Personality differences are natural. In the past, differences between people’s personalities were seen from a moral standpoint. Today, psychologists recognize that personality differences are the result of adaptations to distinct environmental and genetic influences during early childhood development.
Several factors can have predictable and measurable effects on personality development. Mental health professionals recognize that pathological personality styles often emerge as a result of neglect or trauma. Moreover, these personality adaptations can successfully be treated using evidence-based therapeutic modalities, offered as part of personality disorder treatment programs.
What is Personality Disorder?
Everyone has a unique personality. How does one define a personality disorder? From a clinical standpoint, a personality disorder is a condition that emerges when a person develops a behavior in a certain environment but continues to practice the behavior in a new environment. In many cases, these behavioral adaptations make sense in a chaotic environment, such as an abusive or neglectful childhood home, but become maladaptive in a more “normal” environment, such as a school or workplace setting.
Personality disorders are defined by the American Psychiatric Association as “a way of thinking, feeling, and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.”
Just as all personalities are unique, so too are all personality disorders. The specific symptoms of personality disorders, sometimes known as “traits,” tend to be stable over time, however, though there is considerable variation. These traits often reflect childhood circumstances.
For example, a person who grew up with demanding or abusive parents may develop anxious or withdrawn personality traits. Their fearful and rigid way of relating to the world, which may have made sense in their childhood home, might later develop into a full-fledged avoidant personality disorder.
Personality disorders are not simply “strange” personalities. A personality disorder is a serious and legitimate mental health disorder. To be diagnosed with a personality disorder, it is crucial to see a professional psychiatrist or medical professional.
Physicians diagnose personality disorders based on criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). The DSM-V distinguishes between three different “clusters” of personality disorders. Each cluster contains several personality disorders that share several traits while differing in the details.
Types of Personality Disorders
The three main clusters of personality disorders can be broadly grouped by the traits they share. Cluster A personality disorders are often known for being eccentric or odd. Personality disorders in Cluster B are often notably dramatic. Meanwhile, Cluster C personality disorders are widely recognized as anxiety-driven.
These traits are often the most notable expressions of the disorders, and they often become apparent by late adolescence or early adulthood at the latest.
Cluster A Personality Disorders
Cluster A personality disorders are recognized by medical professionals as the most severe types of personality disorders. These mental health conditions share several characteristics with schizophrenia, which the DSM at one point considered a similar condition. Nonetheless, it is important to specify that personality disorders are not the same as schizophrenia.
Unlike schizophrenia, those who suffer from Cluster A personality disorders do not experience hallucinations. They are also likely to experience several types of delusional thinking that schizophrenic individuals rarely experience.
Schizoid Personality Disorder
Despite having a similar sounding name, schizoid personality disorder is not the same as schizophrenia. Both names are derived from the Greek prefix “schiz,” which means “split.” Individuals with schizoid personality disorder generally display a restricted emotional range, and they often are very socially withdrawn. Physicians diagnose a person with schizoid personality disorder when they exhibit four or more of the following traits:
- A lack of interest in friendships and close relationships, even with family members
- A lack of interest in having sexual experiences
- An overwhelming preference for solitary activities
- A lack of friends, confidants, and other relationships aside from first-degree relatives
- A notable lack of interest and lack of pleasure in most activities
- Emotional detachment, coldness, or flat affect
- A lack of reaction and seeming indifference to both criticism and praise
Schizoid personality disorder may appear similar to social anxiety or introversion. Unlike these other personality traits, though, a person suffering from schizoid personality disorder will generally exhibit a lack of expressed emotion. While introverts and anxious individuals generally have some feeling about being alone, those with schizoid personality disorder often show neither positive nor negative reactions to social isolation.
