Notes on personality disorder in Mental Health, Psychology.

1. What Are Personality Disorders?
Personality disorders include 10 diagnosable psychiatric conditions that are recognized
and described in the fifth and most recent version of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5).
Each is a distinct mental illness defined by personality traits that can be troubling
enough to create problems with relating to other people in healthy ways, and can lead to
significant distress or impairment in important areas of functioning.
Types
The DSM-5 organizes personality disorders into three groups, or clusters, based on
shared key features.
Cluster A
These personality disorders are characterized by odd or eccentric behavior. People with
cluster A personality disorders tend to experience major disruptions in relationships
because their behavior may be perceived as peculiar, suspicious, or detached.
Cluster A personality disorders include:1
 Paranoid personality disorder, which affects between 2.3% to 4.4% of adults
in the U.S. Symptoms include chronic, pervasive distrust of other people;
suspicion of being deceived or exploited by others, including friends, family, and
partners.
 Schizoid personality disorder, which is characterized by social isolation and
indifference toward other people. It affects slightly more men than women.
People with this disorder often are described as cold or withdrawn, rarely have
close relationships with other people, and may be preoccupied with introspection
and fantasy.
 Schizotypal personality disorder, which features odd speech, behavior, and
appearance, as well as strange beliefs and difficulty forming relationships.
Cluster B
The cluster B personality disorders are characterized by dramatic or erratic behavior.
People who have a personality disorder from this cluster tend to either experience very
intense emotions or engage in extremely impulsive, theatrical, promiscuous, or
law-breaking behaviors.
Cluster B personality disorders include:
 Antisocial personality disorder, which tends to show up in childhood, unlike
most other personality disorders (most don't become apparent until adolescence
or young adulthood). Symptoms include a disregard for rules and social norms
and a lack of remorse for other people.
 Borderline personality disorder, which is characterized by instability in
interpersonal relationships, emotions, self-image, and impulsive behaviors.
 Histrionic personality disorder, which features excessive emotionality and
attention seeking that often leads to socially inappropriate behavior in order to
get attention.

2.  Narcissistic personality disorder, which is associated with self-centeredness,
exaggerated self-image, and lack of empathy for others and is often driven by an
underlying fragility in the sense of self.
Understanding Cluster B Personality Disorders in the DSM-5
Cluster C
Cluster C personality disorders are characterized by anxiety. People with personality
disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.
Cluster C personality disorders include:
 Avoidant personality disorder is a pattern of social inhibition and avoidance
fueled by fears of inadequacy and criticism by others.
 Dependent personality disorder, which involves fear of being alone and often
causes those who have the disorder to do things to try to get other people to take
care of them.
 Obsessive-compulsive personality disorder, which is characterized by a
preoccupation with orderliness, perfection, and control of relationships. Though
similarly named, it is not the same as obsessive-compulsive disorder (OCD).
Symptoms
Personality disorders tend to appear in adolescence or early adulthood, continue over
many years, and can cause a great deal of distress. They can potentially cause
enormous conflict with other people, impacting relationships, social situations, and life
goals. People with personality disorders often don't recognize that they have problems
and are often confusing and frustrating to people around them (including clinicians).
Certain symptoms of personality disorders can fall into two categories: self-identity and
interpersonal functioning.1
Self-identity problems include:
 Unstable self-image
 Inconsistencies in values, goals, and appearance
Interpersonal problems include:
 Being insensitive to others (unable to empathize)
 Difficulty knowing boundaries between themselves and others
 Inconsistent, detached, overemotional, abusive, or irresponsible styles of
relating
Diagnosis
According to the DMS-5, a person must meet the following criteria to be diagnosed with
a personality disorder:2
 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

3.  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 a clinician can diagnose a personality disorder, they must make a differential
diagnosis to rule out other disorders or medical conditions that may be causing the
symptoms.
A differential diagnosis is very important but can be difficult since personality disorders
also commonly co-occur with other mental illnesses. A person who meets the criteria for
one personality disorder will often also meet criteria for one or more additional
personality disorders.3
One study, funded by the National Institute of Mental Health, found that about 85% of
people with borderline personality disorder (BPD) also meet diagnostic criteria for at
least one other personality or mood disorder.
Mixed Personality Disorder Definition, Diagnosis, and Criteria
Causes
Personality disorders don’t discriminate. Roughly 10% of the general population and up
to half of psychiatric patients in clinical settings have a personality disorder.1
Although experts are yet to fully understand the causes of personality disorders, they
believe that both genetic and environmental factors play a role.
Roughly 50% of personality disorders are attributed to genetic factors and family
history.1
Genetic vulnerabilities may make people more susceptible to these conditions,
while experiences and other environmental factors may act as a trigger in the
development of a personality disorder.
There is also a significant association between a history of childhood trauma as well as
verbal abuse. One study found that children who experience verbal abuse were three
times more likely to have borderline, narcissistic, obsessive-compulsive or paranoid
personality disorders in adulthood.4
High reactivity in children, including sensitivity to light, noise, texture, and other stimuli,
has also been linked to certain personality disorders.5
Treatment
Compared to mood disorders such as clinical depression and bipolar disorder, there have
historically been relatively few studies on how to effectively treat personality disorders.
Many experts believe that personality disorders are difficult to treat because they are, by
definition, long-standing patterns of personality. However, there are an increasing
number of evidence-based treatments that are being found effective for personality
disorders.
In general, the goal of personality disorder treatment includes the following:1
 Reducing subjective distress and symptoms such as anxiety and depression

4.  Helping people to understand the aspect of their problems that are internal to
themselves
 Changing maladaptive and socially undesirable behaviors, including
recklessness, social isolation, lack of assertiveness, and temper outbursts
 Modifying problematic personality traits like dependency, distrust, arrogance,
and manipulativeness
Psychotherapy
The National Alliance on Mental Illness (NAMI) lists several types of psychotherapy that
may be useful in the treatment of personality disorders:6
 Dialectical behavior therapy (DBT), which teaches coping skills and
strategies for dealing with urges related to self-harm and suicide, regulating
emotions, and improving relationships.
 Cognitive behavior therapy (CBT), the goal of which as stated by NAMI is "to
recognize negative thoughts and learn effective coping strategies."
 Mentalization-based therapy (MBT), which teaches people to notice and
reflect on their internal states of mind and those of others.
 Psychodynamic therapy, which places a large emphasis on the unconscious
mind, where upsetting feelings, urges, and thoughts that are too painful for us to
directly look at are housed.
 Family therapy, during which family members learn to change unhealthy
reactions to each other and learn effective communication skills.
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Medication
Medication can be useful to treat associated or co-morbid depression or anxiety.
Depending on your symptoms, your healthcare provider may prescribe one or more of
the following:
 Anti-anxiety medication
 Antidepressant
 Antipsychotic
 Mood stabilizer
Coping
Learning how to cope with a personality disorder is key to functioning at your best. In
addition to seeking professional support, it's important to reach out to a supportive
friend or family member who can help when you are struggling with strong emotions. If
you don’t have someone in mind that is supportive and you are in a crisis, call a helpline.
 Become an expert. The more you know about your condition, the better able
you’ll be to understand and cope with symptoms. Education about your condition
can also help motivate you to stay the treatment course.
 Play an active role in your treatment. Take time to think about your
treatment goals during and after therapy sessions. Even if you’re not feeling well,
don’t skip your sessions or stop taking your medications without talking to your
healthcare professional. Similarly, be sure to stick with regular appointments.
 Practice self-care strategies. Regular exercise and consistent eating and
sleeping schedules can help prevent mood swings and manage anxiety, stress,

