What are Personality Disorders?

Personality disorders are long-term patterns of thinking, feeling and behaving that cause problems in relationships, work and self-care. They reflect enduring ways of relating to self and others and are best understood through clinical formulation that includes temperament, life history and current context.

Cluster overview (DSM-style)

Traditionally grouped in three clusters for clinical utility:

Core symptoms across personality disorders

• Pervasive interpersonal difficulties (trust, intimacy, boundaries).
• Rigid and maladaptive cognitive patterns (schemas about self/others).
• Emotion regulation problems (intense reactivity or emotional blunting).
• Impulse-control issues or overcontrol (impulsivity vs perfectionism).
• Functional impairment in work, relationships and self-care.

Common personality disorders — brief guide

Borderline Personality Disorder (BPD)

Marked by affective instability, unstable relationships, identity disturbance, impulsivity and self-harm risk. Evidence-based treatments: DBT, MBT, schema therapy.

Narcissistic Personality Disorder (NPD)

Grandiosity, need for admiration and lack of empathy. Treatment focuses on engagement, mentalizing, and exploring vulnerabilities beneath the grandiose stance.

Antisocial Personality Disorder (ASPD)

Pattern of disregard for others’ rights, impulsivity and often legal/forensic involvement. Interventions emphasise risk management, behavioural contracts and treating comorbidities.

Avoidant Personality Disorder (AvPD)

Social inhibition, feelings of inadequacy and hypersensitivity to criticism — therapy focuses on graded exposure, social skills and CBT/schema work.

Dependent Personality Disorder (DPD)

Excessive need to be cared for leading to clinginess and submission; therapy targets autonomy-building, decision-making and assertiveness.

Obsessive–Compulsive Personality Disorder (OCPD)

Perfectionism, rigidity and preoccupation with control; treatment uses CBT, schema therapy and behavioural experiments to increase flexibility.

Assessment — practical approach

1. Comprehensive history: developmental, relational, occupational, trauma and medical history.
2. Collateral information: with consent, obtain partner/family/employer reports for chronic patterns.
3. Structured tools: SCID-5-PD, PID-5 or other validated inventories support formulation.
4. Functional analysis: map triggers, maintaining factors and strengths.
5. Risk assessment: suicidality, self-harm, aggression, exploitation vulnerability.

Use diagnosis to inform treatment planning, not to stigmatise — a formulation-based approach is recommended.

Differential diagnosis & common confounds

• Distinguish personality disorder from mood, anxiety, psychotic or neurodevelopmental disorders that can mimic personality features.
• Consider cultural norms — personality traits may be shaped by cultural context and should not be pathologised without context.
• Temporary personality change due to substance use or medical conditions should be excluded.

Treatment principles — general

• Therapy is the cornerstone — long-term, evidence-based psychotherapies tailored to the disorder and needs.
• Work in phases: engagement & safety → skills & stabilisation → deeper schema/integration work.
• Set clear contracts, boundaries and collaborative goals to reduce enactments.
• Address comorbidities (depression, PTSD, substance use) concurrently.
• Use multidisciplinary care for complex cases (psychiatry, social work, occupational therapy).

Evidence-based therapies — selected

• Dialectical Behavior Therapy (DBT): particularly effective for BPD and self-harm reduction.
• Schema Therapy: helpful for entrenched personality patterns across diagnoses.
• Mentalization-Based Therapy (MBT): improves interpersonal understanding and reduces crises.
• Cognitive Behavioral Therapy (CBT): useful for specific patterns (avoidant, OCPD) and skill-building.
• Transference-Focused Psychotherapy (TFP): psychodynamic modality for severe identity disturbance.

Medications — role & limitations

No medication cures personality disorders. Medications treat target symptoms (mood, anxiety, impulsivity) or comorbid conditions. Use lowest effective doses, combine with psychotherapy, and review regularly.

Working with families and systems

• Psychoeducation reduces blame and helps carers respond consistently.
• Family therapy can address relationship patterns if safe and consented.
• Workplace adaptations and social supports improve functional outcomes.

Recovery & prognosis

Many individuals with personality disorders improve with time and appropriate treatment. Recovery focuses on reducing harmful behaviours, improving relationships and increasing life participation. Early intervention and consistent therapy increase positive outcomes.

Key takeaways

• Personality disorders are enduring, pervasive patterns that require formulation-led care rather than simple labeling.
• Assessment should be comprehensive, include collateral information, and prioritise safety.
• Psychotherapy is primary; choose evidence-based models suited to the presentation.
• Combined multidisciplinary care, family involvement and long-term engagement improve outcomes.