What is a personality disorder?

A personality disorder refers to a long-term pattern of thinking, behaviour and emotion that is dysfunctional, extreme and inflexible. It causes distress and makes it difficult to function in everyday life. People with personality disorders find it hard to change their behaviour or adapt to different situations. They may have trouble sustaining work or forming positive relationships with others.

There are many different types of personality disorder. Some people with a personality disorder may appear withdrawn, some dramatic and emotional, and others odd or eccentric. The one thing they have in common is that their symptoms are severe enough to affect many different areas of life.

People often develop the early signs of a personality disorder in adolescence. The exact number of Australians with personality disorders is not known. People with a personality disorder also have high rates of coexisting mental health conditions such as depression and substance abuse.

The difference between personality traits and personality disorders

There are many different ways to understand personality, and many different theories about personality traits and personality types. For example, some people are more extroverted and prefer the company of others, while others are introverted and enjoy being alone.

The term personality disorder is not ideal and can lead to stigma. No one likes to be told that there is something wrong with their personality, and some people may use the term inappropriately to discriminate against others. However, personality disorders are genuine mental health disorders that cause distress.

What are the types of personality disorders?

There are different ways to classify personality disorders, and experts often disagree about the best way to group them together. Generally, they agree that personality disorders lie on a spectrum, along with normal personality traits. So, some people may have some features of a personality disorder without having the entire disorder.

Some people may also show features of more than one personality disorder.

One of the main classification systems groups personality disorders into 3 main 'clusters'.

Cluster A

People with this type of disorder are generally described as having 'odd' or 'eccentric' thoughts or behaviours:

• Paranoid personality disorder: people with this disorder are suspicious and mistrustful of others, interpret other people’s motives as harmful, and may be hostile or emotionally detached.
• Schizoid personality disorder: this disorder causes someone to lack interest in social relationships and have an unemotional response to social interactions.
• Schizotypal personality disorder: this may cause people to behave eccentrically, have peculiar dress, have unusual or bizarre thoughts and beliefs, feel discomfort in social settings, and have trouble forming close relationships.

Cluster B

General features of this group include unstable emotions and dramatic or impulsive behaviours:

• Antisocial personality disorder: this disorder may cause a disregard for the law or for the rights of others, with a lack of remorse, including lying and stealing, aggression, violence or illegal behaviour.
• Histrionic personality disorder: people with this disorder are highly emotional and dramatic, have an excessive need for attention and approval, and may be obsessed with their appearance.
• Borderline personality disorder: the main features include fear of abandonment, intense and unstable relationships, extreme emotional outbursts, deliberate self-harm or self-destructive behaviour and a fragile sense of self or identity.
• Narcissistic personality disorder: a pattern of inflated self-esteem, need for admiration, lack of empathy or concern for others, and fantasies of success, power or beauty.

Cluster C

General features of these disorders include anxious and fearful thoughts and behaviour:

• Avoidant personality disorder: people with this disorder avoid social interaction and are extremely sensitive to negative judgements by others; they may be timid and socially isolated with feelings of inadequacy.
• Obsessive-compulsive personality disorder: people with this disorder are preoccupied by rules, orderliness and value work above other aspects of life. They are perfectionistic and have a need to be in control. Note that this is different from obsessive-compulsive disorder (OCD).
• Dependent personality disorder: this disorder causes a fear of being alone and a need to be taken care of, difficulty separating from loved ones or making independent decisions. People may be submissive and even tolerate domineering or abusive relationships.

What are the symptoms of personality disorders?

The symptoms depend on the type of personality disorder. However, many of the symptoms of different personality disorders overlap.

Common signs of a personality disorder include:

• strange or erratic behaviour
• suspicion and distrust
• taking risks
• extreme mood swings (angry outbursts)
• difficulty with relationships
• problems at school or work
• need for instant gratification

Many people have some of these traits, but they do not necessarily have a diagnosis of personality disorder.