5. and depression. It’s also important to avoid drugs and alcohol, which can worsen
symptoms and interact with medications.
CLUSTER A
Paranoid personality disorder is a chronic and pervasive condition characterized by
disruptive patterns of thought, behavior, and functioning. This disorder is thought to
affect between 1.21 to 4.4% of U.S. adults.1
Individuals with paranoid personality disorder are at a greater risk
of experiencing depression, substance abuse, and agoraphobia.
Symptoms
Individuals with paranoid personality disorder typically experience symptoms that
interfere with daily life.2
In general, people with this condition feel suspicious of others.
While this mistrust is unfounded, their distrust of others makes it difficult to form
relationships and can interfere with many aspects of life including at home, at school,
and at work. People with PPD do not see their behaviors as out of the ordinary but are
perceived by others as hostile and suspicious.
The primary characteristic of this condition is a chronic and pervasive distrust and
suspicion of others. Other symptoms of paranoid personality disorder include:
 Feelings that they are being lied to, deceived, or exploited by other people
 May believe that friends, family, and romantic partners are untrustworthy and
unfaithful
 Outbursts of anger in response to perceived deception
 Often described as cold, jealous, secretive, and serious
 Overly controlling in relationships in order to avoid being exploited or
manipulated
 Look for hidden meanings in gestures and conversations
 Find it difficult to relax
 Often hold negative views of other people
 Overly sensitive to criticism
 Overreacts in response to perceived criticism
The Diagnostic and Statistical Manual of Mental Disorders (DSM5) specifies that in
addition to having symptoms of pervasive suspicion and distrust, a diagnosis of PPD
requires that these symptoms must not be related to a psychotic episode associated
with schizophrenia, bipolar disorder, or depressive disorder with psychotic features.
Causes
While the exact causes of PDD are not known, it is believed that both genetics and
psychological factors play a role. There is also likely a strong genetic component since a
family history of schizophrenia is considered a risk factor for paranoid personality
disorder.
Childhood experiences and trauma may also play a part in the development of the
condition.1

6. Treatment
Paranoid personality disorder is generally treated with psychotherapy. With ongoing
treatment and appropriate support, people with this condition can manage their
symptoms and function more effectively in daily life.
However, people who have PPD may not seek treatment for their condition, usually
because they do not feel that they have a problem. To those with PPD, their suspicions
of others are justified and it is other people who are the problem.
The distrust and paranoia that characterizes the condition also make it difficult for
people with PPD to trust their doctors and therapists.3
This can make it challenging for
healthcare professionals to establish a therapeutic rapport with the individual.
Psychotherapy
Treatments for PPD usually focus on helping people develop coping skills. Therapy often
focuses on building empathy, trust, communication, self-esteem, social relationships,
communication skills, and general coping abilities.
Cognitive-behavioral therapy is often effective in helping individuals adjust distorted
thought patterns and maladaptive behaviors.1
Cognitive behavior therapy (CBT) is a
type of psychotherapeutic treatment that helps patients understand the thoughts and
feelings that influence behaviors.
During the course of treatment, people learn how to identify and change destructive or
disturbing thought patterns that have a negative influence on behavior.
Ingrained paranoid beliefs and maladaptive thoughts play a role in maintaining paranoid
personality disorder, which is why addressing these thoughts and beliefs through CBT
can be helpful.4
CBT may help people with PPD become better able to trust others.
By challenging maladaptive thoughts and working to change harmful behaviors, people
with this condition may become less suspicious of others, including friends and family,
which can improve relationships and social interactions. In addition to addressing
harmful thoughts and beliefs, CBT also works to help people with PPD better manage
their responses to others.
Rather than responding to comments with anger or hostility, for example, people can
learn more appropriate ways of dealing with their emotions.
Medication
While medication is not usually used to treat paranoid personality disorder, but may be
used in cases where symptoms are severe or if an associated condition such as
depression or anxiety is also present. Prescribed drugs included antidepressants,
antipsychotics, and anti-anxiety medications. 2
Medications alone are not a
recommended treatment for personality disorders and are best used in combination
with psychotherapy.
II SCHIZOID PERSONALITY DISORDER
Schizoid personality disorder (SPD) is a chronic and pervasive condition characterized
by social isolation and feelings of indifference toward other people.1
Those who live with

7. this disorder are often described as distant or withdrawn and tend to avoid social
situations that involve interaction with other people.
They find it difficult to express emotions and lack the desire to form close personal
relationships. This type of personality disorder is believed to be relatively rare and tends
to affect more men than women.2
People with schizoid personality disorder are also at
risk of experiencing depression.
Schizoid Personality Disorder Symptoms
People with schizoid personality disorder typically experience:
 A preoccupation with introspection and fantasy3
 A sense of indifference to praise and affirmation, as well as to criticism or
rejection
 Detachment from other people
 Little or no desire to form close relationships with others
 Indifference to social norms and expectations
 Infrequent participation in activities for fun or pleasure
 Not enjoying social or family relationships
 Often described as cold, uninterested, withdrawn, and aloof
Typical Onset
The disorder is often first noticeable during childhood and is usually apparent by early
adulthood. The symptoms of the disorder can have an impact on multiple life domains
including family relationships, school, and work.
The DSM-5 defines schizoid personality disorder as a "pervasive pattern of social and
interpersonal deficits marked by acute discomfort with, and reduced capacity to form
close relationships as well as by cognitive or perceptual distortions and eccentricities of
behavior, beginning by early adulthood and present in a variety of contexts."4
People with schizoid personality disorder are often described by others as aloof, cold,
and detached. Those who have the disorder may prefer being alone, but some may also
experience loneliness and social isolation as a result.
Work-Life Impact
Those with this disorder also tend to have few friendships, date rarely, and often do not
marry. The symptoms of the disorder may also make it difficult to work in positions that
require a lot of social interaction or people skills. People with a schizoid personality
disorder may do better in jobs that involve working in solitude.
Forming Intimate Relationships With Others
Schizoid Personality Disorder vs. Schizophrenia
While schizoid personality disorder is considered one of the schizophrenia spectrum
disorders and shares some common symptoms with schizophrenia and schizotypal
personality disorder, there are important distinctions that separate SPD from those two
disorders.
Those with SPD rarely experience paranoia or hallucinations.1
Also, while they may seem
aloof and distant during conversations, they do make sense when they speak, which

