Personality disorders are mental health conditions where the person’s behavior can become irrational, guarded, hysterical, or even violent. They include long-term patterns of thoughts and behaviors that are harmful and inflexible. The behaviors lead to severe problems with relationships and work. People with personality disorders are troubled by dealing with everyday stress and problems. They often have stormy relationships with others.

No one knows what causes personality disorders. Scientists theorize that genes and childhood experiences may play a role, but there is no definitive scientific evidence to back that up at this time. Research is ongoing, and scientists hope to find answers that will help people with personality disorders in the years to come.

Because mental health issues have come to the forefront in media, television, and film, the public needs to be made aware of the symptoms, treatment options, and even myths about personality disorders. While we all like to think we are open-minded and educated, we all have a lot to learn about personality disorders.

There are 10 Types of Personality Disorders

While certain types of disorders have historically been categorized elsewhere in the Diagnostic and Statistical Manual of Mental Disorders, scientists, researchers, and doctors have taken another look at the symptoms, behaviors, and treatments of these ten conditions and labeled them each as a unique personality disorder:

• Antisocial personality disorder
• Avoidant personality disorder
• Borderline personality disorder
• Dependent personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Obsessive-compulsive personality disorder
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

Let’s define each disorder before discussing what makes them all different or closer together than we might think. The following are definitions provided by the Mayo Clinic:

Antisocial personality disorder – a mental health condition where a person consistently shows no regard for right or wrong and ignores the rights and feelings of others. People with antisocial personality disorder will antagonize, manipulate or treat others with callous indifference. They show no guilt or remorse.

Patients with antisocial personality disorder will often break the law. They may lie, behave violently, have impulse control problems, and have problems with drug and alcohol abuse. Because of this disorder, patients typically can’t fulfill personal or work responsibilities.

Avoidant personality disorder – this disorder is characterized by anxious, fearful thinking or behavior. Those with APD are overly sensitive to criticism or rejection; feel inadequate, inferior or unattractive; avoid work activities that require interpersonal contact; are socially inhibited, timid and isolated; demonstrate extreme shyness in social situations and personal relationships; and have a great fear of disapproval, embarrassment or ridicule.

Borderline personality disorder – a mental health disorder that impacts the way you think and feel about yourself and others, including self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships. With borderline personality disorder, the patient has an intense fear of abandonment or instability and will have difficulty being alone.

Their inappropriate anger, impulsiveness and frequent mood swings may push others away, but they yearn for loving and long-lasting relationships. The disorder usually begins in early adulthood. The condition seems to be worse in young patients but may get better with age.

Dependent personality disorder – These patients exhibit intense dependence on others and are overwhelmed by the need to be taken care of. They tend to be submissive or clingy with others, which can lead to an unhealthy relationship. They fear having to provide self-care or fend for themselves.

Patients lack self-confidence, requiring excessive advice and reassurance from others; have difficulty starting or doing projects on their own; have difficulty disagreeing with others because they fear disapproval; they stay in abusive or harmful relationships for fear of rejection; and they will quickly start new relationships when one has ended.

Histrionic personality disorder – attention seeking, overly emotional patients who act out dramatically or sexually. While they may sometimes seem like the life of the party, they are excessively emotional, dramatic or sexually provocative. This patient speaks dramatically with strong opinions but doesn’t back them up with evidence. They are easily influenced by others and have shallow emotions. They are overly concerned with their appearance and fully believe that everyone loves them.

Narcissistic personality disorder – a mental condition in which people have an inflated sense of their own importance. They crave excessive attention and admiration, but often have troubled relationships. One of the hallmarks of a narcissist is a lack of empathy for others. Narcissists appear extremely confident, but it is because deep down they have a seriously fragile self-image.

Narcissistic personality disorder causes problems in relationships, work, school, and financial affairs. Patients with narcissistic personality disorder can be unhappy or disappointed when they’re not given the special favors or admiration they think they deserve. Their relationships are often unfulfilling, and people may not like being around them.

Obsessive-compulsive personality disorder – features a pattern of unreasonable obsessions that lead to repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily life and cause substantial distress. The OCD patient must have order and will act out if that order is disturbed.

Patients may try to ignore or stop their obsessions, but that increases distress and anxiety. Ultimately, the patient feels driven to perform compulsive acts to ease the stress. This leads to more ritualized behavior — the vicious cycle of OCD.

Paranoid personality disorder – those who suffer from paranoia have an inherent distrust and suspicion of people and their motives, with the unjustified belief that people are trying to harm them or lie to them. They don’t find anyone loyal or trustworthy and will avoid confiding in others because of their lack of trust.

They also have a warped perception of innocent remarks or nonthreatening situations as personal insults or attacks and will react in an angry or hostile manner at perceived insults. They tend to hold grudges and are constantly (but unjustifiably) convinced their partner or spouse is having an affair.

Schizoid personality disorder – these patients have a lack of interest in relationships, preferring to be alone. They don’t express themselves emotionally and can’t find the pleasure in daily activities. They have difficulty picking up normal social cues and may appear cold or indifferent. These patients also have either a limited or are completely void of interest in sexual relations.

Schizotypal personality disorder – you may think of the schizotypal patient as peculiar or weird in their manner of dress, thinking, beliefs, patterns of speech, or outward behavior. They have odd perceptual experiences, like hearing voices. People with schizotypal disorder have flat emotions or inappropriate emotional responses and a lack of or discomfort with close relationships.