Personality disorders tend to start in childhood, and the thoughts and behaviours become more ingrained into adulthood.

People with personality disorders may be unaware that they have a problem or may find it hard to seek help. Family or friends may be severely impacted by caring for someone with a personality disorder and they may be the ones to seek assistance.

What causes personality disorders?

The causes of personality disorders are not fully understood.

We know that personality in general is formed in childhood and is a combination of how you are born and your environment in early childhood. There is no single gene for personality or personality disorders — multiple genes are involved. Having a secure bonding process or attachment between a parent (or other caregiver) and an infant provides a positive environment in which their personality can develop.

People with personality disorders (particularly certain types, such as borderline personality disorder) have higher rates of childhood abuse, trauma or neglect.

It is thought that personality disorders may occur due to a complex interaction between negative early life experiences and genetic factors. Disruptions to the attachment between parents and infants can happen due to mental or physical illness or substance abuse in the parent, or long separations between parents and infants. A lack of positive caregiving in early childhood can also have a negative impact on personality development.

When should I see my doctor?

Don’t assume that someone has a personality disorder just because they are behaving a certain way. But if you or someone you know has signs of a personality disorder such as erratic behaviour, mood swings, or problems in relationships, then it’s worth seeing a doctor.

A personality disorder is hard to deal with alone. Talking to a doctor or mental health professional is the first step towards getting support and treatment.

If you or someone you know is any immediate danger of suicide, then please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.

How are personality disorders diagnosed?

A doctor will ask questions about the current symptoms and any recent events, as well as past mental health issues, family background, relationships, medical history and any drug or alcohol problems.

The doctor may also do a physical examination or blood tests to rule out medical issues. They may need to refer to a psychiatrist or psychologist for further assessment or treatment. The diagnosis of a personality disorder may take some time to establish since a health professional will need time to get to know the person.

How are personality disorders treated?

It can be difficult for someone with a personality disorder to learn to trust a doctor or therapist. However, establishing a positive relationship with a healthcare provider is an important step towards recovery. The treatment may vary, based on the type of personality disorder and any other conditions that might be present.

With treatment and support, many people with personality disorders are able to learn to manage their symptoms, develop positive and healthy relationships, and create a meaningful and fulfilling life.

Psychotherapy

Psychotherapy is the most effective long-term treatment option for personality disorders. Psychotherapy is when a psychologist, psychiatrist or psychotherapist helps people to understand their thoughts, motivations and feelings. These insights can help people to manage their symptoms, develop satisfying relationships and make positive behaviour changes.

Methods include:

• cognitive behaviour therapy (CBT)
• dialectical behaviour therapy (DBT)
• psychodynamic psychotherapy
• psychoeducation

Medicine and personality disorders

There is no specific medicine to treat personality disorders. However, antidepressant medicines may be used to treat associated conditions such as anxiety and depression, or to help people cope with their symptoms. Less frequently, other types of medicines such as antipsychotics or mood stabilisers may be prescribed.

Medicine works most effectively in combination with psychotherapy.

Crisis management

Some people with personality disorders have trouble coping with stressful events, and may need support in a crisis. They may develop suicidal thoughts and behaviours and require emergency assistance. Rarely, hospitalisation may be required in severe cases to prevent the risk of self-harm or suicide, or for the treatment of other mental health conditions. This is a temporary solution to ensure safety and, in general, long-term hospital admission is not recommended for people with personality disorders.

Resources and support

If you need help, talking to your doctor is a good place to start. If you’d like to find out more or talk to someone else, here are some organisations that can help:

• Reachout (Support services for personality disorders)
• SANE Australia (people living with a mental illness) — call 1800 187 263.
• Beyond Blue (anyone feeling depressed or anxious) — call 1300 22 4636 or chat online.
• Black Dog Institute (people affected by mood disorders) — online help.
• Lifeline (anyone having a personal crisis) — call 13 11 14 or chat online.
• Suicide Call Back Service (anyone thinking about suicide) — call 1300 659 467.