Paranoid Personality Disorder
Individuals with paranoid personality disorder generally show distrust or suspiciousness toward other people. They are likely to interpret other people’s motives as malevolent, hostile, or manipulative. The disorder is diagnosed when a person exhibits four or more of the following symptoms;
- Unjustified and recurrent suspicions about a partner’s sexual fidelity
- Quick aggressive counter-reactions to other people, and inaccurate perceptions about their level of hostility
- Refusal to forgive slights or insults, and long-term retention of grudges
- Perceiving threatening or demeaning meanings in neutral events or statements
- Being hesitant to confide in others for fear that this information will one day be used against them
- Preoccupation with unjustified concerns about other people’s trustworthiness or loyalty
- Unjustified suspicion that people are harming, deceiving, or exploiting them
While the other two Cluster A personality disorders are characterized by significant social withdrawal, paranoid personality disorder is not. Nonetheless, the high levels of paranoia can make it difficult for sufferers to develop and maintain long-term relationships, especially intimate or romantic relationships.
Schizotypal Personality Disorder
In many ways, people with schizotypal personality disorder share a lot of commonalities with those who have schizoid personality disorder. Both types of personality disorders cause people to be socially avoidant. Schizotypal personality disorder is unique, however, in that it causes distorted perception and eccentric behavior as well. Schizotypal personality disorder is generally diagnosed when a person meets four or more of the following criteria:
- Strange beliefs or magical thinking that is not consistent with cultural norms
- Ideas of reference (believing that neutral events relate specifically to them)
- Odd speech or thinking patterns, such as circular or stereotyped speech
- Odd perceptions, including illusions about the body
- Constricted or inappropriate affect
- Paranoid or suspicious ideation
- Strange appearance or behavior
- Excessive and unjustified paranoid anxiety that does not lessen with familiarity
- Few confidants or close friends aside from first-degree relatives
When a person has schizoid personality disorder, they often suffer from significant delusions. However, these delusions are rarely as intricate or elaborate as the delusions that characterize schizophrenia. They are also rarely as paranoid as the delusions associated with schizophrenia.
Cluster B Personality Disorders
The disorders that fall under Cluster B are less detrimental than those in Cluster A. For the most part, Cluster B personality disorders are known for causing impulsive, dramatic, and emotionally dysregulated behavior. These conditions share several common traits, including neuroticism, negative temperament, and disinhibition.
While these personality disorders are generally perceived as less severe than Cluster A personality disorders, they do come with several risks. Sufferers are more likely to engage in self-harm and substance abuse than the rest of the population.
Borderline Personality Disorder
Borderline personality disorder, or BPD, is a personality disorder that affects a person’s ability to have interpersonal relationships and. It causes people to have an unstable sense of personal identity, and it also leads to severe emotional regulation problems. The condition is diagnosed when a person displays five or more of the following personality traits:
- Temporary, stress-related paranoid ideation or extreme dissociative symptoms
- Unjustified and inappropriate intense rage or difficulty controlling rage
- A continual feeling of emptiness
- Unstable affect and reactivity of mood, with episodic anxiety, irritability, and dysphoria
- Frequent suicidal features, threats, and acts, as well as self-mutilating behavior
- Impulsivity in at least two areas that can potentially be harmful to the self
- A persistently unstable sense of self as well as identity disturbance
- A pattern of intense, unstable relationships characterized by extremes of idealization and devaluation
- Frantic efforts to avoid imagined or real abandonment
Individuals with BPD vary in terms of how they express their disorders. Some people keep their emotional intensity hidden, and they may be seen as introverts or socially withdrawn. Others, on the other hand, can be very extroverted.
Both groups are vulnerable to self-destructive behavior and substance use disorders. Individuals with borderline personality disorder tend to exhibit the most reactive symptoms when they are responding to a real or perceived threat of abandonment or rejection.
