in the grey area. As a result, they may display extreme rigidity around morality and values, making it difficult to relax and enjoy life.

Personality Disorder Symptoms and Diagnosis

Personality disorders can be quite tricky to diagnose, as a person may show symptoms of several overlapping personality disorders. The DSM-5 states a personality disorder diagnosis is only warranted when there has been long-term deviation from cultural expectations that causes significant distress or impairment in at least two of these areas:

  • The way you interpret and perceive yourself, others and events
  • Appropriateness of your emotional responses
  • Interactions with other people and in relationships
  • Impulse control

Due to the sometimes elusive nature of the above criteria, clinicians will sometimes use the diagnosis of personality disorder not otherwise specified (PD NOS). This is for patients who meet fewer personality disorder criteria and are experiencing less severe psychological impairment.

Comorbidity — the presence of two or more co-occurring diseases — presents another potential challenge to personality disorder diagnosis. According to the National Institute of Mental Health, around 84.5% of people with personality disorders also had one or more co-occurring mental health disorders. This is another reason why care should be taken when diagnosing personality disorders, as patients can often have overlapping symptoms from another disorder.

Personality Disorder Treatment

Psychotherapy, or talk therapy, is the primary treatment method for personality disorders. Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) have been shown to be particularly effective for these disorders. Some health care providers may also recommend psychiatric treatment and prescribed medication to assist with the treatment process. If both of these methods are being used and there is not a reduction in symptoms, inpatient or outpatient care might be recommended.

It is important to consider the biopsychosocial roots of personality disorders during diagnosis and treatment. This means it’s important to look at all aspects of a patient’s experience when making a diagnosis, including their early childhood environment and other personal factors. The biopsychosocial strategy emphasizes a person-centered approach with a focus on the relationship between the patient and provider.

Just like any other diagnostic process, diagnosing a personality disorder can be complicated and is best done with care and compassion. If you believe that you or a loved one may be experiencing symptoms of a personality disorder, please seek help and guidance from a qualified professional.

The free-to-use Nobu app provides a wide range of resources that can help you maintain your mental health. You can track your treatment progress and goals, practice mindfulness, follow along with guided yoga and develop coping strategies for life’s toughest challenges. Nobu offers easy but effective ways to supplement your ongoing personality disorder treatment program — download the smartphone app today and see how it can benefit your mental health.

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Edited by – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor’s in Communication in 2017 and has been writing professionally ever since. He has written, edited and published content for health care professionals, educators, real estate agents, lawyers and high-level university faculty… Read more.

Amalia Sirica

Written by – Amalia Sirica, LCSW

Amalia Sirica is New York State Licensed Clinical Social Worker and a writer. She has spent the last ten years working with children, young adults and adults of all different backgrounds and experiences. She received her bachelor’s degree in Psychology from Duke University, and her master’s degree in Social Work from New York University… Read more.

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Medically Reviewed by – Dr. Angela Phillips

Angela is a licensed therapist and clinical researcher, and has worked in public, private, government, and not-for-profit organizations, across clinical and research-oriented roles. Angela’s clinical and research experience has included suicide prevention, cognitive behavioral… Read more.

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U.S. National Library of Medicine. “Antisocial Personality Disorder.” MedlinePlus, October 8, 2021. Accessed October 21, 2021. 

Bonn, Scott A. “The Differences Between Psychopaths and Sociopaths.” Psychology Today, January 9, 2018. Accessed October 21, 2021.

Harms, William. “Psychopaths are not neurally equipped to have concern for others.” University of Chicago Office of Communications, April 24, 2013. Accessed October 22, 2021. National Institute of Mental Health. “Common Mental Health Disorders: National Institute of Mental Health.” Niagara University First Responders Disability Awareness Training. Accessed October 22, 2021.