8. differs from the difficult to follow speech patterns that often demonstrated by people
with schizophrenia.
Schizophrenia
Causes
The causes of schizoid personality disorder are not known,1
although it is believed that a
combination of genetic and environmental factors play a role. Personality is shaped by a
wide variety of factors including inherited traits and tendencies, childhood experiences,
parenting, education, and social interactions. All of these factors may play some part in
contributing to the development of SPD.5
Diagnosis
If you are concerned about your symptoms, you may start by consulting your doctor.
Your doctor will evaluate your symptoms and check for any underlying medical
conditions that might be contributing to your symptoms. In most cases, you will likely
then be referred to a mental health professional.
The DSM-5 diagnostic criteria state that people must display at least four of the following
symptoms in order to be diagnosed with SPD:
 Always chooses solitary activities
 Emotional detachment and lack of emotional expression4
 Experiences little pleasure from activities
 Indifference to criticism or praise
 Lack of desire or enjoyment for close personal relationships
 Little or no interest in sex with other people
 No close friends other than immediate family
Schizoid personality disorder is most often diagnosed by a psychiatrist or another
mental health professional who is trained to diagnose and treat personality disorders.
General practitioners often lack the training to make this type of diagnosis, especially
since the condition is so uncommon and is often confused with other mental disorders.
People who have schizoid personality disorder rarely seek out treatment on their own. It
is often only after the condition has severely interrupted multiple areas of a person's life
that treatment is sought.
The Psychological Benefits of Being Alone
Treatment
Schizoid personality disorder can be challenging to treat. Those with the disorder rarely
seek treatment and may struggle with psychotherapy because they find it difficult to
develop working relationships with a therapist.1
The social isolation that characterizes
schizoid personality disorder also makes it difficult to find support and assistance.
People with schizoid personality disorder may find it easier to form relationships that
center on intellectual, occupational, or recreational pursuits because such relationships
do not rely on self-disclosure and emotional intimacy.1

9. Medications may be used to treat some of the symptoms of schizoid personality disorder
such as anxiety and depression. Such medications are usually used in conjunction with
other treatment options such as cognitive behavioral therapy (CBT) or group therapy.
CBT can help people with SPD identify problematic thoughts and behaviors and develop
new coping skills. Group therapy may help people practice interpersonal skills.
One-on-one therapy can seem intimidating for people with this condition because it
requires a great deal of social interaction. Such treatments may be most effective when
mental health professionals are careful to avoid pushing too hard and clients are not
faced with excessive pressure and emotional demands.1
III
Schizotypal
Schizotypal personality disorder is marked by a pervasive pattern of social and
interpersonal deficits. Individuals with schizotypal personality disorder have little
capacity—and perhaps even need—for close relationships.
They’re often described as eccentric or bizarre. They may be suspicious and paranoid of
others. They come across as “stiff” and don’t seem to fit in anywhere they go.
Schizotypal Personality Disorder Symptoms
Individuals with schizotypal personality disorders experience extreme discomfort during
interpersonal interactions.
Unlike in social anxiety disorder, where an individual is likely to grow more comfortable
with time, individuals with schizotypal personality disorder remain uncomfortable even
when they’re interacting with the same people in the same environment over and over
again.
The disorder also involves distorted thinking and eccentric behavior—which tends to
push people away and create even more isolation.
Superstitious Beliefs
Sometimes, individuals with schizotypal personality disorder are superstitious or
preoccupied with paranormal phenomena that are outside what would be expected in
their culture.
They may think they have special powers or magical control over others (such as
thinking the reason their co-worker is leaving early is that they wished an illness upon
them). They may also believe their behavior prevents a harmful outcome, such as
thinking that they can prevent bad things from happening by placing an object in a
certain place.
They may experience perceptual alternations, such as hearing someone mumbling their
name or sensing that a spirit is present.
Their speech may be vague or incoherent at times. They may use strange phrases or talk
in a way that confuses others.
Strange Behavior

10. They might also appear constricted and show little emotion during their interactions.
They may have unusual mannerisms, such as an unkempt manner of dress.
An individual with this disorder may wear ill-fitting clothing or bizarre clothing
combinations (winter boots with shorts) and may be unable to participate in the normal
give-and-take of a conversation.
They may occasionally express sadness over their lack of close relationships but their
behavior suggests they have little desire for close connections. They often interact with
people when they have to but prefer to keep to themselves.
They might also experience transient psychotic episodes during times of extreme stress
(lasting minutes to hours) but they do not have regular hallucinations or delusions (such
as in the case with schizophrenia).
How to Stop Magical Thinking in Generalized Anxiety Disorder
DSM-5 Diagnostic Criteria
According to the fifth edition of the Diagnostic and Statistical Manual, symptoms must
begin by early adulthood. In order to meet the criteria for a diagnosis, individuals must
experience at least five of the following symptoms:
 Ideas of reference (incorrect interpretations of causal incidents or events as
having an unusual meaning specifically for the person)
 Odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms
 Unusual perceptual experiences, including bodily illusions
 Odd thinking and speech
 Suspiciousness and paranoid ideation
 Inappropriate and constricted affect
 Behavior or appearance that is odd, eccentric, or peculiar
 Lack of close friends or confidants other than first-degree relatives
 Excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgments about oneself
The symptoms may begin during childhood or adolescence. Symptoms evident during
childhood may include:
 Poor peer relationships
 Social anxiety, isolation
 Underachievement in school
 Hypersensitivity
 Peculiar thoughts and language
 Bizarre fantasies
Causes
In community studies, the prevalence of schizotypal personality disorder ranges from .6
percent of the population in Norway to 4.6 percent in samples taken in the United
States.
There isn’t a single known cause for schizotypal personality disorder. It appears there is
a strong genetic component, however.

11. Individuals with first-degree biological relatives with schizophrenia are more likely to
have a schizotypal personality disorder.
Diagnosis
A mental health professional can diagnose a schizotypal personality disorder. Like all
personality disorders, a clinician must take into account what type of impairments are
caused by the symptoms.
Someone who is eccentric with few friends doesn’t necessarily have a schizotypal
personality disorder. In order to meet the criteria for a diagnosis, the symptoms must
interfere with a person’s social, occupational, or educational functioning.
There isn’t a test that determines whether someone has a personality disorder. Instead,
a clinician will conduct a thorough interview that gathers the history of the symptoms
and assesses the impairments. The clinician also observes the individual throughout the
interview to look for signs of the condition.
Assessment tools may be used as part of the diagnostic process. The individual may be
given a questionnaire to complete or may be asked to answer specific diagnostic
questions.
Sometimes, close family members are interviewed as well.
Ruling out Other Disorders
Before a diagnosis can be made, a clinician must rule out other disorders that can cause
someone to exhibit symptoms that appear similar to the symptoms of schizotypal
personality disorder. Schizophrenia, bipolar disorder, psychotic
disorders, neurodevelopmental disorders, and other personality disorders may be
confused with a schizotypal personality disorder because they have certain features in
common.
Schizotypal Personality Disorder Treatment
Like other personality disorders, there is no cure for schizotypal personality disorder.
Like all personality disorders, the symptoms are likely to persist throughout the life span.
That doesn’t mean you can’t reduce the severity of the symptoms or improve your
functioning, however.
Over half of individuals with schizotypal personality disorder may have a history of at
least one depressive episode. Sometimes, individuals seek treatment for their
depression, rather than the symptoms related to their personality disorder.
Treatment for schizotypal personality disorder may include a combination of
psychotherapy and medication.
Psychotherapy may include cognitive-behavioral therapy to address distorted thinking
patterns and to teach specific social skills. It may also help address problematic
behavior.
Family therapy may also be used to help family members understand the symptoms and
to assist in helping everyone communicate better and support the individual.

