Ultimate guide to Personality Disorders

This ultimate guid explains personality disorders, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

What are personality disorders?

Our personality is the collection of thoughts, feelings and behaviours that makes each of us the individuals we are.

We don’t always think, feel and behave in exactly the same way – it depends on the situation we are in, the people with us and many other interconnecting factors.

However, if you experience significant difficulties in how you relate to yourself and others and have problems coping day to day, you may receive a diagnosis of personality disorder.

“Everyone is shouting at me, ‘why do you find things so difficult? Why can’t you just be normal?’ and I try and explain that I’m on a tightrope way in the air, and they all have their feet on the ground, but they all just laugh.”

What are the signs of a personality disorder?

You might be given a diagnosis of personality disorder if all of these apply:

• The way you think, feel and behave causes you significant problems in daily life. For example, you may feel unable to trust others or you may often feel abandoned, causing you or others distress in day-to-day relationships.
• You experience these problems across different aspects of your life. For example, you may struggle to start or keep friendships, to control your feelings and  behavior, or get on with people. There may be an intensity to your emotions that makes them feel frightening and overwhelming sometimes.
• These problems continue for a long time. These difficult patterns may have started when you were a child or teenager and can carry on into your life as an adult.
• These problems are not solely caused by a substance or a medical condition. For example, using drugs or medication can cause changes in people, as can the physical effects of experiences like head trauma.

Does it mean there’s something wrong with who I am?

No.

We all have parts of our personality that can cause us or others difficulties. What is different for people with personality disorders is the intensity of these difficulties and the fact that you might need extra support. See our page on self- care for tips on how to help yourself now and in the longer term.

“The important thing to remember is that we’re not broken, we just think differently and experience the world in a different way… there’s no shame in doing whatever we need to do to cope with our emotions in a safe and supportive way.”

Who can diagnose me with a personality disorder?

You can only be diagnosed with a personality disorder by a mental health professional experienced in diagnosing and treating mental health problems, such as a psychiatrist or psychologist – not by your GP.

If you speak to your GP about your mental health and they think you might have a personality disorder, they can refer you to your local community mental health team (CMHT) who will be able to assess you.

“Initially I took this diagnosis of BPD as an insult, a criticism of my whole being, but then I began to understand that it is just a diagnosis, an explanation of why I feel as I do. Just as in a medical situation the pain in my stomach being diagnosed as appendicitis means that I am ill, there is a reason for the pain and I can get treatment.”

What types of personality disorder are there?

Currently psychiatrists tend to use a system of diagnosis which identifies ten types of personality disorder. These are grouped into three categories.

Suspicious:

• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder
• Antisocial personality disorder

Emotional and impulsive:

• Borderline personality disorder (BPD)
• Histrionic personality disorder
• Narcissistic personality disorder

Anxious:

• Avoidant personality disorder
• Dependent personality disorder
• Obsessive compulsive personality disorder (OCPD)

Each personality disorder has its own set of diagnostic criteria. To get a specific diagnosis you must meet some of these criteria. The minimum amount you need to meet is different for different types, but it should always be more than one or two. If you meet criteria for more than one type this may be called mixed personality disorder.

It is also possible to get a diagnosis without meeting the full criteria for a specific type. This is known as personality disorder not otherwise specified (PD-NOS) or personality disorder trait specified.

A wide range of people may get the same diagnosis, despite having very different personalities and different individual experiences. Your experience of living with a personality disorder will be unique to you.

A controversial diagnosis

Our understanding of what it means to experience a personality disorder is constantly evolving. It is a controversial diagnosis. People have different views about these terms, and not everyone agrees with using them.

The important thing to remember is that the feelings and behaviours associated with personality disorders are very difficult to live with. However you understand your diagnosis, and whatever terms you prefer to use, you deserve understanding and support.

Paranoid personality disorder

The thoughts, feelings and experiences associated with paranoia may cause you to:

• find it hard to confide in people, even your friends and family
• find it very difficult to trust other people, believing they will use you or take advantage of you
• have difficulty relaxing
• read threats and danger (which others don’t see) into everyday situations, innocent remarks or casual looks from others.

This might become such a big problem in your life that you are given a diagnosis of paranoid personality disorder. See our page on paranoia for more information.

“I suffer from extreme paranoia and most people find this extremely irritating and become angry with me when I’m paranoid.”

