What is a personality disorder?

Personality is a unique collection of traits (characteristics or qualities) that affect how you think and behave.

A personality disorder is when some’s personality traits cause distress. It can make it hard for them 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 finding and keeping a job and forming positive relationships with others.

There are many different types of personality disorder. Across all types, the person’s behaviour affects their ability to interact well with others and function in everyday life.

Around 6 in 100 Australians experience personality disorder. People with a personality disorder are also more likely to have other mental health conditions such as depression and substance abuse.

The difference between personality traits and personality disorders

There are many ways to understand personality, and different theories about personality traits and types. For example, some people are more extroverted (outgoing, sociable and prefer to be with other people), while others are introverted (enjoy being alone or with just a few people). Everyone has a unique collection of traits that make up their personality. This influences their thoughts and behaviour.

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. Some people may also 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. Most experts agree that personality disorders lie on a spectrum, along with normal personality traits. This means that people may have some features of a personality disorder without having a personality 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 untrusting of others.
• Schizoid personality disorder: This disorder causes someone to lack interest in social relationships and have an unemotional response to social interactions.
• Schizotypal personality disorder: People with this disorder may have difficulty forming close relationships. They may also behave strangely and have strange beliefs. For example, they may believe that their thoughts can influence people and events.

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, along with a lack of remorse (feelings of regret or guilt). This may lead to behaviours including lying, stealing, aggression, violence and/or illegal behaviour.
• Histrionic personality disorder: People with this disorder are highly emotional and dramatic. They have a high need for attention and approval.
• Borderline personality disorder: The main features include fear of abandonment (being rejected or left alone), intense and unstable relationships, extreme emotional outbursts, self-harm or self-destructive behaviour and a fragile sense of self or identity.
• Narcissistic personality disorder: People with this disorder have a pattern of inflated (high) self-esteem, and belief that they are better than other people.

Cluster C

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

• Avoidant personality disorder: People with this disorder are extremely sensitive to criticism or rejection by others. They may experience extreme shyness.
• Obsessive-compulsive personality disorder: People with this disorder are very focussed on rules, orderliness, and value work above other aspects of life. They are perfectionistic and controlling. Note that this is different from obsessive-compulsive disorder (OCD).
• Dependent personality disorder: This disorder causes an extreme fear of being alone and a need to be taken care of.

What are the symptoms of personality disorders?

The symptoms depend on the type of personality disorder. Many of the symptoms of different personality disorders overlap.

Common signs of a personality disorder include:

• strange or unpredictable behaviour
• suspicion and distrust (not trusting others)
• taking risks
• extreme mood swings or emotional outbursts
• difficulty with relationships
• problems at school or work
• need for instant gratification (immediate pleasure or reward)

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

Personality disorders tend to start in adolescence (teenage years). The thoughts and behaviours become more firmly fixed in adulthood.

People with personality disorders might not be aware that they have a problem. They may find it hard to seek help. Family or friends may be severely affected by caring for someone with a personality disorder and they may be the ones to seek help.

What causes personality disorders?

The causes of personality disorders are not fully understood.

We know that personality in general is formed in childhood. It is thought to result from a combination of how you are born and your environment in early childhood. There is no single gene for personality or personality disorders — many genes are involved.

Having a secure bond or attachment with a parent (or other caregiver) gives infants and children a positive environment for their personality to develop in a healthy way.

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. Unstable or chaotic family life during childhood can have a negative effect 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 that are causing them distress, 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.

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How are personality disorders diagnosed?

A doctor will ask questions about the person’s symptoms and any recent major life events. They will also ask about 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 refer you to a psychiatrist or psychologist for further assessment or treatment. It can take some time to diagnose a personality disorder, 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 depending on the type of personality disorder and any other conditions the person may have.

Psychotherapy

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

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

Some types of psychotherapy are especially effective for certain types of personality disorders.

Medicine and personality disorders

No specific medicine treats personality disorders, but medicines can help treat associated conditions.

For example, antidepressants may help if someone has anxiety or depression as well as a personality disorder.

Less often, other types of medicines such as antipsychotics or mood stabilisers may be prescribed.

Medicine is often more effective if it is used in combination with psychotherapy.

Crisis management

Some people with personality disorders have trouble coping with stressful events. This means that they may need more support in a crisis, especially if they develop suicidal thoughts or behaviours.

Rarely, hospitalisation may be needed 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 the person’s safety and wellbeing.

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 with specific skills, here are some organisations that can help:

• ReachOut lists a range of support services for personality disorders.
• SANE Australia supports people living with a mental illness and their loved ones — call 1800 187 263.
• Beyond Blue provides information and support for anyone feeling depressed or anxious and their loved ones — call 1300 22 4636 or chat online.
• Black Dog Institute provides information and advocacy for people affected by mood disorders.
• Lifeline provides support for anyone having a personal crisis — call 13 11 14 or chat online.
• The Suicide Call Back Service provides support to anyone thinking about suicide — call 1300 659 467.