12. While there isn’t a specific drug used to treat schizotypal personality disorder,
medications may be used to address depression, anxiety, or psychotic symptoms. Some
medications may reduce distorted thinking.
CLUSTER B
What Is Antisocial Personality Disorder?
Antisocial Personality Disorder:
Antisocial personality disorder (ASPD) is a condition characterized by a lack of empathy
and regard for other people.
People with antisocial personality disorder have little or no regard for right or wrong.
They antagonize and often act insensitively or in an unfeeling manner. Individuals with
this disorder may lie, engage in aggressive or violent behavior, and participate in
criminal activity.
Psychopathy is associated with antisocial personality disorder. However, research has
shown that not every person with ASPD is a psychopath.1
Approximately one-third of
people with antisocial personality disorder meet the criteria for psychopathy.2
Introduction to the DSM Personality Disorders
Symptoms of Antisocial Personality Disorder
There are a number of defining symptoms of antisocial personality disorder. People with
ASPD:
 May begin displaying symptoms during childhood; such behaviors may include
fire setting, cruelty to animals, and difficulty with authority
 Often have legal problems resulting from failures to conform to social norms and
a lack of concern for the rights of others
 Often act out impulsively and fail to consider the consequences of their actions
 Display aggressiveness and irritability that often lead to physical assaults
 Have difficulty feeling empathy for others
 Display a lack of remorse for damaging behavior
 Often have poor or abusive relationships with others and are more likely to
abuse or neglect their children
 Frequently lie and deceive others for personal gain
These characteristics often lead to major difficulties in many life areas. At its core, the
inability to consider the thoughts, feelings, and motivations of other people can lead to
harmful disregard for others.
As adults, the disorder can be destructive to both the person living with it and those who
come into contact with them. People with antisocial personality disorder are more likely
to engage in risk-taking behaviors, dangerous activities, and criminal acts.3
Those with
the disorder are often described as having no conscience and feel no regret or remorse
for their harmful actions.

13. Diagnosis of ASPD
Symptoms of antisocial personality disorder often begin during childhood, although the
condition is often not diagnosed until later in life. As children, it is common for those who
develop this disorder to experience violent bursts of anger and show cruelty towards
animals. They are also often described as bullies by their peers.
While the condition may begin in childhood, it cannot be officially diagnosed before the
age of 18. Kids who display these symptoms are diagnosed with conduct disorder.
In order to be diagnosed with ASPD, a person must display a disregard and violation of
the rights of others before the age of 15. This disregard is indicated by displaying at least
one of seven symptoms:
 Disregard for the safety of the self and others
 Failure to obey laws
 Impulsive behavior
 Irritability and aggression
 Lack of remorse for actions
 Lying or manipulating others for profit or amusement
 Pattern of irresponsibility
In addition to displaying at least one of these symptoms, the person must be at least 18
years old and not display antisocial behavior as a result of another condition such
as bipolar disorder to schizophrenia.
According to some critics, the DSM diagnostic criteria are too focused on behaviors
related to criminal actions.4
Concerns have been raised that the diagnosis may at times
be misapplied to individuals in low socioeconomic or urban settings in which seemingly
antisocial behavior may be a part of a protective survival strategy.5
Because of this, it is
possible that the prevalence of this disorder has been overstated.
Prevalence
According to the DSM-V, 0.2% to 3.3% of U.S. adults have antisocial personality
disorder and the condition tends to affect men more than women.6
Causes of Antisocial Personality Disorder
The exact causes of antisocial personality disorder are not known.3
Personality is shaped
by a variety of forces including nature and nurture.
Genetics
ASPD is more common among the first-degree biological relatives of those with the
disorder than in the general population. Research suggests that ASPD is likely strongly
linked to inheritance and that environmental influences probably exacerbate its
development.7
Upbringing
Upbringing can also have an important influence. Childhood abuse, neglect, and trauma
have also been linked to the onset of ASPD.8
If a child's parents are abusive and
dysfunctional, children may learn such behavioral patterns and later display them with
their own kids.

14. Kids who grow up in disorganized and neglectful homes also lack the opportunities to
develop a strong sense of discipline, self-control, and empathy for others.
Brain Differences
A number of factors have been found to increase the risk of the disorder, including
smoking during pregnancy and abnormal brain function. Research suggests that people
with ASPD have differences in the frontal lobe, the area of the brain that plays a role in
planning and judgment.9
People with the disorder also tend to require greater stimulation and may seek out
dangerous or illegal activities to raise their arousal to an optimal level.
What Is Personality?
Treatments for Antisocial Personality
Disorder
Antisocial personality disorder is difficult to treat for a number of reasons. People with
the disorder rarely seek out treatment on their own. Those who do generally receive
treatment only after some type of altercation with the legal system.
While people with ASPD often come into contact with the criminal justice system,
research suggests that incarceration and other punitive measures are largely ineffective
since people with the condition are usually unresponsive to punishment.10
Psychotherapy
Cognitive behavioral therapy (CBT) can be useful in helping individuals gain insight into
their behaviors and to change maladaptive thought patterns.11
Effective results usually
occur only after long-term treatment.
Group and family therapy as well as mentalization-based therapy, which targets the
ability to recognize and understand the mental state of oneself and others, have also
been studied for ASPD and show promise.12
Medication
Medications may be used to treat some of the symptoms that a person with ASPDl may
experience. Some of the medications that may be prescribed include:
 Anti-anxiety medications
 Antidepressants
 Antipsychotics
 Mood stabilizers
What Is Borderline Personality Disorder
(BPD)?

15. Borderline personality disorder (BPD) is a serious psychological condition characterized
by unstable moods and emotions, relationships, and behavior. During a BPD episode, a
person may act impulsively, engage in risky behaviors, switch moods quickly, have
higher levels of anger, appear numb, or experience paranoia.
An estimated 1.4% of the adult population has borderline personality disorder, with
roughly three-quarters of the diagnoses occurring in women; although, it is suggested
that this is due to high rates of misdiagnosis in men.1
BPD is one of the many personality disorders recognized by the American Psychiatric
Association (APA). It is categorized as a cluster B personality disorder, meaning that
someone with this type is more likely to be dramatic, overly emotional, and
unpredictable in their thoughts or behaviors.
Personality disorders are psychological conditions that begin in adolescence or early
adulthood, continue over many years, and, when left untreated, can cause a great deal
of distress.2
Thankfully, the right treatments can help significantly.
Types of Borderline Personality Disorder
Some experts propose that there are different types or subtypes of BPD. However, they
often differ on what these types or subtypes may be.
For example, in one 2017 study, researchers classified BPD patients into three clusters:
those with "core BPD" features only, those with "extravert/externalizing" features
(histrionic, narcissistic, antisocial), and those with "schizotypal/paranoid" features.3
Another study supports the notion of three subtypes of borderline personality but lists
them as affect dysregulation (which was associated with co-occurring diagnoses
of generalized anxiety and panic disorders), rejection sensitivity, and mentalization
failure (the latter of which predicted post-traumatic stress disorder).
A 2015 study of hospitalized BPD patients suggests that there are five subtypes.
According to this approach, the different subtypes, in order of their prevalence, are:
impulsive (37%), dependent (29%), affective (26%), empty (5%), and aggressive
(4%).4
No consensus currently exists about the types of borderline personality disorder as this
mental health condition's characteristics can be categorized in several different ways.
Symptoms of Borderline Personality Disorder
Borderline personality disorder can interfere with a person's ability to enjoy life or
achieve fulfillment in relationships, work, or school. Because it is a personality disorder,
someone may not show signs of BPD until their personality develops, with most
diagnoses occurring in patients over 18 years of age.5
Symptoms of borderline personality often appear and can create significant problems in
the following areas:2
 Behaviors: BPD is associated with a tendency to engage in risky and impulsive
behaviors, such as going on shopping sprees, excessive drug or alcohol use,
engaging in promiscuous or risky sex, or binge eating. They're also more prone
to engage in self-harming behaviors, such as cutting or burning and attempting
suicide.

