Personality Disorders

Your personality is a system of traits and behaviors that showcase who you are to the world around you. Everyone has a unique personality, and it characterizes how they think, feel and behave, from being charismatic to spontaneous. It’s possible to have a mental health condition that causes a person to have behavioral patterns that deviate from what is generally accepted in society.

Personality disorders refer to conditions that involve harmful emotional, cognitive and behavioral patterns. They can cause internal and interpersonal distress. They can affect a person’s ability to be productive, maintain quality relationships and establish a strong sense of self. 

Approximately 9.1% of U.S. adults experience symptoms of a personality disorder. There are 10 personality disorders as determined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). They are categorized into three clusters:

• Cluster A — Unusual or eccentric behaviors and thoughts
• Cluster B — Dramatic or emotional behaviors and thoughts
• Cluster C — Anxious or fearful behaviors and thoughts

Borderline personality disorder, characterized by intense mood changes and a constantly changing self-image, is a Cluster B personality disorder. It can impact a person’s ability to form a stable sense of self and how they perceive others. 

Borderline personality disorder can stem from a root fear of abandonment. It can lead to overwhelming anxiety and distress in a person’s relationships.

BPD symptoms include:

• Rapid shifts in mood
• Feeling overwhelmed by emotions, leading to outbursts
• Feeling empty or a lack of purpose
• Having changing goals and beliefs
• Being clingy or avoidant in relationships due to trust issues
• Impulsive behaviors 
• Self-harm, such as cutting
• Suicidal thoughts

If you or someone you know is at risk of harming themselves or others, call or text 988 to reach the 988 Suicide & Crisis Lifeline.

A person can be diagnosed with borderline personality disorder by a physician, psychiatrist or psychologist. The process involves an interview and examination, discussing symptoms, family mental health history and related experiences. A thorough evaluation can also prevent a potential misdiagnosis. For instance, the symptoms can be similar to bipolar disorder.

The provider will determine if DSM-5-TR criteria for a BPD diagnosis are met, which include experiencing at least five of the following symptoms:

1. Desperate efforts to avoid abandonment or perceived abandonment
2. Pattern of unstable relationships from idealization and devaluation
3. Unsteady self-image
4. Impulsive behaviors in at least two areas, such as overspending and substance use
5. Suicidal or self-harming behaviors
6. Intense yet temporary mood swings
7. Persistent or overwhelming feelings of emptiness
8. Intense anger or difficulty controlling anger
9. Stress-related paranoia or dissociation

Borderline personality disorder often requires a combination of psychotherapy and medication, which can reduce and manage symptoms that are impacting a person’s overall quality of life. There isn’t medication specifically targeted toward BPD; however, there are options that can help increase mood regulation and decrease feelings of anxiety and depression that come from it.

Narcissism refers to prioritizing one’s own ego and lacking empathy for other people. Many people have narcissistic tendencies; however, narcissistic personality disorder is a Cluster B disorder that involves having persistent thought and behavioral patterns of arrogance and need for attention.

People with narcissistic personality disorder have an overinflated sense of self-importance. It can impact their ability to form healthy relationships with loved ones and co-workers, affecting both their personal and professional well-being. 

Symptoms of narcissistic personality disorder include:

• Being entitled to things, opportunities or an unfounded level of respect
• Arrogance or feeling superior to others
• Lack of acknowledgment or care for other people’s feelings
• Constantly seeking praise and admiration from others 
• Taking advantage of others for personal gain, such as taking credit for a job task
• Controlling behavior that hurts the emotional and mental well-being of others
• Reckless behavior in pursuit of power or admiration, such as impulsive spending
• Difficulty accepting criticism 

Narcissistic personality disorder can be diagnosed by a physician, psychiatrist or psychologist. After an initial evaluation of a person’s potential symptoms, the provider will determine how the person aligns with the DSM-5-TR criteria for an NPD diagnosis. The criteria include experiencing at least five of the following symptoms:

