Personality disorders are a group of mental health conditions where a person’s way of thinking, behaving, and relating to others is unhealthy and inflexible. People with personality disorders have trouble perceiving others accurately and connecting with them meaningfully. They also struggle to manage their thoughts, feelings, and actions in a flexible and healthy way.
Personality disorders are chronic conditions and typically show up during a person’s adolescence and persist for life. Because personality disorders involve enduring patterns of behaviour and relating to others, they are not diagnosed in childhood. It can take years of observation across various situations to determine if someone meets the criteria for a personality disorder. Personality disorders are difficult to treat and often require long-term psychotherapy.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizes personality disorders into three clusters based on some similarities, though there are significant differences between each disorder.
- Cluster A includes paranoid, schizoid, and schizotypal personality disorders. These disorders are marked by feelings of paranoia and distrust, odd or eccentric ways of thinking and relating, and social awkwardness or withdrawal.
- Cluster B includes borderline, narcissistic, histrionic, and antisocial personality disorders. These disorders are characterized by emotional or erratic thinking or behaviour, especially in interpersonal situations.
- Cluster C includes obsessive-compulsive, dependent, and avoidant personality disorders. These disorders are characterized by anxiety, compulsions, and a need for control.
The current classification system remains controversial, and many clinicians view personality disorders dimensionally rather than categorically. This means that people can exhibit traits or characteristics of one or more personality disorders to varying degrees, which can lead to issues like anxiety and depression.
Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a widely-known and well-researched mental health condition. It is characterized by diverse variations in presentation, with symptoms manifesting differently in each individual. BPD is marked by a consistent pattern of instability in interpersonal relationships, self-image, emotions, and impulsive behaviour.
Common symptoms of BPD can include, but are not limited to:
- Desperate attempts to prevent real or imagined abandonment
- Suicidal ideation, self-harm (e.g., cutting, hitting, burning), often triggered by interpersonal situations, such as someone leaving
- Emotional dysregulation and heightened sensitivity to various situations
- Persistent feelings of emptiness
- Unstable and intense relationships, often characterized by idealization followed by devaluation
- Rapid shifts in self-identity and self-image, including fluctuating goals, values, and self-perception
- Impulsive and risky behaviors, such as gambling, unprotected sex, excessive spending, binge eating, or substance abuse
- Inappropriate and intense anger, often resulting in conflict
- Mood swings lasting from hours to days, with emotions ranging from elation to anger or irritability
People with BPD may engage in maladaptive behaviours, like repeatedly contacting someone they fear will abandon them or experiencing uncontrolled anger, only to later feel shame about their actions. Despite recognizing the unproductiveness of these behaviours, they may struggle to control them in the moment, which compounds their feelings of shame.
Treating BPD can be challenging, often requiring a long-term commitment to psychotherapy. One highly effective approach for BPD treatment is Dialectical Behavior Therapy (DBT).
Narcissistic Personality Disorder
Narcissistic personality disorder is characterized by an exaggerated sense of self-importance, an intense need of admiration, and a sense of entitlement. Additionally, individuals with narcissistic personality disorder may take advantage of others and lack empathy.
Symptoms of narcissistic personality disorder can include (but are not limited to):
- Belief that they are special or more important than others
- Having fantasies about power, success, and/or attractiveness
- Failing to recognize others’ needs and feelings
- Exaggeration of achievements
- Behaving in an arrogant manner
- Persistent and frequent need for validation from others
- Unable to accept accountability or responsibility for their actions or behaviour
- Expecting special treatment due to perceived superiority
- Pervasive envy of others or belief that others are jealous of them
- Unreasonable expectations of favours or advantages
- Often taking advantage of other people to get what they want
- Belittling or looking down on others that they see as inferior
- Reacting negatively to criticism
Although individuals with narcissistic personality disorder rarely seek treatment, psychotherapy can help these individuals learn how to better relate to others and strengthen relationships, as well as understand their emotions and control their impulses.