What Are Personality Disorders?

What Are Personality Disorders?

Personality disorders are characterized by enduring and deeply ingrained patterns of behavior that significantly deviate from cultural norms. They often arise in adolescence or young adulthood, and consistently cause distress and impairment in many different situations.^1,3

Types of Personality Disorders

There are currently 10 different types of personality disorder diagnoses, clustered into 3 categories based on similarities in diagnostic features: Clusters A, B, and C.³ 

Cluster A Personality Disorders

Cluster A personality disorders include:³

• Paranoid personality disorder. Paranoid personality disorder is characterized by patterns of distrust and suspicion of others; thinks others are out to harm or deceive them.
• Schizoid personality disorder. People with schizoid personality disorder are typically detached from social relationships, experience a limited range of emotions, and don’t seem to care about approval from others.
• Schizotypal personality disorder. Schizotypal personality disorder features distorted thinking and discomfort in close relationships. May exhibit extreme social anxiety and eccentric behaviors.

Cluster B Personality Disorders

Cluster B personality disorders include:³

• Antisocial personality disorder (ASPD). Characterized by a pattern of disregard for others, people with ASPD often lie and deceive others and may be overly impulsive.
• Borderline personality disorder (BPD). Borderline personality disorder is marked by instability in relationships, poor self-image, and extreme emotions. People with BPD also exhibit an intense fear of abandonment,  impulsivity, and often experience suicidal ideation.
• Histrionic personality disorder. Histrionic personality disorder is characterized by patterns of exaggerated emotions and attention-seeking behavior.
• Narcissistic personality disorder. People with narcissistic personality disorder often display a need for admiration, inflated sense of self-importance and entitlement, and lack of empathy for others.

Cluster C Personality Disorders

Cluster C personality disorders include:³

• Avoidant personality disorder. Avoidant personality disorder is characterized by extreme shyness, feelings of inadequacy, and hypersensitivity to negative evaluation, leading to avoidance of social interactions.
• Dependent personality disorder. People with dependent personality disorder typically exhibit the need to be taken care of, fear of separation, or helplessness when alone, and constant reassurance-seeking behavior.
• Obsessive-compulsive personality disorder (OCPD). OCPD is characterized by a preoccupation with orderliness, perfectionism, and control, often at the expense of social interactions. OCPD is not the same as obsessive-compulsive disorder (OCD), which is a separate diagnosis characterized by the presence of true obsessions and compulsions.

Common Signs & Symptoms of Personality Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the diagnostic criteria for a personality disorder includes the following:³

• An enduring pattern of thinking and behaviors that differs from the expectation of one’s culture.
• The pattern of thinking and behavior is enduring, inflexible, and pervasive across a range of social and personal situations.
• This pattern is associated with significant distress or impairment across various essential aspects of life, including social, occupational, and other important areas of functioning
• The pattern is stable and enduring, and can be traced back to adolescence or early adulthood.
• The pattern is not better explained by another mental disorder.
• The pattern can not be explained by the psychological effects of substance use or a medical condition (e.g., traumatic brain injury).

The Link Between Personality Disorders and Addiction

Personality disorders prevalently co-occur with substance use disorders, or addiction. A 2018 review published in the Indian Journal of Psychological Medicine found that between 34.8% to 73% people in addiction treatment also have a personality disorder.² There are several theoretical explanations for the link between personality disorders and addiction.

For one, personality disorders may influence the development of addiction through shared biological pathways. For example, traits like impulsivity and disinhibition are linked to brain networks involving the prefrontal cortex. Studies suggest that functional differences in these brain areas could contribute to the types of disinhibition sometimes exhibited by people with substance use disorders (SUDs).²

Generally, researchers believe that addiction—as well as co-occurring disorders—may be predicted by a complex combination of environmental, genetic, and biological factors. However, in many cases, it may be impossible to determine the cause of someone’s addiction or mental illness or to discern whether a personality disorder or addiction came first.⁴ Fortunately, research has found that simultaneous treatment for addiction and co-occurring disorders typically results in improved outcomes overall.⁵

Treating Personality Disorders & Co-Occurring Substance Use Disorder

Currently, there are no evidence-based treatments for personality disorders; however, psychotherapy is effective in managing some common symptoms of PDs, such as suicidality, emotional dysregulation, unhealthy thought patterns, and problems with interpersonal relationships.⁷

While there are no medications specifically designed for treating personality disorders, certain medications such as antidepressants, mood stabilizers, or anti-anxiety medications may help alleviate some symptoms associated with certain personality disorders.⁷

Research has identified several therapeutic interventions that effectively treat co-occurring substance use and mental health disorders.⁹ These include:^7,8

• Cognitive-behavioral therapy (CBT), which helps participants identify and modify negative or harmful beliefs and subsequent patterns of behavior.
• Dialectical behavioral therapy (DBT). DBT aims to help participants regulate their emotions, mitigate self-harming behaviors, and improve relationships. DBT utilizes principles of mindfulness,acceptance, and awareness of one’s emotional state.
• Group counseling, where sharing experiences in sessions guided by a therapist helps participants develop more positive attitudes and connections in recovery.
• Psychoeducation, which helps those in treatment and their families develop a deeper understanding of mental health and SUDs and learn how to cope with diagnoses and communicate more effectively.

Treatment for addiction and co-occurring personality disorders may be provided in a variety of settings, including:⁹

• Medical detox. In medically managed detox, patients are stabilized and monitored as they go through acute withdrawal. Detox is often necessary for patients with addictions to certain substances that have uncomfortable, painful, and even life-threatening withdrawal symptoms; however, detox without continued treatment is seldom effective in helping someone achieve long-term recovery.
• Inpatient treatment or residential treatment. In an inpatient or residential program, patients reside at the facility 24/7 and receive treatment through various evidence-based methods like behavioral therapy, peer support, psychoeducation, and medications for substance use disorder.
• Partial hospitalization or intensive outpatient treatment programs. These programs allow people to live at home while receiving several hours of treatment programming daily. Patients in partial hospitalization programs (PHPs) typically attend treatment for a minimum of 20 hours a week, while intensive outpatient programs (IOPs) require less.
• Outpatient treatment. Outpatient programs utilize the same treatment strategies used in other levels of care but afford more flexibility in scheduling.

Contact American Addiction Centers (AAC) now and connect with a compassionate admissions navigator, available 24/7. Take the first step toward learning about treatment options across the country. You don’t have to face this journey alone—call today.