A personality disorder is a mental health condition in which people have a lifelong pattern of seeing themselves and reacting to others in ways that cause problems. Individuals with personality disorders often have a hard time understanding emotions, dealing with stress, and may have unusual beliefs and behaviors. They also may seem inconsistent, confusing, and frustrating to the people around them.
Personality disorder classifications have evolved and continue to as more research is done to understand them. Currently, there are 10 types of personality disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revised (or DSM-5-TR). These are categorized into clusters: Cluster A (“odd-eccentric”) includes paranoid, schizoid, and schizotypal personality disorders; Cluster B (“dramatic-emotional-erratic”) includes antisocial, borderline, histrionic, and narcissistic personality disorders; and Cluster C (“anxious-fearful”) includes avoidant, dependent, and obsessive-compulsive personality disorders. Roughly 9% of adults in the U.S. have a personality disorder of some kind, and personality disorders are considered underdiagnosed as they often present as depression or anxiety rather than a personality disorder. Signs and symptoms usually start to appear during late adolescence or early adulthood, but sometimes appear sooner.
A personality disorder diagnosis requires a persistent pattern of two or more of the following traits:
- Cognition (ways of perceiving and interpreting self, others, and events)
- Affectivity (range, intensity, lability, and appropriateness of emotional response)
- Interpersonal functioning
- Impulse control issues
- A persistent pattern of maladaptive traits that causes significant distress or impaired functioning in social, occupational, and other important areas
- The pattern is stable and has an early onset (traced back to at least adolescence or early adulthood)
Research suggests that personality disorders are usually caused by a combination of genetics, environment, and life experiences. Signs and symptoms of personality disorders can vary, both from person to person and disorder to disorder. For example, someone with narcissistic personality disorder may require constant attention and admiration, be highly critical of others, and withdraw from situations in which they may fail. Someone with borderline personality disorder may act impulsively, have intense feelings in relationships, and experience difficulty controlling their emotions. While symptoms vary, many individuals with a personality disorder will also deal with depression, anxiety, and substance abuse.
Lauren Hall
President and CEO, First Things First.
Erin Rayburn, LMFT, LPC-MHSP, EAGALA
Founder and Clinical Director, Evergreen Therapy
Tyler Rogers, PhD, LMFT, LPC, NCC
Owner and Director, Scout Counseling, PLLC
Managing Personality Disorders
Personality disorders are often difficult to treat. However, as science has come to better understand personality disorders, new treatments and therapies are being utilized with success. Psychotherapy is considered the best approach to treatment, with the goals of understanding the interpersonal problems, reducing distress, decreasing maladaptive and undesirable behaviors, and modifying problematic personality traits. Various therapies can be used to treat personality disorders, including:
- Psychoanalytic/psychodynamic/transference-focused therapy
- Dialectical behavior therapy
- Cognitive behavioral therapy
- Group therapy
- Psychoeducation
In addition to these forms of therapy, art therapy and equine therapy have also been shown to have a positive impact. Along with individual therapy, self-help groups and family therapy can also be quite impactful, as family members and friends can act in ways that either reinforce or diminish the patient’s maladaptive behaviors or thoughts, and they can be allies in treatment. While there are no medications specifically used to treat personality disorders, some antidepressant and antianxiety medications or mood stabilizers can assist in treating symptoms. In addition to therapies and medications, self-care and coping strategies can be helpful. This includes being active, avoiding harmful substances, joining a support group, and engaging in stress-management strategies.
A research study published in 2023 asked participants with diagnosed personality disorders to share their life stories before and after undergoing therapeutic treatment at a psychotherapeutic treatment center. While experiences varied, prior to treatment participants most commonly wrote about difficulty communicating and relating to others, a lack of quality in relationships, feelings of isolation, and poor coping mechanisms amongst other challenges. Post-treatment, these experiences were reframed
in the life stories and patients were able to report a higher sense of control in their own lives.
As a result of these common challenges with self-identity and interpersonal functioning, personality disorders can affect an individual’s close relationships in a variety of ways. Professional help and a support system help individuals with personality disorders manage their symptoms and address the issues that they may be facing. Here, we speak to local mental health professionals about how personality disorders may affect relationships and ways to navigate these challenges.
