Defining Personality Disorders

In the field of psychology, "personality" refers to the set of enduring behavioral and mental traits that distinguish an individual from other people. According to the DSM-5, "personality disorder" refers to when an individual displays a personality style (i.e., patterns of cognition, behavior, and emotion) that:

1. differs significantly from the norms and expectations of their culture in two or more of the following areas: cognition, affect, interpersonal functioning, or impulse control;
2. causes them and/or others around them "clinically significant" distress and impairment in important areas of functioning;
3. is pervasive (i.e., applies across many contexts, such as school, work, and home) and enduring (i.e., has been exhibited over a long duration of time, since at least adolescence or early adulthood); and
4. cannot be better explained by another mental disorder or be due to the direct physiological effects of a substance or general medical condition (e.g., head trauma).

The patterns found in personality disorders develop early and are inflexible. Someone diagnosed with a personality disorder may experience difficulties in cognition, emotion, impulse control, and interpersonal functioning. That said, though personality disorders are typically associated with significant distress or disability, they are also ego-syntonic, which means that individuals do not feel as though their values, thoughts, and behaviors are out of place or unacceptable. In other words, their thoughts and behaviors are consistent with their own ideal self-image.

The DSM-5: Grouping Personality Disorders

To be fully diagnosed, an individual must meet both the DSM-5's general diagnostic criteria for a personality disorder (provided above) as well as the criteria for a specific disorder.

The DSM-5 lists ten different personality disorders, grouped into three clusters based on common features. Personality disorders are often researched within these clusters, since the disorders in a cluster exhibit many common disturbances.

Cluster A (odd and eccentric)

• Paranoid personality disorder: Characterized by a pattern of irrational suspicion and mistrust of others and the interpretation of motivations as malevolent. The person is guarded, defensive, distrustful, suspicious, and always looking for evidence to confirm hidden plots and schemes.
• Schizoid personality disorder: Characterized by a lack of interest and detachment from social relationships, and restricted emotional expression. The individual is apathetic, indifferent, remote, solitary, distant, and humorless. They neither desire, nor need, human attachments, and withdraw from relationships and prefer to be alone.
• Schizotypal personality disorder: Characterized by a pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions. One is eccentric, self-estranged, bizarre, absent, and exhibits magical thinking and strange beliefs.

Cluster B (dramatic, emotional, or erratic)

• Antisocial personality disorder: A pervasive pattern of disregard for, and violation of, the rights of others, rooted in a lack of empathy. The person is impulsive, irresponsible, unruly, inconsiderate, and sometimes violent. They comply with social obligations only when they see personal benefit.
• Borderline personality disorder: A pervasive pattern of instability in relationships, self-image, identity, behavior, and affect, often leading to self-harm and impulsivity. One is unpredictable, manipulative, unstable, and frantically fears abandonment and isolation. One shifts rapidly between loving and hating.
• Histrionic personality disorder: A pervasive pattern of attention-seeking behavior and excessive emotions. One is dramatic, seductive, shallow, stimulus-seeking, and vain. One overreacts to minor events and is exhibitionistic.
• Narcissistic personality disorder: A pervasive pattern of grandiosity, need for admiration, and a lack of empathy.

Cluster C (anxious or fearful)

• Avoidant personality disorder: Pervasive feelings of social inhibition and inadequacy, and extreme sensitivity to negative evaluation. One is hesitant, self-conscious, embarrassed, anxious, and sees self as inept, inferior, or unappealing.
• Dependent personality disorder: A pervasive psychological need to be cared for by other people. One is helpless, incompetent, submissive, immature, and sees self as weak or fragile.
• Obsessive-compulsive personality disorder: Characterized by a rigid conformity to rules, perfectionism, and control. One maintains a rule-bound lifestyle, adheres closely to social conventions, sees the world in terms of regulations and hierarchies, and often follows directions and rules to the point of missing the purpose of the task.

Challenges of Personality Disorders

The disruptive nature of personality disorders, as well as the fact that their symptoms are long-lasting and affect multiple areas of functioning, means that these are possibly the most challenging group of disorders to manage. In addition, individuals with personality disorders may not even be able to recognize that their personality is causing distress or issues with other people.

Unfortunately, there is substantial social stigma and discrimination related to a diagnosis of a personality disorder. Community mental health services may view individuals with personality disorders as too complex or difficult to deal with and so directly or indirectly exclude them from receiving care.