Narcissistic Personality Disorder
A person develops narcissistic personality disorder as a result of receiving very few empathic responses from parents, authority figures, and caregivers during childhood. Narcissistic personality disorder is characterized by grandiosity and severely diminished empathy. It is diagnosed when a person displays five or more of the traits listed below:
- Demanding excessive admiration
- Being convinced they are special, and needing recognition from high-status people or institutions
- Preoccupation with fantasies of unlimited success, power, or ideal beauty or love
- Possessing a grandiose sense of self-importance or an unmerited sense of superiority
- Displaying haughty or arrogant behavior or attitudes
- Often envying others or believing (without evidence) that others are envious of them
- Lacking empathy, and being unable to identify with or recognize other people’s needs or feelings
- Exploiting or taking advantage of other people for personal ends
- Possessing a sense of entitlement, or unreasonable expectations of uniquely favorable treatment
Individuals with narcissistic personality disorder generally keep their most vulnerable emotional reactions hidden. In most cases, they aim to keep them hidden from other people — but they often even keep their vulnerable emotions hidden from themselves. For this reason, individuals with narcissistic personality disorder often come off as aloof or cold.
They may not be aloof or cold at all, and they may be experiencing significant inner turmoil. These individuals are also prone to exploiting others. Their primary motivation for doing so, however, is to validate their social status or their feeling that they deserve admiration.
Histrionic Personality Disorder
People who have histrionic personality disorder are highly dependent on the attention of other people. This condition worsens emotional regulation, but its most identifiable feature is how sufferers engage in attention-seeking patterns. It is diagnosed when a person suffers from five or more of the symptoms listed below:
- Interacting with other people in provocative or inappropriately sexual ways
- Feeling uncomfortable when one is not the center of attention
- Using one’s physical appearance to get attention from other people
- Having shallow or rapidly changing emotional states
- SPeaking in excessively impressionistic or vague ways
- Being easily influenced or suggestible by others or by circumstances
- Exhibiting dramatic, exaggerated, or theatrical displays of emotion
- Believing that certain relationships are more intimate than they really are
While histrionic personality disorder may sound like mere extraversion, it is important to note that extraversion can be a healthy trait. In contrast, individuals with histrionic personality disorder generally find that their dependence on attention is unhealthy and maladaptive.
Antisocial Personality Disorder
Antisocial personality disorder is defined by the DSM-5 as “a pervasive pattern of disregard for and violation of the rights of others.” Antisocial personality disorder is the clinical term for being a “sociopath.” They often have a poor understanding of right and wrong and struggle to experience empathy for other people.
Antisocial personality disorder is diagnosed when a person demonstrates three or more of the symptoms listed below:
- Failing to plan ahead and engaging in impulsive behavior
- Being deceptive, using a fake name, and conning others for pleasure or personal profit
- Failing to conform to laws or social norms, and acting in ways that could lead to an arrest
- Acting in ways that show disregard for the safety of other people or oneself
- Exhibiting aggression and irritability, as indicated by repeated physical assaults
- Rationalizing hurtful actions and showing a lack of remorse
- Consistently acting irresponsibly, such as failing to uphold financial or work obligations
A person cannot be diagnosed with antisocial personality disorder before the age of 18. Nonetheless, they must have shown some evidence of the disorder before the age of 15. These traits cannot be the result of a schizophrenic or manic episode. It is common for people with antisocial personality disorder to have involvement with the criminal justice system.
Cluster C Personality Disorders
While Cluster A personality disorders share similar traits with schizophrenia, Cluster C personality disorders tend to resemble anxiety disorders, such as obsessive-compulsive disorder or social anxiety disorder.
Unlike anxiety disorders, however, Cluster C personality disorders are often more pervasive and deeply internalized. With typical anxiety disorders, recovery often involves learning coping tools and alternative ways of conceptualizing one’s problems. Anxious personality disorders are more ingrained, however. This makes them significantly more difficult to treat.
Avoidant Personality Disorder
Avoidant personality disorder causes people to avoid social situations as much as possible. They do not avoid social situations because they like to be alone. In fact, people with avoidant personality disorder might even hate solitude. Despite that, their fear of rejection and judgment is so strong that they will often go to any lengths to avoid social interactions.