16.  Emotions: Emotional instability is a key feature of BPD. Individuals feel like
they're on an emotional roller coaster with quick mood shifts (i.e., going from
feeling okay to feeling extremely down or blue within a few minutes). Mood
changes can last from minutes to days and are often intense. Anger, anxiety,
and overwhelming emptiness are common as well.
 Relationships: People with borderline personality disorder tend to have intense
relationships with loved ones characterized by frequent conflict, arguments, and
break-ups. BPD is associated with an intense fear of being abandoned by loved
ones. This leads to difficulty trusting others and attempts to avoid real or
imagined abandonment, putting a strain on relationships. It's also common for
someone with BPD to have a 'favorite person,' or someone they feel they cannot
live without.
 Self-image: Individuals with BPD have difficulties related to the stability of their
sense of self. They report many ups and downs in how they feel about
themselves. One moment they may feel good about themselves, but the next
they may feel that they are bad or even evil.
 Stress-related changes in thinking: Under conditions of stress, people with
borderline personality disorder may experience changes in thinking,
including paranoid thoughts (for example, thoughts that others may be trying to
cause them harm) or dissociation (feeling spaced out, numb, or like they're not
really in their body).
Not everyone with BPD experiences every symptom. Some people have a few of these
symptoms while others may experience most, if not all of them.6
Signs and Symptoms of BPD
Diagnosis of Borderline Personality Disorder
BPD is diagnosed by evaluating an individual's symptoms and reviewing their medical
history. A healthcare provider may also perform a physical exam and order lab tests to
rule out medical illnesses that might be contributing to the symptoms.7
At this time, there is no definitive borderline personality disorder test. Instead, to be
diagnosed with BPD, the American Psychiatric Association's Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) indicates that the individual must experience five
or more of the nine symptoms of BPD, which are:2
 Efforts to avoid abandonment
 Emotional instability
 Feelings of emptiness
 Identity disturbances
 Impulsive behaviors
 Inappropriate, intense anger
 Unstable interpersonal relationships
 Suicidal or self-harming behaviors
 Transient paranoid or dissociative symptoms
If you are having suicidal thoughts, contact the National Suicide Prevention
Lifeline at 988 for support and assistance from a trained counselor. If you or a loved
one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Related Conditions

17. When making their diagnosis, a health provider or therapist will also rule out other
mental health conditions that can cause symptoms similar to those experienced with
BPD. Conditions related to borderline personality disorder include:
 Bipolar disorder
 Histrionic personality disorder
 Narcissistic personality disorder
Making this differentiation is important to finding the right treatment. For example,
when comparing borderline personality disorder vs. bipolar disorder, the mood changes
in people with BPD are often shorter in term, while people with bipolar tend to
experience mood changes that last days or weeks.
Co-Occurring Conditions
It's common for borderline personality disorder to co-occur with certain other mental
conditions, sometimes making it more difficult to diagnose. Conditions often co-existing
with BPD include:6
 Anxiety disorders
 Bipolar disorder
 Depression
 Eating disorders
 Post-traumatic stress disorder
 Substance use disorder
Comparing Borderline Personality Disorder With ADHD
Causes of Borderline Personality Disorder
Like most psychological disorders, the exact cause of BPD is not known. However, there
is research to suggest that some combination of nature (biology or genetics) and
nurture (environment) is at play.
A few of the proposed causes of borderline personality disorder include:
 Brain structure: There is evidence of differences in brain structure and function
in individuals with BPD, especially in the parts of the brain that affect impulse
control and emotional regulation.8
However, it's unclear if these differences are a
result of having BPD or if they are part of the cause.
 Genetics: There appears to be a genetic component to borderline personality
disorder as it's not uncommon for close family members to have this condition.1
 Negative experiences: Many people diagnosed with BPD have
experienced childhood abuse, trauma, neglect, or were separated from their
caregivers at an early age.9
At the same time, not all people with BPD had one of
these childhood experiences, and, conversely, many people who have had them
do not develop BPD.
Risk Factors for Borderline Personality
Disorder
Certain factors may increase your risk of developing BPD. They include:10
 Being abandoned during childhood or adolescence

18.  Experiencing abuse (sexual, physical, or emotional)
 Having a disruption in your family life
 Poor communication skills within the family unit
Remember that a risk factor is not the same as a cause. Because you have risk factors
doesn't mean you will develop BPD, just as people without them can develop it as well.
Treatment for Borderline Personality Disorder
At one time, experts believed that borderline personality was unlikely to respond to
treatment. But research has since shown that BPD is very treatable.11
Since BPD is
associated with risky behaviors, self-harm, and suicide, treatment can help curb these
behaviors.
Getting help from a mental health professional is critical. With consistent treatment, you
can live a better quality of life with fewer symptoms. Find someone who specializes in
BPD and can provide treatments targeted to this condition. This is important because, if
you aren't getting the right treatment, it may not be as effective.
The usual order of treatment for borderline personality disorder includes psychotherapy,
medication, then other treatments.
Psychotherapy
Psychotherapy is the standard treatment for BPD. Depending on your situation, this
treatment option may also include the involvement of your family, friends, or
caregivers.12
Examples of psychotherapy that are often targeted to BPD include:
 Dialectical behavior therapy (DBT), a type of cognitive behavioral therapy
(CBT) that teaches you how to be present, also providing skills related to coping
with stress, emotional regulation, and relationship improvement
 Mentalization-based treatment (MBT), which helps someone with
borderline personality disorder better recognize how their thoughts and feelings
are associated with their behaviors
 Group therapy, or engaging in treatment with others who also have BPD, also
learning from them and their experiences
Medication
Your mental health professional may recommend that you take medication to help treat
certain borderline personality disorder symptoms, such as depression or mood
swings.13
Medications prescribed to help treat BPD symptoms often fall into one of the
following categories:
 Antidepressants
 Antipsychotics
 Anxiolytics (anxiety medications)
 Mood stabilizers
What Medications Can You Take for Borderline Personality Disorder?
Other Treatments

19. In times of crisis, hospitalization or more intensive treatments may be necessary for
someone with borderline personality disorder. Inpatient treatment for BPD is common,
with roughly 79% of individuals with this condition being hospitalized at least once and
60% having multiple hospitalizations.14
Complications of Borderline Personality
Disorder
If left untreated, people with BPD have a higher risk of developing depression, also
developing other behaviors that can negatively impact their health, some of which
include:5
 Drug or alcohol misuse
 Engaging in self-harm behaviors
 Suicide attempts
HISTRIONIC
Histrionic personality disorder (HPD) is a personality disorder that tends to co-occur with
other personality disorders, particularly borderline personality disorder (BPD),
narcissistic, and dependent personality disorders. There is a great deal of overlap
between BPD and HPD features, so much so that some experts believe that HPD may not
actually be distinguishable from BPD.1
Understanding Histrionic Personality
Disorder
HPD is one of 10 personality disorders recognized in the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5). HPD is one of the Cluster
B disorders, which are characterized as dramatic, overly emotional, and/or erratic.
The DSM-5 defines histrionic personality disorder as a pattern of extreme emotionality
and attention-seeking behavior that begins by early adulthood and is obvious in
different situations. In addition, you must have five or more of the following signs or
symptoms to be diagnosed with HPD:2
 Discomfort in situations in which you're not the center of attention
 Interaction with others that's often characterized by inappropriate sexually
seductive or provocative behavior
 Rapidly shifting and shallow expression of emotion
 Consistently uses physical appearance to draw attention to self
 Style of speech that is excessively impressionistic and lacking in detail
 Shows self-dramatization, theatricality, and exaggerated expression of emotion
 Is easily influenced by others or by circumstances
 Considers relationships to be more intimate than they actually are
People with HPD might be described as being overly dramatic, emotional, or
attention-seeking. This pattern of behavior rises to the level of a clinical disorder when
it significantly interferes with relationships, work, or other important domains in life.

