What are the Personality Disorders? A Summary from the Personality Disorders Foundation

This summary of the personality disorders was produced by the former Personality Disorders Foundation and is based upon the American Psychiatric Association’s DSM IV. Additional separate sections on the ICD description of each individual personality disorder are also available from the submenu at the side of the page.

What are Personality Disorders?

Personality Disorders are generalized, inflexible patterns of inner experience and behavior. These patterns significantly differ from cultural expectations, and begin in adolescence or early adulthood. Personality Disorders are long-term, maladaptive patterns of perception, emotional regulation, anxiety, and impulse control. They can lead to enormous personal and societal costs, including lost productivity, hospitalizations, significant unhappiness, imprisonment, and suicide.

Personality Disorders are among the least understood and recognized disorders in both psychiatry and general medical care. Ironically, as a group of disorders, they are among the most common of the severe mental disorders, and occur frequently with other illnesses (e.g., substance use disorders, mood disorders, anxiety disorders). Many imprisoned individuals also have a diagnosable personality disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM IV, American Psychiatric Association, 1994), organizes personality disorders into three groups, with three or four disorders per group:

Eccentric Personality Disorders: Paranoid, Schizoid, Schizotypal

Individuals with these disorders often appear odd or peculiar, and show these patterns by early adulthood and in various contexts (e.g., work, home, social situations).

An individual with Paranoid Personality Disorder generally tends to interpret the actions of others as threatening. This distrust and suspiciousness is indicated by four (or more) of the following (from DSM-IV, American Psychiatric Association, 1994):

1. suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
2. is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. is reluctant to confide in others because of unwarranted fear that the information will be used against him or her
4. reads hurtful or threatening meanings into kind remarks or events
5. is unforgiving of insults or injuries
6. perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily
7. has recurrent suspicions, without justification, regarding faithfulness of spouse or sexual partner

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An individual with Schizoid Personality Disorder is generally detached from social relationships, and shows a narrow range of emotional expression in various social settings. This pattern is indicated by four (or more) of the following (from DSM-IV, American Psychiatric Association, 1994):

1. neither desires nor enjoys close relationships, including family relationships
2. often chooses activities that don’t involve other people.
3. has little interest in having sexual relations with another person
4. enjoys few activities
5. lacks close friends other than immediate family
6. appears indifferent to praise or criticism
7. shows emotional coldness, detachment, or little emotional expression

A diagnosis of Schizoid Personality Disorder would not be made if the criteria only occurred during the course of a Pervasive Developmental Disorder (e.g., Autism).

A person with Schizotypal Personality Disorder is uncomfortable in close relationships, has thought or perceptual distortions, and peculiarities of behavior. This disorder is indicated by five (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. ideas of reference, i.e., believes that casual and external events have a particular and unusual meaning that is specific to him or her
2. odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms (e.g., belief in superstitions or clairvoyance, telepathy, or “sixth sense”
3. unusual perceptual experiences (e.g., hears a voice murmuring his or her name; reports bodily illusions)
4. odd thinking and speech (e.g., unusual phrasing, speech which is vague, overly elaborate, and wanders from the main point)
5. excessively suspicious thinking
6. inappropriate or constricted emotions (reduced range and intensity of emotion)
7. behavior or appearance that is odd or peculiar (e.g., unusual mannerisms, avoids eye contact, wears stained, ill-fitting clothes)
8. lack of close friends or confidants other than immediate family
9. excessive social anxiety that remains despite familiarity with people and social situation. The anxiety relates more to suspiciousness about others’ motivations than to negative judgments about self.

In addition to the exclusions described above, this disorder would not be diagnosed if the pattern described above only occurred during the course of a Pervasive Developmental Disorder (e.g., Autism).

Dramatic Personality Disorders: Antisocial, Borderline, Histrionic, and Narcissistic

Individuals with these disorders have intense, unstable emotions, distorted self-perception, and/or behavioral impulsiveness.

Individuals with Antisocial Personality Disorder show a pervasive disregard for, and violation of, the rights of others since age 15 years, as indicated by three (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. repeated acts that are grounds for arrest
2. deceitfulness, i.e., repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsiveness or failure to plan ahead
4. irritability and aggressiveness, such as repeated physical fights or assaults
5. reckless disregard for the safety of self or others
6. consistent irresponsibility, i.e., repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by indifference to, or rationalizing having hurt, mistreated, or stolen from another

To receive this diagnosis, an individual also needs to be at least 18 years old, to show evidence of a Conduct Disorder (which begins before age 15), and to show antisocial behavior that does not only occur during a Manic Episode or the course of Schizophrenia.