Schizotypals can be indifferent to others, exhibit inappropriate behavior, or respond to others with suspicion. They also demonstrate what’s called “Magical thinking” — believing they can influence people and events with their thoughts, and that

certain casual incidents or events have hidden messages in them meant just for the patient.

Some Symptoms of Personality Disorders

While each personality disorder will have its own cluster of symptoms, there are some symptoms that are common to personality disorders in general:

• Odd, eccentric thinking or behavior
• Dramatic, overly emotional responses and behavior
• Unpredictable thinking or behavior
• Anxiety
• Fearful thinking or behavior
• Lack of remorse or empathy

What is essential is that the public is educated on the symptoms to watch out for or to be aware of should a loved one or friend start exhibiting strange behavior. More often than not, your friend or loved one doesn’t even know anything is wrong.

Patients Have Trouble Realizing There is a Problem

No one would want to admit that they have a serious mental health condition like a personality disorder. To the patient, their thoughts are normal, and they tend to blame others for their issues. They may try to get help if their problems invade relationships and work. But personality disorders often sneak up on people and they don’t realize what is happening until things are unpleasant.

It’s interesting that some people with personality disorders will routinely experience difficulties in their relationships, difficulties at work, or trouble at school, but they don’t think there’s anything wrong. They may not be bothered much at all because their personality traits do not appear to be causing them any distress; but, they are causing distress and discomfort to everyone around them.

That’s why it is often other people in their lives who notice the person is frequently hard to get along with or difficult to relate to. These people are often blissfully unaware of the problem. It is readily apparent to others that they have great difficulty adapting to life’s ordinary challenges, and often seem to look for trouble.

So why does this happen? There are several reasons for their lack of awareness. To begin with, a person with personality disorder may not know any differently. They may not know there is an alternative way of thinking, feeling, or behaving – they have nothing to compare to their way of being in the world.

For example, suppose the patient has only experienced relationships in which he or she was abused. This person would lack experience with alternative relationships built on kindness and respect. Therefore, the person simply wouldn’t know it is preferable to be treated kindly and would blithely accept mistreatment from others.

Similarly, someone may have grown up with poor role models and may not know how to behave any differently. A person with personality disorder who only ever heard parents yell and scream to get what they wanted, would not know that people can just as easily ask politely and respectfully if they want something.  Because of that, that person would grow up lacking these critical skills and will not know how to behave differently. 

For some people, the experience of life with their personality disorder may simply be too painful, overwhelming, or embarrassing to acknowledge. They can’t accept that they are at least partially responsible for any of the problems they experience. They retreat to a position of blaming everyone else. This can be a more comfortable, less painful position, but not a helpful one.

Sometimes the anxiety and discomfort are so intense, that the person with a personality disorder acts out. They simply don’t know there are alternative responses. There are several reasons for this inability to choose a more considered and gentle response. A person may lack the interpersonal skills needed to address conflict and it may be difficult to express themselves in a confident and effective manner. They could be too upset to think clearly, or they may lack empathy.

Whatever reason a person may have for not recognizing they have a problem personality disorders must be treated to improve the life and relationships of the patients.

Treatment for People With Personality Disorders

The treatment that’s best for each patient depends on the particular personality disorder, its severity, and the patient’s life situation. Most often, a team approach is required to make sure all of the psychiatric, medical, and social needs of the patient are met. There is no quick fix; treatment can require months or years.

The medical team assembled for treatment may include the patient’s primary doctor or other primary care provider as well as a:

• Psychiatrist
• Psychologist or therapist
• Psychiatric nurse
• Pharmacist
• Social worker

Patients with mild symptoms that are well-controlled may need treatment from only a primary doctor, a psychiatrist, or other therapist. Regardless, it’s important to find a mental health professional who specializes in personality disorders.

Psychotherapy, also called talk therapy, is the primary treatment choice for people with personality disorders. During psychotherapy, patients can learn about their condition and talk about any aberrant moods, feelings, thoughts and behaviors. The psychiatrist or therapist can teach a patient skills to cope with stress and manage the disorder.

Patients can also receive social skills training. During this training, patients use the insight and knowledge they gain in counseling to learn healthy ways to manage symptoms and reduce negative behaviors. And while patients may want to try medication to help with their condition, there are no specific drugs designated to treat personality disorders.

However, several types of psychiatric medications may help with various personality disorder symptoms, including Antidepressants (for depressed mood, anger, impulsivity, irritability or hopelessness); Mood stabilizers(to even out mood swings or reduce irritability, impulsivity and aggression); Antipsychotic medications (for symptoms include losing touch with reality, anxiety, or anger problems); and Anti-anxiety medications (for  anxiety, agitation or insomnia).

Conclusion

Dealing with the diagnosis and treatment of a personality disorder is difficult under the best of circumstances. If your child – or another adolescent in your family – appears to be dealing with a personality disorder, an evaluation is the first step towards stability.

At Beachside, we pride ourselves on providing comprehensive mental health treatment for teenagers who are struggling with mental health issues and may need residential treatment to help them manage it. If your child – or a child you’re responsible for – appears to be showing signs of a personality disorder, contact Beachside to find out how we can help!