Avoidant personality disorder is diagnosed when a person demonstrates four or more of the symptoms listed below:
- Reluctance or unwillingness to get involved with people without 100% certainty that one is liked
- Avoiding social activities due to fears of disapproval, rejection, or criticism
- Being preoccupied with rejection or criticism in social situations
- Holding back in intimate relationships out of fear of being ridiculed or shamed
- Shutting down in new interpersonal situations as a result of feeling inadequate
- Seeing oneself as personally unappealing, inferior to others, or socially inept
- Being unusually reluctant to try new activities or take risks out of fear of embarrassment
Though avoidant personality disorder resembles anxiety disorder, the former is unique because it often affects a person much more deeply. While anxiety disorder might cause a person to experience panic in social situations, avoidant personality disorder causes a person to maintain a lot of firmly held convictions about themselves and their self-worth. These negative self-evaluations are deeply ingrained.
Obsessive-Compulsive Personality Disorder
When a person suffers from obsessive-compulsive personality disorder, or OCPD, then they place an enormous emphasis on order, control, and perfectionism. Suffers can be diagnosed when they exhibit at least four of the symptoms listed below;
- Their perfectionism interferes with the ability to complete tasks
- They’re so preoccupied with rules or details that the point of any given activity is lost
- They are extremely conscientious and inflexible regarding matters of ethics, morality, or values
- They are excessively devoted to work and productivity, at the expense of friendship and leisure
- They are excessively stubborn and rigid
- They spend money in a miserly style, and they are fixated on hoarding money in case a catastrophe occurs
- They are reluctant to delegate tasks to others without being able to control how they perform those tasks
- They are unable to discard worthless or worn-out objects even when these objects do not possess sentimental value
While OCPD resembles obsessive-compulsive disorder in many ways, individuals with OCD generally recognize their compulsions and obsessions as irrational. Individuals with obsessive-compulsive personality disorder, however, do not feel as powerless over their thoughts and behaviors — and they may in fact see what they’re doing as healthy or correct.
They are less prone to engaging in the kinds of repetitive compulsions that characterize OCD. Instead, they tend to exhibit a rigid approach to a wide variety of situations in their lives.
Dependent Personality Disorder
The DSM-5 defines dependent personality disorder as “a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts.”
Individuals with dependent personality disorder tend to struggle in their interpersonal relationships, and their prevailing mode of interacting with others tends to be one of co-dependence. The condition is diagnosed when an individual meets five or more of the following criteria:
- They depend on other people to take responsibility for major routines and life decisions
- They struggle to make daily decisions without reassurance from others and excessive advice
- They resist new projects or independent activities due to a lack of self-confidence
- They are reluctant to disagree with people out of fear or loss of approval or support
- They make excessive efforts to please other people, even when they are personally unpleasant
- They urgently seek other relationships as a source of care when a close relationship ends
- They have an unrealistic preoccupation and fear of being left alone
- They are uncomfortable with being alone due to a fear that they are unable to care for themself
The Relation Between Personality Disorder and Substance Abuse
Individuals who suffer from mental health disorders are generally more likely to engage in substance abuse and develop drug and alcohol addictions. In fact, according to the National Institute on Drug Abuse, roughly 50% of people with diagnosed mental health conditions also suffer from substance use disorders.
Clinicians use the term “comorbid’ when a person suffers from both mental illness and addiction; the term implies that there is an interaction between both conditions.
In most cases, the two conditions exacerbate each other. Many people with mental health disorders begin abusing drugs and alcohol because the substances offer temporary relief from the distressing symptoms of their mental health problem.
Over time, however, drugs and alcohol tend to worsen these very same symptoms. Withdrawal symptoms can cause depression, anxiety, and even psychotic episodes.
Unfortunately, these emotional difficulties can drive a person to abuse drugs and alcohol to an even greater extent — especially when they are not getting actual personality disorder treatment for their underlying condition.