Individuals with Borderline Personality Disorder show a generalized pattern of instability in interpersonal relationships, self-image, and observable emotions, and significant impulsiveness. This pattern begins by early adulthood, occurs in various contexts, and is indicated by five (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. frantic efforts (excluding suicidal or self-inflicted cuts or burns) to avoid real or imagined abandonment
2. a pattern of intense and unstable interpersonal relationships that may quickly alternate between extremes of idealization (the other person may be “put on a pedestal”) and devaluation (the other person’s negative qualities are now exaggerated)
3. identity disturbance: sudden and dramatic shifts in self-image in terms of shifting values (e.g., sexual identity, types of friends) and vocational goals
4. impulsiveness in at least two areas that are potentially harmful (e.g., spending, sex, substance abuse, reckless driving, binge eating, excluding suicidal or self-mutilating behavior)
5. repeated suicidal behavior or threats, or self-inflicted cuts or burns (e.g., self-mutilating behavior)
6. significant, sudden changes in mood and observable emotion (e.g., intense periodic sadness, irritability, or anxiety, usually lasting a few hours and rarely lasting more than a few days; extreme reactivity to interpersonal stresses)
7. chronic feelings of emptiness; also may be easily bored
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. temporary, stress-related psychosis (symptoms such as paranoia or grossly distorted body image)

Beginning in early adulthood, individuals with Histrionic Personality Disorder often display excessive emotionality and attention seeking in various contexts. They tend to overreact to other people, and are often perceived as shallow and self-centered. This pattern is suggested by five (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. discomfort in situations in which he or she is not the center of attention
2. frequent, inappropriate, seductive or provocative behavior in interpersonal interactions
3. rapid shifts of emotions, and shallow expression of emotions; emotions often appear to be “turned on and off too quickly” to be deeply felt
4. consistent use of physical appearance to draw attention to self
5. excessively dramatic style of speech that lacks detail; opinions are strongly presented, but underlying reasons may be vague, without supporting facts and details
6. self-dramatic, theatrical, and exaggerated expression of emotion
7. easily influenced by others or circumstances (e.g., fads)
8. views relationships as more intimate than they actually are

Individuals with Narcissistic Personality Disorder often have a grandiose view of themselves, a need for admiration, and a lack of empathy that begins by early adulthood and is present in various situations. These individuals are very demanding in their relationships. This pattern is indicated by five (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. has an inflated sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without corresponding achievements)
2. is overly concerned with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. requires excessive admiration
5. has a sense of entitlement, i.e., unreasonable expectations of very positive treatment or automatic compliance with his or her expectations
6. takes advantage of others to achieve his or her own ends
7. lacks empathy: is unwilling to identify with the feelings and needs of others
8. is often jealous of others or believes that others are jealous of him or her
9. shows arrogant or domineering behaviors or attitudes

Anxious Personality Disorders: Avoidant, Dependent, Obsessive-Compulsive

Individuals with these disorders often appear anxious or fearful, and like the other personality disorders, the generalized patterns described below typically begin in early adulthood, and are present in various contexts.

An individual with Avoidant Personality Disorder typically is socially inhibited, feels inadequate, and is oversensitive to criticism, as indicated by four (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. avoids work-related activities that involve much social contact, because of fears of criticism, disapproval, or rejection
2. is unwilling to get involved with people unless certain of being liked
3. fears of shame or ridicule lead to excessive shyness within intimate relationships
4. is overly concerned with criticism and rejection in social situations
5. is inhibited in new social situations because of feelings of inadequacy
6. views self as socially incompetent, personally unappealing, or inferior to others
7. unusually reluctant to take personal risks or do new activities because of fear of embarrassment

A person with Dependent Personality Disorder shows an extreme need to be taken care of that leads to fears of separation, and passive and clinging behavior. This disorder is indicated by five (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. difficulty making daily decisions without an excessive amount of advice and reassurance from others
2. needs others to assume responsibility for most major areas of his or her life
3. difficulty voicing disagreement with others because of fear of loss of support or approval (excluding realistic fears of punishment)
4. difficulty starting projects or doing things on his or her own (because of little self-confidence in judgment or abilities, rather than a lack of motivation or energy)
5. excessively attempts to obtain support from others such that he or she volunteers to do unpleasant tasks
6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
7. urgently seeks another relationship as a source of support when a close relationship ends
8. overly worried about being left to take care of himself or herself

An individual with Obsessive Compulsive Personality Disorder is preoccupied with orderliness, perfectionism, and control at the expense of flexibility, openness, and efficiency. This pattern is indicated by four (or more) of the following (from DSM IV, American Psychiatric Association, 1994):

1. is overly concerned with details, rules, lists, order, organization, or schedules such that the major point of the activity is lost
2. is unable to complete a project because his or her own overly strict standards are not met
3. excessive emphasis on work and productivity such that leisure activities and friendships are devalued (not accounted for by obvious economic need)
4. is overly conscientious and inflexible about issues involving morality, ethics, or values (not accounted for by cultural or religious identification)
5. is unable to throw out worn-out or worthless objects despite lack of emotional value
6. is reluctant to delegate tasks or work with others unless they agree to exactly his or her way of doing things
7. adopts a stingy spending style toward both self and others; money is seen as something to be gathered for future catastrophes
8. rigidity and stubbornness

There also is a diagnosis known as “Personality Disorders Not Otherwise Specified”, which is separate from the above three groups of disorders.

This diagnosis would be given for disturbed personality functioning that does not meet criteria for any specific Personality Disorder, but which leads to distress or harm in one or more important areas of functioning (e.g., social or work-related). The clinician also may give this diagnosis if a specific personality disorder that is not included in the DSM IV Classification seems to apply to an individual (e.g., depressive personality disorder, or passive-aggressive personality disorder; DSM IV, American Psychiatric Association, 1994).