Understanding Personality Disorders: Symptoms and Signs
A personality disorder is a way of thinking, feeling and behaving that deviates from cultural and societal expectations, causes distress or problems functioning and lasts for a duration of time.1 While every individual experiences symptoms a little differently, people with personality disorders typically share both an inability to regulate their emotions and a tendency to alienate others. Many individuals can be unpleasant to interact with and are generally dissatisfied with their current circumstances (with some notable exceptions). According to a 2007 study, 9.1% of people in the U.S. met the diagnostic criteria for any type of personality disorder.1
Ten specific personality disorders are grouped into three categories called clusters. Those in the same cluster have similarities, but each has its own defining characteristics.2
Cluster A: Odd or Eccentric Behavior
Paranoid personality disorder: A pattern of pervasive distrust and suspiciousness in which other peoples’ motives are seen as mean or spiteful.2 According to a 2007 study, 2.3% of people in the U.S. met the diagnostic criteria for paranoid personality disorder.1 Symptoms include:
- Suspects (without sufficient evidence) others are exploiting, harming or deceiving them
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
- Reluctance to confide in others because of unwarranted fear information will be used maliciously against them
- Interprets harmless remarks or events as threatening or insulting
- Persistently bears grudges (e.g. is unforgiving of insults, injuries or slights)
- Perceives attacks on character or reputation not apparent to others; reacts in anger or with a counterattack
- Has recurring suspicions (without justification) regarding fidelity of spouse or sexual partner3
Schizoid personality disorder: A pattern of detachment from social relationships and a limited range of emotional expression.2 According to a 2007 study, 4.9% of people in the U.S. met the diagnostic criteria for schizoid personality disorder.1 Symptoms include:
- Takes pleasure in few, if any activities
- Does not desire or enjoy close relationships, even with family
- Appears emotionally cold, detached or devoid of emotions
- Exhibits few observable changes in mood
- Avoids social activities involving significant contact with other people
- Chooses solitary activities nearly all the time
- Has little or no interest in sexual experiences with another person
- Lacks close relationships other than with immediate relatives4
Schizotypal personality disorder: A pattern of acute discomfort in close relationships, distortions in thinking or perception and eccentric behavior.2 According to a 2007 study, 3.3% of people in the U.S. met the diagnostic criteria for schizotypal personality disorder.1 Symptoms include:
- Ideas of reference (e.g. imagining strangers are noticing or somehow communicating with them)
- Odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms (e.g. belief in clairvoyance, telepathy or sixth sense; in children and adolescents this may involve bizarre fantasies or preoccupations)
- Unusual perceptions
- Odd thinking and speech (e.g. vague speech, speaking in metaphors, overly elaborate or stereotypical language)
- Suspiciousness or paranoid thoughts
- Inappropriate or constricted ways of expressing emotion (affect)
- Odd, eccentric or strange behavior or appearance
- Lack of close friends or confidants other than close relatives
- Excessive social anxiety that does not decrease with familiarity and tends to be associated with paranoid fears, rather than negative thoughts about oneself5
Cluster B: Dramatic, Emotional or Erratic Behavior
Antisocial personality disorder: A pattern in which people disregard or violate the rights of others.2 According to a 2007 study, 1% of people in the U.S. met the diagnostic criteria for antisocial personality disorder.1 While a person’s pattern of antisocial behavior can occur starting at age 15, only adults age 18 and older can be diagnosed.6 Symptoms include:
- Failure to conform to social norms with respect to lawful behaviors, manifested by repeatedly performing acts that are grounds for arrest
- Deceitfulness, manifested by repeated lying, use of aliases or conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness, manifested by repeated physical fights or assaults
- Reckless disregard for personal safety or the safety of others
- Consistent irresponsibility, manifested by repeated failure to sustain consistent work performance or honor financial obligations
- Lack of remorse, manifested by being indifferent to or justifying hurting, mistreating or stealing from another person6
Borderline personality disorder: A pattern of instability in personal relationships, emotional response, self-image and impulsivity. Borderline personality disorder affects about 5.9% of adults (some 14 million Americans) at some point in their life, 20% of individuals admitted to psychiatric hospitals and 10% of people in outpatient mental health treatment.7 Symptoms include:
- Mood swings
- Rage and angry outbursts
- Impulsive thoughts and behaviors
- Extreme sensitivity to rejection
- Severe depression
- Feelings of emptiness or worthlessness
- Thoughts of suicide and self-harm
- Troubled interpersonal relationships
- A tendency to alternate between idealizing and vilifying others8
Histrionic personality disorder: A pattern of excessive emotion and attention-seeking. The prevalence of histrionic personality disorder in the general population is estimated to be 1% to 3%.9 Symptoms include:
- The ability to rapidly shift emotions
- An apparent lack of sincerity when engaging in activities and social situations
- The use of exaggerated motions and expressions, as if performing a dramatic piece for an audience
- Seeking approval and/or reassurance from others
- Being overly concerned about one’s physical appearance and aesthetic appeal
- Showing extreme sensitivity to criticism or when not getting one’s way
- An inability to focus and complete one project (e.g. jumping from task to task to keep oneself entertained)
- Self-centered tendencies and the inability to care about other people
- Difficulty maintaining beneficial social relationships, believing they will be perceived as shallow or phony9
Narcissistic personality disorder: A pattern of need for admiration and lack of empathy for others. Narcissistic personality disorder affects an estimated 1% of the population, with greater prevalence in men than women. Symptoms include:
- Has a grandiose sense of self-importance (e.g. exaggerates achievements and talents or expects to be recognized as superior without reason)