20. Co-Occurrence of HPD and BPD
There are only a few studies that have examined the co-occurrence of HPD and BPD.
One often-quoted study found that HPD frequently occurs with BPD.3
In another study
that used a community sample, about 10% of people with BPD also met criteria for HPD.
HPD Versus BPD
There is a marked overlap between the symptoms of HPD and BPD. For example, both
share the features of rapidly shifting and reactive emotions, both are associated
with impulsive behavior, and both are characterized by a very strong expression of
emotion.2
While some clinicians argue that the qualities of these symptoms are different in HPD
versus BPD, for example, that the rapidly shifting emotions in HPD are not experienced
with the same depth and intensity as those in BPD, other experts have argued that HPD
and BPD are not necessarily distinct disorders. However, despite predictions that the
HPD diagnosis would be dropped in DSM-5, it was not, and so it remains its own specific
and unique diagnosis.
Treatment
While there is some advice for clinicians treating HPD, it's generally based on expert
opinion or experiences rather than on research data. Much more research is needed on
this topic, but in general, psychotherapy is often used and may be helpful. If you have
symptoms of other issues such as depression or anxiety, medication may help to
alleviate those symptoms as well.
Borderline Personality Disorder and
Narcissism
By
Kristalyn Salters-Pedneault, PhD
Updated on February 23, 2022
Medically reviewed by
Daniel B. Block, MD
Print

22. Westend61 / Getty Images
Table of Contents
VIEW ALL
Table of Contents

What Is NPD?


What Is BPD?


Co-Occurrence


How NPD Affects BPD


Treatment

Borderline personality disorder and narcissism (more accurately, narcissistic personality
disorder, or NPD) are both personality disorders. When the two occur together,
symptoms of each may worsen. It may be more challenging to diagnose and treat the
conditions. But it's possible that treating BPD (borderline personality disorder) may help
alleviate some of the symptoms of NPD.
0 seconds of 1 minute, 24 secondsVolume 90%
1:24
How to Identify a Malignant Narcissist
Narcissistic Personality Disorder (NPD)
Narcissistic personality disorder (NPD) is one of 10 personality disorders recognized in
the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
NPD is one of the "Cluster B", or dramatic/erratic, personality disorders.
Narcissistic personality disorder is characterized by the presence of five or more of the
following symptoms:1
 A sense of entitlement
 An inflated sense of self-importance
 Arrogant, egotistical, or haughty behavior
 Envious of others or believes others are envious of them
 Lack of empathy
 Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love
 Requiring excessive admiration
 Taking advantage of others
 Believing that they are "special" and can only be understood by other special or
high-status people
In short, people with NPD might be described as being very self-absorbed or egotistical.
This self-absorption rises to the level of a clinical disorder when it significantly interferes
with the person's relationships, job, or other important domains in life. Many experts
believe that this egotistical style is actually an attempt to deal with an underlying poor
sense of self-worth.
What to Know About Narcissistic Personality Disorder
Borderline Personality Disorder (BPD)
Borderline personality disorder (BPD) is also a Cluster B personality disorder. It is
characterized by consistent changes in behavior, mood, and self-image. Episodes
of anger, depression, and anxiety lasting up to a few days are common for people with
BPD.2

23. People with BPD frequently change their opinion of themselves and others and their
interests. Drastic changes in opinion often lead to tumultuous or unstable relationships
with others. Other symptoms of BPD include:
 Extreme fear of abandonment
 Impulsive behaviors (such as unsafe sex or substance use)
 Self-harm
 Thoughts of suicide
Especially during times of stress, people with BPD can experience dissociation. Someone
experiencing dissociation can feel like they don't have a sense of self or identity.3
They
can feel detached from their emotions, memories, and thoughts. They can also
experience significant memory loss of times in their life, people, and events.
If you or someone you care about is having suicidal thoughts, contact the National
Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor.
If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
What to Know About Borderline Personality Disorder
How Often NPD and BPD Co-Occur
While the overlap between NPD and BPD is discussed often in the popular psychology
literature and online, very few careful studies of the co-occurrence of NPD and BPD have
been conducted. One older study reported that almost 39% of people with BPD also
have NPD.4
A 2018 study that drew from a treatment-seeking sample rather than a community
sample found that about 13% of patients with BPD also meet the diagnostic criteria for
NPD.5
Another 2018 study showed a strong correlation between BPD and a certain type of
narcissism: vulnerable narcissism, which is characterized by hypersensitivity,
defensiveness, and low self-esteem. The same study also found that male patients had
higher narcissistic scores than female patients. But its sample size was small (65
people).6
How Common Is Borderline Personality Disorder?
How NPD Affects BPD
There are a number of theoretical reasons to believe that someone with both NPD and
BPD would be less likely to get better over time. People with NPD can be resistant to
treatment, and often have poor insight into the ways that their behaviors are
detrimental to themselves or others.
Also, people with NPD may cause more emotional pain to others than they cause
themselves. This can mean that their motivation to change their behavior is very low.
Research supports the theory that when people have both borderline personality
disorder and narcissism, their BPD symptoms are less likely to improve over time.
One study that followed BPD patients over six years found that rates of co-occurring NPD
were fairly low, about 6%, in patients whose BPD eventually went away (remitted).
However, rates of co-occurring NPD were higher (around 19%) in patients whose BPD
did not remit after six years.7
So there is a subset of people with non-remitting BPD and
higher rates of NPD.
NPD and BPD in Relationships
The relationships of people with BPD are often quite dysfunctional. Adding NPD into the
mix can create even more disordered conditions. One study notes, for example, that as
the severity of NPD increases, so does aggression (directed at oneself or others) and
difficulty with interpersonal behavior and moral functioning.8
In addition to the chaotic emotional life and fears of abandonment associated with BPD,
a person with co-occurring NPD may also take advantage of or manipulate others
while having little empathy for others' concerns. This combination can be incredibly
destructive in relationships.
If you are in a relationship with someone who has BPD, NPD, or both, encourage them
to seek treatment. Individual therapy for each partner, along with couples' therapy, may
help you both cope with the symptoms of personality disorders that make relationships
difficult.

