What Are Personality Disorders in the DSM-5?

Personality Disorders: An Overview

Personality disorders are a group of 10 diagnosable mental illnesses that are recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Each disorder is characterized by specific personality traits that can cause problems in relationships, social functioning, and overall well-being.

Types of Personality Disorders

The DSM-5 organizers personality disorders into three clusters based on shared key features:

Cluster A: Odd or Eccentric Behavior

• Paranoid personality disorder: This disorder is characterized by chronic distrust and suspiciousness of others, even in the absence of any evidence to support these beliefs. People with paranoid personality disorder may also be preoccupied with thoughts of being persecuted or harmed by others.
• Schizoid personality disorder: Individuals with schizoid personality disorder are characterized by a lack of interest in social relationships and a preference for solitary activities. They may also have difficulty expressing emotions and may seem indifferent to praise or criticism.
• Schizotypal personality disorder: This disorder is characterized by odd speech, behavior, and beliefs. People with schizotypal personality disorder may also experience magical thinking, unusual perceptual experiences, and difficulty forming close relationships.

Cluster B: Dramatic or Erratic Behavior

• Antisocial personality disorder: Individuals with antisocial personality disorder disregard social norms and the rights of others. They may be impulsive, aggressive, and manipulative. They may also have a history of criminal behavior.
• Borderline personality disorder: This disorder is characterized by instability in relationships, emotions, and self-image. People with borderline personality disorder may also experience impulsivity, self-harm, and suicidal thoughts or behaviors.
• Histrionic personality disorder: This disorder is characterized by excessive emotionality and attention-seeking behavior. People with histrionic personality disorder may be overly dramatic, theatrical, and exaggerated in their speech and behavior.
• Narcissistic personality disorder: Individuals with narcissistic personality disorder have an exaggerated sense of self-importance, a need for admiration, and a lack of empathy for others. They may also be arrogant, entitled, and exploitative.

Cluster C: Anxious or Fearful Behavior

• Avoidant personality disorder: This disorder is characterized by social inhibition and fear of criticism. People with avoidant personality disorder may go to great lengths to avoid social situations in which they fear they will be rejected or humiliated.
• Dependent personality disorder: Individuals with dependent personality disorder have an excessive need for reassurance and support from others. They may be overly reliant on others to make decisions and take care of their needs, and they may have difficulty standing up for themselves.
• Obsessive-compulsive personality disorder: This disorder is characterized by excessive preoccupation with orderliness, perfectionism, and control. People with obsessive-compulsive personality disorder may also have difficulty expressing emotions and may be rigid and inflexible in their thinking.

Symptoms of Personality Disorders

Self-Identity Problems

• Unstable self-image
• Inconsistencies in values, goals, and appearance

Interpersonal Problems

• Being insensitive to others (unable to empathize)
• Difficulty knowing boundaries between themselves and others
• Inconsistent, detached, overemotional, abusive, or irresponsible styles of relating

Diagnosis of Personality Disorders

To be diagnosed with a personality disorder, a person must meet the following criteria according to the DSM-5:

• Chronic and pervasive patterns of behavior that affect social functioning, work, school, and close relationships
• Symptoms that affect two or more of the following four areas: thoughts, emotions, interpersonal functioning, impulse control
• Onset of patterns of behavior that can be traced back to adolescence or early adulthood
• Patterns of behaviors that cannot be explained by any other mental disorders, substance use, or medical conditions

Differential Diagnosis

Before diagnosing a personality disorder, a clinician must rule out other disorders or medical conditions that may be causing the symptoms. This is important because personality disorders commonly co-occur with other mental illnesses, and a person may meet the criteria for multiple personality disorders.

Causes of Personality Disorders

The exact causes of personality disorders are unknown, but both genetic and environmental factors are thought to play a role.

Genetic Factors

• Studies have shown that personality disorders tend to run in families, suggesting a genetic predisposition.

Environmental Factors

• Childhood trauma, abuse, neglect, and other adverse experiences have been linked to an increased risk of developing a personality disorder.

Treatment for Personality Disorders

Personality disorders can be challenging to treat, but there are several evidence-based treatments that have been found to be effective.

Psychotherapy

• Dialectical behavior therapy (DBT): This therapy teaches coping skills for managing emotions, relationships, and self-harm urges.
• Cognitive behavior therapy (CBT): This therapy helps individuals identify and change negative thinking patterns and behaviors.
• Mentalization-based therapy (MBT): This therapy teaches individuals to recognize and understand their own and others' mental states.
• Psychodynamic therapy: This therapy explores unconscious conflicts and patterns that contribute to personality problems.
• Family therapy: This therapy helps family members learn to communicate and interact with each other in healthier ways.

Medication

• Medication is not a cure for personality disorders but can be helpful in managing associated symptoms such as anxiety, depression, or mood swings.

Coping with a Personality Disorder

Coping with a personality disorder involves a combination of professional support, self-care strategies, and support from loved ones.

• Seek professional help: Working with a mental health professional can help individuals understand their condition, develop coping skills, and manage symptoms.
• Educate yourself: Learning about your condition can help you understand and cope with symptoms, as well as motivate you to stay the course of treatment.
• Play an active role in your treatment: Take an active role in your treatment by attending sessions regularly, taking medications as prescribed, and following through with recommendations.
• Practice self-care: Regular exercise, a balanced diet, and adequate sleep can help improve mood, reduce stress, and manage symptoms. Avoid drugs and alcohol, as they can worsen symptoms and interact with medications.
• Seek support from loved ones: Talk to supportive friends or family members about your condition. Support groups and therapy for loved ones can also provide additional support and information.