Schizoid personality disorder

Many people with schizoid personality disorder are able to function fairly well. Unlike in schizophrenia or schizoaffective disorder, you would not usually have psychotic symptoms. However, as a result of the thoughts and feelings associated with this diagnosis you may:

• find difficulty forming close relationships with other people
• choose to live your life without interference from others
• prefer to be alone with your own thoughts
• not experience pleasure from many activities
• have little interest in sex or intimacy
• have difficulty relating to or are emotionally cold towards others.

Schizotypal personality disorder

Everyone has their own eccentricities or awkward behaviours. But if your patterns of thinking and behaving make relating to others very difficult, you may receive a diagnosis of schizotypal personality disorder.

Unlike in schizophrenia, you usually would not experience psychosis. However, you may:

• experience distorted thoughts or perceptions
• find making close relationships extremely difficult
• think and express yourself in ways that others find ‘odd’, using unusual words or phrases, making relating to others difficult
• believe that you can read minds or that you have special powers such as a ‘sixth sense’
• feel anxious and tense with others who do not share these beliefs
• feel very anxious and paranoid in social situations, finding it hard to relate to others.

See our pages on schizophrenia or schizoaffective disorder for more information on the feelings and symptoms associated with schizoid and schizotypal personality disorders.

“I always feel rather ‘thrown’ when someone doesn’t do what I expect them to do. Knowing there are lots of ways in which the problem could be approached would have made me feel a lot more prepared for what came next.”

Antisocial personality disorder

It is natural to sometimes put our own needs, pleasure or personal gain before those of others around us. However, if these actions occur very frequently and you struggle to

keep stability in your life, or you regularly act impulsively out of anger or lack of consideration for others, this could lead to a diagnosis of antisocial personality disorder.

You may:

• put yourself in dangerous or risky situations, often without thinking about the consequences for yourself or other people
• behave dangerously and sometimes illegally (you may have a criminal record)
• behave in ways that are unpleasant for others
• feel very easily bored and act on impulse – for example, you may find it difficult to hold down a job for long
• behave aggressively and get into fights easily
• do things even though they may hurt people – to get what you want, putting your needs and desires above other people’s
• have problems with empathy – for example, you may not feel or show any sense of guilt if you have mistreated others
• have had a diagnosis of conduct disorder before the age of 15.

This diagnosis includes ‘psychopathy’ and ‘sociopathy’. These terms are no longer used in the Mental Health Act but a ‘psychopathy checklist’ questionnaire may be used in your assessment.

“As a child anger seemed to be my only way to express how I felt.”

Borderline personality disorder (BPD)

Borderline personality disorder (BPD) is also known as emotionally unstable personality disorder (EUPD).

We can all experience difficulties with our relationships, self-image and emotions. But you might get a diagnosis of BPD/EUPD if these feel consistently unstable or intense and   cause you significant problems in daily life.

You may:

• feel very worried about people abandoning you, and either do anything to stop that happening or push them away
• have very intense emotions that can change quickly (for example, from feeling very happy and confident in the morning to feeling low and sad in the afternoon)
• not have a strong sense of who you are or what you want from life, with your ideas about this changing significantly depending on who you’re with
• find it very hard to make and keep stable relationships or friendships
• act impulsively and do things that could harm you (such as binge eating, using drugs or driving dangerously)
• have suicidal thoughts
• self-harm
• feel empty and lonely a lot of the time
• get very angry, and struggle to control your anger
• struggle to trust other people
• experience other mental health problems alongside BPD, including anxiety, depression, eating problems and post-traumatic stress disorder.

When very stressed, sometimes you might:

• feel paranoid
• have psychotic experiences, such as seeing or hearing things that other people don’t

• feel numb or ‘checked out’ and not remember things very well after they’ve happened (known as dissociation).

BPD is currently the most commonly diagnosed personality disorder. You can read more about it on our pages on borderline personality disorder (BPD).

“BPD is like having no emotional buffer. I can go from nothing to suddenly extremely overwhelming emotions and I struggle with expressing them healthily.”

Histrionic personality disorder

Most people enjoy being given compliments or positive feedback about their actions. But if you depend very heavily on being noticed, or are seeking approval so much that this affects your day-to-day living, you might get a diagnosis of histrionic personality disorder.

You may:

• feel very uncomfortable if you are not the centre of attention
• feel that you have to entertain people
• constantly seek, or feel dependent on, the approval of others
• make rash decisions
• flirt or behave/dress provocatively to ensure that you remain the centre of attention
• get a reputation for being dramatic and overemotional
• be easily influenced by others.

“After being told my diagnosis I was then able to understand how and why I behaved the way I did: my life made a little bit more sense.”