How can personality disorders affect relationships?
Personality disorders can deeply impact relationships by causing difficulties in communication, trust, and emotional connection. Individuals with these disorders might struggle with managing emotions, handling conflicts, or maintaining stable behaviors, which can lead to misunderstandings, frequent arguments, and emotional strain. The unpredictability and intensity of symptoms can create an environment of instability, making it challenging for both partners to feel secure and supported. However, with understanding, proper boundaries, and professional support, it’s possible to build healthier, more resilient relationships. –Lauren Hall
How can various therapies help individuals treat and manage personality disorders?
Dialectal Behavioral Therapy (DBT) is most often indicated for disorders that fit in the borderline personality category, as well as medication depending on the recommendation of the treating clinician. Other personality disorders can be treated with various forms of psychotherapy, including cognitive behavior therapy or group therapy, as well as various medications depending on the specific diagnosis. The important thing to remember is that while we can be hurt by someone who has a personality disorder, only the treating clinician of that person and that person can determine the appropriate diagnosis and treatment plan. –Dr. Tyler Rogers
While personality disorders can vary greatly, what are some general tips in navigating a relationship with a loved one who has a personality disorder?
Navigating a relationship with someone who has a personality disorder requires patience, empathy, and clear communication. Educate yourself about the disorder to better understand their perspective. Establish healthy boundaries to protect your own well-being while also being supportive. Encourage your loved one to seek professional help and consider therapy for both of you to learn coping strategies. Practice self-care and remember that it’s okay to seek support for yourself. Open, non-judgmental communication is key to managing challenges and maintaining a strong relationship. –Lauren Hall
How can I support a loved one with a personality disorder?
Living with a loved one with a personality disorder can be difficult, but you have to really understand your own boundaries so you can maintain a compassionate perspective. If you start losing compassion, that’s a good sign to check in on where your boundaries are. Overall, be careful to not judge a person because of a set of symptoms. Remember, this is their journey in life, and it’s not your job to fix them. Consider seeking your own support through therapy in order to understand how to manage the dynamics and respond to your loved one when life gets difficult. –Erin Rayburn
How can various therapies help individuals treat and manage personality disorders?
A diagnosis is important to understand. It’s not an identity but a label for a set of symptoms. Keeping this in mind will help with taking care of yourself. Try to have as much self-compassion as possible and curiosity about your symptoms; learn how you respond to perceived abandonment and rejection. Most importantly, take great care in building a support system, which should include a deeply compassionate therapist, surrounding yourselves with loved ones who accept you for who you are, consulting a psychiatrist to help manage symptoms, and developing hobbies and routines to foster a healthy self-esteem and identity. –Erin Rayburn
How can personality disorders affect close relationships?
There are several different personality disorders, and the way in which they affect relationships can vary depending upon the disorder. The “Cluster B” type (borderline, narcissistic, antisocial, histrionic) of personality disorders can make relationships challenging in a few ways and are probably most often discussed regarding relationships. Whether someone has a few traits or characteristics of these disorders or the full disorder, each can make relationships feel controlling, chaotic, and even intoxicating at times. It is not unusual to feel drawn to some of the aspects of these disorders, such as being idealized by the person, only to later feel the pain of begin devalued or hurt without remorse. –Dr. Tyler Rogers
Meet the Author
Kristen Dee, BS, MA, Summa Cum Laude
Kristen Dee is a graduate of Winthrop University where she earned a Bachelor of Science degree in integrated marketing communications, with the distinction of Magna Cum Laude and IMC Student of the Year. Following Winthrop, Kristen earned a Master of Arts in Communication from Wake Forest University. Prior to joining CMC Publications as editor, Kristen successfully fulfilled roles involving internal corporate communications. Today, Kristen leads ideation, conceptualization, and development of numerous health, wellness, and lifestyle articles published in print and online for HealthScope, CityScope, and Choose Chattanooga magazines – premier publications serving S.E. Tennessee and North Georgia.