24. Treatment for NPD and BPD
There are currently no empirically supported treatments for NPD9
and no published
clinical trials of treatments for NPD alone or co-occurring with BPD.
Published research on the treatment of NPD is limited to some case studies or anecdotal
accounts, but these types of studies tend to be unreliable and subject to bias. The case
study literature on the treatment of NPD has primarily centered around the use of
modified psychoanalytic techniques and has recognized the challenges of successfully
treating the disorder.10
The clinical literature, in general, tends to regard NPD as very difficult to treat,
particularly in its most severe forms.8
Some researchers suggest that because there is some overlap between NPD and BPD
symptoms (such as impulsivity and destructive behaviors), treatments designed for
BPD, including dialectical behavior therapy (DBT), mentalization-based
therapy, schema-focused therapy, and transference-based psychotherapy, may also
work with NPD. However, more research on the topic is needed.8
CLUSTER C
What Is Avoidant Personality Disorder?
Avoidant personality disorder (AVPD) is an enduring pattern of behavior related to social
inhibition, feelings of inadequacy, and sensitivity to rejection that causes problems in
work situations and relationships.
The disorder is characterized by extreme shyness and sensitivity to criticism from others
and is known as a Cluster C personality disorder or one that involves anxious and fearful
personality disorders.
AVPD is often associated with other mental health conditions like anxiety disorders, in
particular, social anxiety disorder. People with the disorder show a pattern of avoidance
due to fear of rejection or disapproval, which they experience as extremely painful. The
disorder affects about 2.5% of the population, with roughly equal numbers of men and
women being afflicted.1
Symptoms
The following is a list of common symptoms associated with avoidant personality
disorder:
 A need to be well-liked1
 Anhedonia (lack of pleasure in activities)
 Anxiety about saying or doing the wrong thing
 Anxiety in social situations
 Avoiding conflict (being a "people-pleaser")
 Avoiding interaction in work settings or turning down promotions
 Avoiding intimate relationships or sharing intimate feelings
 Avoiding making decisions2
 Avoiding situations due to fear of rejection
 Avoiding social situations or events1
 Easily hurt by criticism or disapproval
 Extreme self-consciousness

25.  Failure to initiate social contact
 Fearful and tense demeanor
 Feelings of inadequacy
 Hypersensitivity to negative evaluation
 Lack of assertiveness
 Lack of trust in others
 Low self-esteem1
 Misinterpreting neutral situations as negative
 No close friends/lacking a social network
 Self-isolation
 Social inhibition
 Unwilling to take risks or try new things
 Viewing oneself as socially inept or inferior3
 Vigilant for signs of disapproval or rejection
Diagnosis
Avoidant personality disorder can only be diagnosed by a trained mental health
professional based on criteria outlined in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). While a family physician can be the first point of contact for a
diagnosis, your doctor should make a referral to a psychologist, psychiatrist, or other
mental health professional for diagnosis.
Avoidant personality disorder is typically diagnosed in adults, as children's personalities
are still developing and behaviors such as shyness can be normal experiences in
childhood that are later outgrown.
According to the DSM-5, a person must have a consistent pattern of avoiding social
contact, being overly sensitive to rejection and criticism, and feeling inadequate, as
displayed by at least four of the following criteria:
 Avoidance of occupational activities involving significant social contact out of
fear of criticism, disapproval, or rejection4
 Unwillingness to become involved with others unless you are certain that they
will like you
 Holding back in intimate relationships out of fear of being ridiculed or humiliated
 Preoccupation with criticism or rejection in social situations4
 Inhibition in new social situations due to feeling inadequate
 Feelings of being socially inept, unappealing, or inferior to others4
 Hesitation to take risks or do new things out of fear of embarrassment
Causes
The causes of avoidant personality disorder are thought to involve genetic,
environmental, social, and psychological factors. Emotional abuse, criticism, ridicule, or
lack of affection or nurturing by a parent or caregiver in childhood may result in the
development of this personality disorder if other factors are also present. Rejection by
peers may similarly be a risk factor.
Often, individuals with the disorder are very shy as children and do not outgrow this
shyness as they age.
Social anxiety disorder and avoidant personality disorder share similar symptoms and
genetics, with AVPD being the more severe form of the condition.5

26. Related Conditions
Avoidant personality disorder may co-occur and overlap with a variety of other
conditions, including:
 Social anxiety disorder6
 Dependent personality disorder
 Borderline personality disorder (BPD)
 Substance use disorder7
 Depression
 Agoraphobia
Treatment
Most people with avoidant personality disorder do not seek treatment.4
When they do, it
is often for a specific life problem they are experiencing or other types of symptoms such
as depression and anxiety, and they will usually discontinue treatment if that problem is
resolved.
Avoidant personality disorder can be hard to treat like other personality disorders
because it is an enduring pattern of behavior and it can be difficult for the person living
with the disorder to recognize that psychotherapeutic help is needed and can be
beneficial.
Unfortunately, the outlook for people with avoidant personality disorder who do not seek
treatment is rather bleak—typically they become self-isolated and use avoidance as
their only coping strategy.8
On the other hand, when treatment is successfully applied, it can help to reduce
symptoms and increase the range of coping strategies that the person can use to
manage their anxiety. A person with avoidant personality disorder will probably always
be somewhat shy, but avoidance won't dominate their thoughts.
Talk Therapy
Talk therapy for avoidant personality disorder may include cognitive behavioral therapy
(CBT), psychodynamic therapy, and schema therapy.9
Group therapy and social skills
training may also be helpful.
CBT is helpful for learning how to change unhelpful thinking patterns, while
psychodynamic therapy is aimed at being aware of how past experiences, pain, and
conflict may be contributing to current symptoms.10
Schema therapy for avoidant personality disorder is an integrative approach that builds
on CBT as well as many other therapeutic techniques. It has a focus on the therapeutic
relationship between therapist and client, and a goal of improving daily functioning and
gaining insight for change based on understanding and re-engineering of early life
experiences.11
A key feature of schema therapy is "limited reparenting," in which the client expresses
childhood needs and learns to develop and internalize a healthy parent voice.11
Main Concepts of Schema Therapy
In schema therapy, the client learns about four main concepts:

27. . How maladaptive schemas are patterns that are repeated throughout life.12
These patterns are grouped into five areas: disconnection and rejection,
impaired autonomy and performance, impaired limits, excessive responsibility
and standards, over-vigilance, and inhibition.
. What coping styles were learned as a child (e.g., escape, fighting back).13
. What schema modes are being used to cope and how they are unhelpful (e.g.,
avoidance, detachment, compliance, punishment).
. How to develop healthy adult modes of coping and get core emotional needs
met.
Medication
While there are currently no medications specifically approved for treating avoidant
personality disorder, if a person has other related disorders such as depression or
anxiety, medication may be prescribed to help with those symptoms.8
For example, antidepressant medication can be helpful for improving mood and
anhedonia, decreasing anxiety symptoms, and may also reduce sensitivity to rejection.
What Is Dependent Personality Disorder?
DPD is a personality disorder characterized by a pervasive and excessive need to be
taken care of. In the fifth edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), the manual used by mental health professionals to establish
diagnostic criteria, DPD is classified as a Cluster C, the cluster made up of anxious and
fearful disorders. Other disorders included in Cluster C are avoidant and
obsessive-compulsive personality disorders; all three show high levels of anxiety.2
Individuals with dependent personalities tend to be very clingy and have difficulties
accomplishing tasks or making decisions without the help of others. They rely on others
to meet their emotional and physical needs. They tend to feel inadequate and helpless
and can have problems in their relationships because of their near-constant need for
support. People with DPD have little trust in themselves or confidence. This can cause
them to be completely reliant on a partner even in the case of domestic abuse.
Common symptoms include:3
 Fear of being alone
 Avoiding taking initiative or responsibility
 Sensitivity to criticism
 Lack of opinions
While a direct cause is unknown, dependent personality disorder often shows itself in
childhood and affects men and women equally.
Dependent Personality Disorder vs.
Borderline Personality Disorder
Unlike those with DPD, people with BPD experience rage, impulsivity, and aggression.4
They can be reckless and can engage in self-harm and see the world as black and white,
with no middle ground.