Narcissistic personality disorder

It is human nature to be aware of our own needs, to express them, and to want others  to  be aware of our abilities and achievements. These are not bad traits. However, if these thoughts, feelings and behaviours are very extreme and cause problems in relating to others, you may get a diagnosis of narcissistic personality disorder.

You may:

• believe that there are special reasons that make you different, better or more deserving than others
• have fragile self-esteem, so that you rely on others to recognise your worth and your needs
• feel upset if others ignore you and don’t give you what you feel you deserve
• resent other people’s successes
• put your own needs above other people’s, and demand they do too
• be seen as selfish and dismissive or unaware of other people’s needs.

Avoidant personality disorder

We all have things, places or people we don’t like, or which make us anxious. But if these things cause so much anxiety that you struggle to maintain relationships in your life, you may get a diagnosis of avoidant personality disorder (sometimes also called anxious personality disorder).

You may:

• avoid work or social activities that mean you must be with others
• expect disapproval and criticism and be very sensitive to it
• worry constantly about being ‘found out’ and rejected
• worry about being ridiculed or shamed by others
• avoid relationships, friendships and intimacy because you fear rejection
• feel lonely and isolated, and inferior to others
• be reluctant to try new activities in case you embarrass yourself.

See our pages on anxiety and panic attacks for more information on how to cope with anxiety.

Dependent personality disorder

It is natural to need other people to care for us or give us reassurance sometimes. A healthy balance involves being able to both depend on others as well as being independent from others sometimes. However, if feelings and thoughts about needing others become so overwhelming that they impact your daily life and relationships, you may get a diagnosis of dependent personality disorder.

You may:

• feel needy, ‘weak’ and unable to make decisions or function day-to-day without help or support from others
• allow or require others to assume responsibility for many areas of your life
• agree to things you feel are wrong or you dislike to avoid being alone or losing someone’s support
• be very afraid of being left to fend for yourself
• have low self-confidence
• see other people as being much more capable than you are.

Obsessive compulsive personality disorder (OCPD)

Obsessive compulsive personality disorder (OCPD) is separate from obsessive compulsive disorder (OCD), which describes a form of behaviour rather than a type of personality.

However, similarly to OCD, OCPD involves problems with perfectionism, the need for control, and significant difficulty being flexible in how you think about things. You may:

• need to keep everything in order and under control
• set unrealistically high standards for yourself and others
• think yours is the best way of doing things
• worry about you or others making mistakes
• feel very anxious if things aren’t ‘perfect’.

Personality disorder not otherwise specified (PD-NOS)

Everybody is individual and behaves in unique ways, so it is only natural to not fit neatly into the categories described above.

If you experience a number of personality disorder traits but not enough to fully meet the criteria of a specific type, you may receive a diagnosis of personality disorder not otherwise specified (PD-NOS). This diagnosis may also be known as personality disorder trait specified.

What causes personality disorders?

Just as everybody’s experience of a personality disorder is unique to them, the causes will be unique as well.

There’s no clear reason why some people develop the feelings and behaviours associated with personality disorders, and others  don’t. Most researchers believe that a complex mix   of factors seems to increase the risk of developing or triggering these experiences,  including:

• environment and social circumstances
• early life experiences
• genetic factors.

Environment and social circumstances

The environment and social circumstances we grow up in and the quality of care we receive can affect the way our personality develops. You may experience difficulties associated with personality disorders if you’ve experienced:

• an unstable or chaotic family life, such as living with a parent who is an alcoholic or who struggles to manage a mental health problem
• little or no support from your caregiver – this may be especially hard if you’ve experienced a traumatic event or situation
• a lack of support or bad experiences during your school life, peer group or wider community, such as bullying or exclusion
• poverty or discrimination
• some form of dislocation, such as migration from abroad.

“I have narcissistic borderline personality disorder. At first it was difficult to accept that the problem was essentially me, my personality. But then being able to put it into perspective as a developmental flaw was much easier to accept – that it was simply the way I’d developed in response to my environment and the situations I’d experienced.”

Early life experiences

Our experiences growing up can affect our personality in later life. If you had a difficult childhood, you might have developed certain beliefs about the way people think or act and how relationships work. This can lead to developing certain  strategies for  coping  which may have been necessary when you were a child, but which aren’t always helpful in your adult life.

If you have been given a personality disorder diagnosis you are more likely than most people to have experienced difficult or traumatic experiences growing up, such as:

• neglect
• losing a parent or experiencing a sudden bereavement
• emotional, physical or sexual abuse
• being involved in major incidents or accidents
• often feeling afraid, upset, unsupported or invalidated.