Among mental health conditions, personality disorders are particularly associated with drug and alcohol abuse. Multiple studies have shown how having a personality disorder increases a person’s vulnerability to substance abuse and addiction.
One such study, entitled “The relationship between personality disorders and substance abuse disorders,” concluded that the different clusters of personality disorders tend to be associated with different types of substance abuse:
- Cluster C: People with Cluster C personality disorders have higher rates of alcohol consumption. Given their high rates of anxiety and desire for social approval, they are less likely to consume illegal drugs. Alcohol can provide temporary relief from anxious thoughts associated with Cluster C personality disorders.
- Cluster B: Cluster B personality disorders, which include narcissistic, histrionic, and antisocial disorders, are associated with the consumption of illegal drugs. Cocaine abuse and addiction are especially common among people with Cluster B personality disorders. These personality disorders are generally associated with a high level of impulsivity, which makes people even more vulnerable to substance abuse and addiction.
- Cluster A: Cluster A personality disorders are not associated with any particular style of substance abuse. Nonetheless, they remain vulnerable to addiction. Studies show that somewhere between 65% and 90% of people with substance use disorders also have at least one comorbid personality disorder.
It is important to understand that alcohol and drug abuse cannot directly cause personality disorders. However, substance abuse and addiction is often a significant factor that changes the development and subsequent effects of personality disorders.
Individuals with borderline personality disorder, for instance, often experience decreased emotional regulation when they develop a substance addiction. Moreover, the aggression and lack of empathy that characterize antisocial personality disorder are generally exacerbated when alcohol enters the picture.
Personality Disorder Treatment
Personality disorders are often very complicated to treat. This is partly because they are generally associated with some underlying beliefs, self-evaluations, and behaviors. In many cases, these are so deeply ingrained that patients might fail to recognize that they suffer from a disorder at all.
Obsessive-compulsive disorder and anxiety disorder, for instance, are generally experienced by patients and distracting and painful intrusions in their lives, whereas people with avoidant personality disorder or obsessive-compulsive personality disorder often believe that their emotions and thoughts and natural reactions to their circumstances.
As a result, it is common for people in this condition to resist personality disorder treatment. Individuals with borderline personality disorder, for instance, often behave in aggressive or hostile ways with their therapists while simultaneously exhibiting severe neediness.
Nonetheless, personality disorders are treatable. Like many mental health conditions, personality disorders respond favorably to psychotherapy, otherwise known as talk therapy. Dialectical behavior therapy, or DBT, is particularly helpful.
Dialectical behavior therapy is a specific subtype of cognitive-behavioral therapy (CBT). This type of therapy combines strategies like acceptance, mindfulness, and emotion regulation. In DBT sessions, clients are encouraged to make healthier choices while nonjudgmentally accepting their emotions and mental states.
It is worth noting that both dialectical behavior therapy and cognitive-behavioral therapy are both also beneficial for substance use disorders. When a dual diagnosis patient comes in to treat their personality disorder, these psychotherapeutic modalities can ultimately benefit both comorbid conditions.
Treating Personality Disorders and Substance Abuse
When a person suffers from both a substance addiction and a personality disorder, they are often referred to as “dual diagnosis.” Dual diagnosis patients often have far more struggles than those who only suffer from one condition. Their disorders generally resist to personality disorder treatment.
This is because they can easily undo any progress they’ve made if they experience worsened symptoms of their other condition. Even a person who has stopped abusing drugs and alcohol, for instance, might relapse if their personality disorders suddenly flare-up.
It is crucial to treat both addiction and mental health disorders at the same time. Quality outpatient rehab centers offer a type of personality disorder treatment modality known as integrated treatment. Integrated treatment means that clients will engage in group and individual therapy, get the medication they need, and learn new coping skills.
In the process, they will be relieved of the most severe symptoms of their personality disorder. This, in turn, removes one of their motivations to drink or abuse drugs. At the same time, they will learn how to live joyful and meaningful lives without having to rely on drugs and alcohol.