28. The two disorders often overlap in feelings of loneliness, avoiding responsibility and
difficulty maintaining relationships.
The Frequency of Co-Occurring DPD and BPD
While studies of the co-occurrence, also known as a comorbidity, of the personality
disorders is somewhat limited, some researchers have examined the overlap between
dependent and borderline personality. A 2014 study found a 20 percent comorbidity rate
among subjects who had both BPD and DPD.5
The prevalence of these comorbidities could be because some of the features of DPD are
very similar to the features of BPD. For example, people with BPD experience rejection
sensitivity—they have a tendency to feel desperate at even the slightest perceived
rejection. Individuals with DPD may react similarly to criticism or perceived
abandonment by loved ones.2
Helping a Loved One with DPD and
Co-Occurring BPD
Research has shown that both dependent and borderline personality disorders are
treatable.6
Through a combination of therapy and medication, the symptoms of each
disorder can be managed, enabling the affected person to live a fuller life. In order to be
most effective, therapy will need to address both disorders in order to achieve a
sustainable recovery.
For example, dialectical behavior therapy (DBT), schema-focused therapy,
and transference-focused therapy all have treatment elements that focus on
relationship problems. These may be appropriate treatment choices for someone with
both BPD and DPD.7
In some cases, residential or outpatient services may be necessary. These treatment
centers will have intensive skills training to make coping with the disorders more
manageable
Obsessive-compulsive personality disorder
What Is Obsessive-Compulsive Personality
Disorder?
Obsessive-compulsive personality disorder (OCPD) is defined by strict orderliness,
control, and perfectionism. Someone with OCPD will likely try to stay in charge of the
smallest details of their life, even at the expense of their flexibility and openness to new
experiences.1
OCPD is a personality disorder, which means it involves personality traits that are stable,
long-held, atypical, and problematic in some way. In the case of OCPD, people with this
condition may find it hard to relate to others, and their devotion to perfectionism and
rigid control can make it difficult to function.
Other personality disorders in this category include narcissistic personality disorder,
histrionic personality disorder, and borderline personality disorder. OCPD is not the

29. same as narcissism, however. People with OCPD dwell on doing things perfectly, while
people with narcissistic personality disorder have an exaggerated sense of grandeur and
believe they should receive constant praise and attention.
OCPD is not the same as obsessive-compulsive disorder (OCD). It is also not a type of
OCD. In the Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5-TR),
OCD is organized in its own category of mental conditions called "Obsessive-Compulsive
and Related Disorders."2
This article discusses the symptoms of OCPD and how to distinguish between OCPD vs.
OCD. It also covers how OCPD is diagnosed, what causes it, and how it is treated.
Symptoms of OCPD
The primary symptoms of OCPD focus on an obsession with perfectionism and a need for
control. Someone with OCPD may experience symptoms like:3
 Acting restrained or restricted with their emotions
 Adherence to rules in an inflexible, rigid way
 Creating order and lists for tasks
 Desire to control their relationships with others
 Difficulty empathizing with others and/or maintaining intimate relationships
 Extreme dedication to their work
 Having trouble giving things to others
 Need for perfection even in the smallest details
 Problems with self-identity and/or self-direction
 Trouble giving up control and delegating tasks
At first glance, OCPD may seem similar to an anal personality type. While someone with
an anal personality might share some of these traits, like perfectionism, orderliness, and
a need to be in control of their environment, having these quirks isn't the same thing as
having a personality disorder.
Diagnosis of OCPD
There is no specific test that can determine if a person has OCPD. In order to make a
diagnosis, a clinician will ask questions about your symptoms and the effect they have
on your life. They may also conduct lab tests and a physical exam to help rule out other
conditions.
In order to be diagnosed with OCPD, a person must exhibit a persistent pattern of
preoccupation with perfectionism, order, and control of the self, situations, and others.
It must also be accompanied by at least four of the following symptoms described in the
DSM-5-TR:3
 Excessive devotion to work at the expense of family or friends
 Extreme need for perfection and relentless control over your environment and
interpersonal relationships
 Inability to be generous to others
 Inability to delegate tasks
 Inability to get rid of worn-out or worthless items (even those without
sentimental value)
 Over-conscientiousness
 Preoccupation with details, rules, lists, and order, which can result in missing the
major objective of an activity

30.  Rigidity and inflexibility with regards to morals, ethics, values, and/or the
adherence to rules
They may also look for additional signs of OCPD. These include the presence of rigid
perfectionism and at least two more personality traits:
 Intimacy avoidance
 Getting mentally "stuck" on an idea
 Reduced emotional expression
Your doctor may also check for any difficulty you have with empathy and intimacy.
People who have OCPD often struggle to maintain interpersonal relationships, including
romantic relationships. They may find it difficult to empathize with others and are
sometimes described as cold or aloof. They also struggle with intimacy and find it
difficult to show affection or express emotions.
In order to be diagnosed with OCPD, these symptoms must create significant disruptions
in a person's ability to function in important life areas including school, work, family, and
other relationships.
OCPD also bears a close resemblance to some other conditions such as OCD, eating
disorders, autism spectrum disorder, and other personality disorders. OCPD may also
co-occur alongside them. A doctor will need to rule out these other conditions before
making a diagnosis of OCPD.4
It may take some time for a doctor or therapist to determine if you have OCPD. They
may need to meet with you a few times to discuss and observe your symptoms. A doctor
or therapist may also need to talk to loved ones to get a better picture of your daily
behaviors and interactions before they make a diagnosis.
Causes of OCPD
We don't yet know what causes OCPD, although there are some theories that explain
different possibilities. One theory deals with attachment styles and says that OCPD may
develop in children who:3
 Had overprotective parents or caregivers who didn't offer much care
 Didn't develop emotionally and empathetically during their childhood
 Weren't able to form secure attachments with their parents or caregivers
There may also be a biological component to OCPD, as having relatives with the
condition might make you more likely to have it.3
Risk Factors for OCPD
OCPD is one of the most common personality disorders. Men and women seem to
experience it at about the same rate, though it's less common in younger adults. It can
occur with several other conditions, like:8
 Depression
 Eating disorders
 Illness anxiety disorder (formerly called hypochondriasis)
 Parkinson's disease

31. One study found that around 7.8% of adults will have OCPD at some point during their
lifetime.9
Treatment for OCPD
Though more research is needed in this area, most treatment plans for personality
disorders begin with psychotherapy, while medication might be used as a complement.10
Psychotherapy
Therapy options for OCPD can include:
 Cognitive behavior therapy (CBT), which focuses on helping you notice and,
eventually, change the negative thought patterns associated with OCPD
 Psychodynamic therapy, which is intended to help you understand your
conscious and unconscious thoughts and emotions, so you can make healthier
choices in your daily life
Medication
Your doctor might recommend medication to help control some of your OCPD symptoms,
especially if you're also experiencing another condition like depression. This might
include medication to control your anxiety and/or antidepressants.