Not everyone who experiences a traumatic situation will develop these problems however. Your unique reactions, as well as the consistency and quality of support and care you received, will make a difference.

Similarly, not everyone who develops a personality disorder will have had a traumatic experience.

Genetic factors

Personality is very complex and researchers currently don’t know much about what makes up our personalities and to what extent genes play a part in this.

Some elements of our personality are likely to be genetic. We are born with different temperaments – for example, babies vary in how active they are, their attention span and how they adapt to change.

While some experts believe genetic inheritance may play a part in the development of personality disorder, others point out that it is difficult to know whether similarities in temperament and behavior have been handed down the generations genetically or through the behavior children were modeled as they grew up. More research needs to  be done in this area.

Why is it controversial?

Our understanding of mental health problems is constantly evolving. So is the language we use when talking about them. The diagnosis of ‘personality disorder’ can be controversial because:

• specialists disagree about how to understand personality disorders
• it doesn’t take social context into enough account
• the term itself can be stigmatising.

Some people with this diagnosis hold the view that their feelings and behaviours are a reasonable, human reaction to going through difficult life experiences. So it’s unhelpful and upsetting to call it an illness or ‘disorder’ in their personality. They argue that professionals should consider what in their life may have contributed to their difficulties, and help with these. Not focus on finding problems in them as an individual.

On the other hand, some people find that getting this diagnosis helps them to name and understand their experiences, to explain themselves to other people, and sometimes get treatment and support they otherwise might not.

Abuse Warrior is committed to ensuring that voices on all sides of this debate are heard. This includes those who:

• understand their experiences and behaviours as a disorder
• think of them as a natural reaction to adversity
• reject the personality disorder label
• do not fully agree with the label but accept it being as a way to access support.

If you have been diagnosed with a personality disorder but you’re concerned that this isn’t right for you, we have information on what you can do if you think your diagnosis is wrong.

Specialists disagree about how to understand personality disorders

The system of personality disorder diagnosis we list on our page on types of personality disorder is the one psychiatrists tend to use in the UK. However, some psychiatrists disagree with its use and find it unhelpful because:

• Most people who are diagnosed with a personality disorder do not fit any one category, and may be diagnosed with more than one.
• Some people believe the focus should instead be on what each person needs in order to deal with their problems and discover new ways of living, not what category they are in.

It doesn’t take social context into enough account

People are complicated. There are many social factors that can affect our capacity to cope, to relate to others and to respond to stress. For example:

• Experiencing trauma in childhood (such as abuse or neglect), or trauma that lasted for a long time.
• Issues to do with your situation and environment, such as poverty and social deprivation, or having to move home to a totally new place or culture.
• Experiencing stigma and discrimination, like racism, sexism, homophobia, biphobia or transphobia.
• If people have treated you badly in past relationships (including your parents or carers).

Any of these can lead to you often feeling overwhelmed with unbearable feelings. This can make it very difficult to deal with the daily challenges of adult life.

The term itself can be stigmatising

Some people feel that the term ‘personality disorder’ can sound very judgmental. Being given a diagnosis or label of personality disorder can feel as if you’re being told there’s something wrong with who you are. You may feel upset, insulted and excluded. Language evolves and it may be that a different term will be used by professionals in future.

“Stigma can sometime come from the professionals themselves, whether intentionally or not.”

It’s important to remember that you’re not alone – there are other people out there experiencing what you are. However you choose to make sense of your difficulties, you deserve to be treated fairly. Here are some options you can consider:

• Show people this information to help them understand more about what your diagnosis really means.
• Get involved in your treatment – our pages on seeking help for a mental health problem and advocacy provide guidance on having your say in your treatment, making your voice heard and steps you can take if you’re not happy with your care.
• Know your rights – our pages on legal rights provide more information.
• Take action with Mind – see our campaigning page for details of the different ways you can get involved in helping us to challenge stigma.

That said, it takes energy to challenge stigma. When you are particularly unwell you may not have the capacity to do any of these things. Be kind to yourself and try not to put yourself under pressure to do anything other than rest and recover when that is what you need.

“The stigma of being violent and dangerous is the worst for me. I am a caring and empathetic soul who would do anything for the people I love.”

Could my diagnosis be wrong?

Some symptoms of personality disorder can be very similar to, or appear alongside, other mental health problems.

Depending on your mood and what’s happening in your life when you speak to mental health professionals, they might find it hard to identify the diagnosis that best fits your experiences.

If you’re worried that your diagnosis doesn’t reflect the way you feel, it’s important to discuss it with a mental health professional so you can make sure you’re getting the right treatment and support to help you.