I receive questions frequently about personality disorders, especially narcissistic and borderline personality disorders. It is important to consider that while everyone has a personality, a “disorder” suggests the person’s style (generally) is difficult or harmful to others. The DSM (Diagnostic and Statistical Manual of Mental Disorders) gathers traits to create categories of personality disorders through a combination of empirical research, clinical observations, and expert consensus. Personality disorders are traditionally classified under Axis II diagnoses.[1] While everyone has a personality, a disorder is diagnosed when someone’s personality traits become so extreme or inflexible that they cause serious problems in their life and the lives of those around them. These disorders are grouped into different categories based on similar traits, and each category contains specific types.
According to the DSM-5, personality disorders are divided into three main groups, each with its own set of subtypes.[2] The first group consists of disorders that are mainly characterized by odd or eccentric behaviors. This includes Paranoid Personality Disorder, where a person is overly suspicious and distrustful of others without good reason.[3] Schizoid Personality Disorder falls into this group as well, where someone tends to avoid social relationships and prefers to be alone. Schizotypal Personality Disorder is another one, where a person may have unusual thoughts or behaviors, such as believing in strange ideas or feeling very uncomfortable around others.[4]
The second group is made up of disorders that are more dramatic, emotional, or unpredictable. This category tends to be the most noticeable because people with these disorders often have intense emotions and unstable relationships.[5] Narcissistic Personality Disorder is one example, where a person has an inflated sense of self-importance, craves admiration, and lacks empathy for others.[6] Histrionic Personality Disorder also falls into this group, where someone is overly emotional, seeks constant attention, and often behaves dramatically to get noticed. Borderline Personality Disorder is another, where a person struggles with intense mood swings, fears of abandonment, impulsive behavior, and unstable self-image.[7]
The third group includes disorders that are primarily related to anxiety and fear. Avoidant Personality Disorder fits into this category, where someone is extremely sensitive to criticism and avoids social situations because they fear rejection.[8] Dependent Personality Disorder is another, where a person relies too much on others for decisions and struggles to be independent. Obsessive-Compulsive Personality Disorder is also in this category, where someone becomes overly focused on rules, order, and control, sometimes at the expense of flexibility and relationships.
These personality disorders vary in severity and can affect people in different ways. While they may seem overwhelming, treatment options such as therapy and, in some cases, medication can help individuals manage their symptoms and improve their quality of life.
When someone has more than one mental illness at the same time, it can make it hard to figure out exactly what’s going on. Symptoms from different disorders can mix together or even hide each other, making it difficult for doctors to make the right diagnosis right away. For example, someone with Borderline Personality Disorder may have extreme mood swings and impulsive behavior, which can look a lot like Bipolar Disorder. Because of this, a doctor might diagnose Bipolar Disorder first and not realize that a personality disorder is also present.
Something similar happens with Avoidant Personality Disorder and Social Anxiety Disorder. Both can cause a person to avoid social situations because they feel nervous or afraid of being judged. But the reason behind the behavior is different, so if a doctor only focuses on the social anxiety part, they might not notice the personality disorder.
Footnotes:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Washington, DC: American Psychiatric Press, 2000, p. 685.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Press, 2013, pp. 645-684.
- Millon, T. (1996). Personality Disorders in Modern Life. Wiley, pp. 203-215.
- Livesley, W. J. (2001). Handbook of Personality Disorders: Theory, Research, and Treatment. Guilford Press, pp. 75-92.
- Gunderson, J. G., & Links, P. S. (2008). Borderline Personality Disorder: A Clinical Guide. American Psychiatric Publishing, pp. 32-47.
- Ronningstam, E. (2005). Identifying and Understanding the Narcissistic Personality. Oxford University Press, pp. 110-128.
- Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press, pp. 5-29.
- Alden, L. E., & Taylor, C. T. (2004). Interpersonal Processes in Personality Disorders. Guilford Press, pp. 213-225.