- Is obsessed with fantasies of unlimited success, power, brilliance, beauty or ideal love
- Believes they are special and unique and can only be understood by or should associate with others who are equally special or unique
- Requires excessive admiration
- Has a very strong sense of entitlement (e.g. unreasonable expectations of highly favorable treatment or unwavering compliance with their expectations)
- Is exploitative of others (e.g. takes advantage of others to achieve their goals)
- Lacks empathy (e.g. is unwilling to recognize or identify with the feelings and needs of others)
- Is often envious of others or believes others are envious of them
- Regularly exhibits arrogant, haughty behaviors or attitudes10
Cluster C: Anxious or Fearful Behavior
Avoidant personality disorder: A pattern of social inhibition, feelings of inadequacy and extreme sensitivity to criticism. Avoidant personality disorder affects an estimated 1.8% to 6.4% of the general population, impacting an equal number of males and females.11 Symptoms include:
- Avoids occupational activities involving significant interpersonal contact because of fears of criticism, disapproval or rejection
- Unwilling to get involved with people unless there is certainty of being liked
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
- Preoccupied with being criticized or rejected in social situations
- Inhibited in new interpersonal situations because of feelings of inadequacy
- Views self as socially inept, personally unappealing or inferior to others
- Unusually reluctant to take personal risks or to engage in any new activities because they may cause embarrassment12
Dependent personality disorder: A pattern of needing to be taken care of in context with submissive and clingy behavior. According to a 2007 study, 0.6% of people in the U.S. met the diagnostic criteria for dependent personality disorder.1 Symptoms include:
- Inability to make the simplest decisions without the advice and reassurance of others
- Avoids personal responsibility (e.g. jobs that require independent functioning and positions of responsibility)
- Intense fear of abandonment and a sense of devastation or helplessness when relationships end; may move rapidly from one to another
- Oversensitivity to criticism
- Pessimism and lack of self-confidence, including a belief they are unable to care for themselves
- Avoids disagreeing with others for fear of losing support or approval
- An inability to start projects
- Difficulty being alone
- Willingness to tolerate mistreatment and abuse from others
- Places the needs of caregivers above their own
- Tendency to be naïve and to live in fantasy13
Obsessive-compulsive personality disorder: Not to be confused with obsessive compulsive disorder, this is a pattern of preoccupation with orderliness, perfectionism and control. According to a 2007 study, 2.4% of people in the U.S. met the diagnostic criteria for obsessive-compulsive personality disorder.1 Symptoms include:
- Extreme devotion to work that impairs social and family activities
- Excessive fixation with lists, rules and minor details
- Perfectionism that interferes with finishing tasks
- Rigid adherence to moral and ethical codes
- Unwillingness to assign tasks unless others perform them exactly as asked
- Lack of generosity (e.g. extreme frugality without reason)
- Hoarding behaviors14
If you know someone who has characteristics of more than one personality disorder, the diagnosis “personality disorder not otherwise defined” is a possibility. Mental health professionals use this label for people who do not quite fit the formal definition of one of the established disorders, but clearly have problems with emotions and relationships. If any of the troubling symptoms mentioned above are interfering with your functioning or that of a loved one, there is hope. Most personality disorders can be effectively treated using different types of psychotherapy, and in some instances, medication.
- How Common Are Personality Disorders. Out of the Fog website. http://outofthefog.website/personality-disorder-statistics#pd1 Accessed December 12, 2016.
- What are Personality Disorders? American Psychiatric Association website. https://www.psychiatry.org/individuals-families/personality-disorders/what-are-personality-disorders Updated February 2016. Accessed December 12, 2016.
- Paranoid Personality Disorder Symptoms. Psych Central website. http://psychcentral.com/disorders/paranoid-personality-disorder-symptoms/ Updated July 17, 2016. Accessed December 12, 2016.
- Schizoid Personality Disorder. Psychology Today website. https://www.psychologytoday.com/conditions/schizoid-personality-disorder Updated November 24, 2014. Accessed December 12, 2016.
- Schizotypal Personality Disorder. MedicineNet website. http://www.medicinenet.com/schizotypal_personality_disorder/page3.htm Updated November 1, 2016. Accessed December 12, 2016.
- Antisocial Personality Disorder Symptoms. Psych Central website. http://psychcentral.com/disorders/antisocial-personality-disorder-symptoms/ Updated July 17, 2016. Accessed December 12, 2016.
- An Overview of BPD. National Education Alliance for Borderline Personality Disorder website. http://www.borderlinepersonalitydisorder.com/what-is-bpd/bpd-overview/ Accessed December 12, 2016.
- Borderline Personality Disorder. National Alliance on Mental Illness website. https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder Accessed December 12, 2016.
- 11 Rare Histrionic Personality Disorder Statistics. Health Research Funding website. http://healthresearchfunding.org/histrionic-personality-disorder-statistics/ Published July 6, 2014. Accessed December 12, 2016.
- Narcissistic Personality Disorder Symptoms. Psych Central website. http://psychcentral.com/disorders/narcissistic-personality-disorder-symptoms/ Updated December 2, 2016. Accessed December 12, 2016.
- Avoidant Personality Disorder (AVPD). Out of the Fog website. http://outofthefog.website/personality-disorders-1/2015/12/6/avoidant-personality-disorder-avpd Accessed December 12, 2016.
- Avoidant Personality Disorder Symptoms. http://psychcentral.com/disorders/avoidant-personality-disorder-symptoms/ Updated July 17, 2016. Accessed December 12, 2016.
- Dependent Personality Disorder Cleveland Clinic website. http://my.clevelandclinic.org/services/neurological_institute/center-for-behavioral-health/disease-conditions/hic-dependent-personality-disorder Accessed December 12, 2016.
- Obsessive Compulsive Personality Disorder (OCPD). International OCD Foundation. https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf Published 2010. Accessed December 12, 2016.