Patient information from BMJ

Personality disorders: what are they?

Last published:Apr 12, 2021

Personality disorders can cause difficulties with how we interact with other people. There are several types of personality disorder and they affect people in different ways. But they all affect how we think, deal with our feelings, and get on with others.

What are personality disorders?

Each one of us thinks and behaves in different ways. For example, some people are more shy than others, and some people don’t find it easy meeting new people, or socialising in large groups.

All these things are normal and they don’t usually cause people any major problems. But if you find that you think or behave differently from most people in ways that distress you, and that you can’t control, you might be affected by a personality disorder.

Personality disorders are fairly common, and there are several types, which have different symptoms. But they all affect people in some similar ways, including:

• the way you think about and understand yourself, other people, and the world around you

• how much you can control your moods and emotions

• the way you interact and get along with other people, including family and friends

• how much you can control how you behave and speak to people. Doctors call this ‘impulse control’.

Many people with personality disorders don’t know that they have them. They might only know that they feel somehow ‘different’ from most people a lot of the time, and that they often feel distressed for reasons they can’t quite pin down.

Many people don’t know anything about personality disorders until they see a doctor for another reason, such as depression. Their doctor might then see the signs of a personality disorder and suggest that they have treatment for it.

It can be distressing to be told by a doctor that you might have a personality disorder. But it doesn’t mean that you’re a ‘bad’ person or that anyone is judging you. In fact, it can be really helpful to finally understand why you think and behave in some of the ways that you do, and that you find hard to control.

Doctors divide personality disorders into 10 types. Some of the names for these types can sound quite scary and medical. But they help doctors to understand and help with your particular difficulties.

• Schizotypal personality disorder: With this type of personality disorder you have trouble interacting with other people and can struggle to form close relationships. You might also see and understand the world in ways that most people think are odd, and you might behave in ways that most people find eccentric. You might also be anxious in social situations, even in places and with people you know well.

• Schizoid personality disorder: You might seem distant or detached in your relationships, and you might struggle to express your feelings. You tend to prefer your own company to that of others.

• Paranoid personality disorder: You might distrust or feel suspicious of other people more than is normal. You might find it hard not to bear grudges, and you feel threatened in situations where most people wouldn’t.

• Avoidant personality disorder: You might struggle in social situations, feel shy and inadequate, and react badly to criticism. Fear of rejection might make you scared about taking risks in your personal life.

• Dependent personality disorder: You might have a very strong need to be taken care of, to the point where you are ‘clingy’ and don’t stand up for yourself in your relationships. You might struggle to make decisions on your own. The fear that you can’t look after yourself might make you scared to be alone.

• Obsessive-compulsive personality disorder: You spend a lot of time thinking about neatness, order, and perfection - not just with regard to things, but in relationships, where you like to be in control. This might mean that people see you as not being flexible, or open, or relaxed. They might see you as stubborn, and too devoted to work.

• Borderline personality disorder: You might struggle to keep a stable relationship going, and you might have low self-esteem. You might also struggle to control your moods, and sometimes be impulsive and angry for very little reason. You might sometimes suddenly think about self-harm or suicide.

• Histrionic personality disorder: You get emotional about things very easily. You also find yourself doing things just to seek attention - maybe through the way you dress. You might feel uneasy when you’re not the centre of attention. People might see you as emotionally shallow.

• Narcissistic personality disorder: You might have big, grand fantasies about your life, and behave as if you are special, and more important than other people. You might have a strong need to be admired, and struggle to consider other people’s feelings. You might find yourself taking advantage of people for your own gain.

• Antisocial personality disorder: You might have little regard for the rights of other people. You often act on impulse and are dishonest when it suits you to be. You might feel little or no remorse when you do things other people think are wrong. You might do things that are illegal or not thought to be socially acceptable.

• Personality disorder not otherwise specified (NOS): This means that you might have some of the traits of more than one personality disorder, or that you might behave in ways that are troubled and distressing, but that don’t fit any of the other types.

It’s not clear what causes personality disorders. Some people are simply born with them as part of the genes they inherit from their parents. But some things that happen to people can make personality disorders more likely.

For example, people who were neglected as children, or who were physically or sexually abused, are more likely than usual to have a personality disorder.

What are the symptoms?

Most people with personality disorders live with them for many years before they realise that they are affected by one. This can cause long-term distress and problems.

It’s very common for people not to be diagnosed until they see a doctor for another reason, who then notices the symptoms of a personality disorder. The doctor might see the symptoms in the patient’s behaviour, or he or she might notice a pattern of behaviour from the patient’s medical records.

The kinds of things the doctor might notice in someone with the signs of a personality disorder include:

• stress and anger out of proportion to the situation

• making unrealistic demands of the doctor or medical staff

• scars or other marks on the skin caused by self-harm

• a tendency to start or get involved in arguments easily

• long-term problems in controlling moods or anxiety

• regular abuse of drugs or alcohol

• issues that might suggest that someone has a troubled or traumatic home life. This applies more to children.

If a doctor notices that you have any of these kinds of symptoms, he or she might ask you questions about how you feel and about your life. After talking with you for a while, the doctor might be closer to making a diagnosis of some type of personality disorder.

The doctor might not be sure which type of disorder you might have. But he or she will be looking for symptoms that fall into three broad categories:

• Symptoms around how you think and see the world. This might include rigidly held ideas, strange ways of thinking, and misunderstanding (getting the ‘wrong end of the stick’) about other people’s intentions.

• Having trouble controlling your moods, and being constantly anxious.

• Having problems with impulse control. This might mean being aggressive, self-harming, having casual sex without thinking about the consequences, and abusing drugs and alcohol.

What will happen?

It’s not possible to say what will happen to you as an individual. The main treatment for personality disorders is psychotherapy or other ‘talking treatments’.

Treatment can’t ‘cure’ personality disorders. But it can help people to deal with their anxiety and social issues, among other things. And perhaps most important, it can help people to understand and be more at ease with themselves.

Treatment takes time, and you will need to have regular follow-up appointments with your doctor and mental-health professional.

Personality disorders are common, and they affect all kinds of ordinary people. And there is plenty of help and advice available if you look online, including from people who are happy to share their own stories to help others like themselves. Your doctor might be able to direct you to a support group in your area.