1. Excessive sense of self-importance, such as believing to be superior to others
2. Hyperfixation on goals of success, power, money and beauty
3. Belief that an individual can only be understood by other people of high status
4. Demanding admiration from others
5. A sense of entitlement
6. Exploiting others for one’s own gain
7. Difficulty having empathy for others
8. Envy toward others or believing that oneself is the source of envy from others
9. An arrogant or haughty attitude 

Treating narcissistic personality disorder centers on psychotherapy, which helps clients improve their self-awareness and strengthen their relationships with communication and problem-solving skills. Medication may be helpful for alleviating feelings of anxiety or depression that come along with the symptoms.

Borderline personality disorder and narcissistic personality disorder are two of the most common personality disorders; however, they aren’t the only ones that can have an impact on a person’s quality of life, especially if the person is undiagnosed. Here are are few more personality disorders to be aware of:

Histrionic personality disorder (HPD)

Histrionic personality disorder is a Cluster B disorder. It’s characterized by intense emotions and an extreme desire for attention. People with HPD tend to exhibit behaviors that will help them become the center of attention. These behaviors are typically out of place or inappropriate. 

The behaviors from this personality disorder are often described as provocative or dramatic. HPD can also cause intense emotional symptoms that affect a person’s productivity and relationships. It’s often connected to heightened frustration and mood fluctuations.

Symptoms of HPD include:

• Exaggerated emotions for attention
• Being easily influenced and too trusting of those a person believes are important
• Focusing on emotions instead of facts while speaking
• Defensiveness when faced with criticism
• Emotions that may seem shallow or theatrical to others

Antisocial personality disorder (ASPD)

Being shy or introverted isn’t the same as having antisocial personality disorder. ASPD isn’t about not wanting to be around others — it’s more about being dismissive of others. Antisocial personality disorder is a Cluster B disorder and is characterized by a lack of empathy for others and often involves manipulative behaviors. It can interfere with a person’s professional success and personal relationships. It also poses a risk for criminal activity.

People with ASPD tend to disregard people’s feelings and safety. ASPD can lead to impulsive and irresponsible behavior with a lack of remorse for any fallout. Individuals may exhibit violence and aggression toward others, raising the risk of legal issues.

Symptoms of ASPD include:

• Lying or cheating
• Acting without consideration for potential consequences
• Lack of guilt for any wrongdoing
• Difficulty managing anger or being short-tempered
• Lack of expressing positive emotions

Avoidant personality disorder (AVPD)

People with avoidant personality disorder, a Cluster C disorder, experience extremely low self-esteem and an intense fear of rejection, making them avoid social contact whenever possible. This not only interferes with their ability to form meaningful relationships with friends and significant others, but it can also impact their productivity and professional success if they struggle to talk to their co-workers or ask for help. 

Avoidant personality disorder can be misdiagnosed as social anxiety disorder, as feeling anxious in social settings is one of the main symptoms. However, AVPD is more about avoiding many situations due to feelings of inadequacy and fear of criticism. It goes beyond social settings (e.g., the workplace).

Symptoms of AVPD include:

• Unwillingness to meet new people
• Lack of intimacy or vulnerability in relationships from fear of shame
• Hyperfixation on potential criticism
• Difficulty taking risks that could lead to embarrassment
• Self-consciousness in unknown situations or environments

All personality disorders can be diagnosed and treated with therapy. It’s also possible to have co-occurring mental health conditions alongside a personality disorder, such as an eating disorder or substance use disorder.

If you have been diagnosed with a personality disorder, it is a significant step in your mental health journey. Treatment can help you work toward becoming the best version of yourself. 

You’ll work with your providers to determine the treatment options that will be the most beneficial for your symptoms. Treatment for a personality disorder includes psychotherapy. The goal of therapy is to find the root causes of your personality disorder and navigate situations connected to the symptoms. You’ll also develop skills to manage your symptoms on a daily basis.

Sometimes you need more help than what you can receive through regular outpatient therapy sessions, and that’s OK. At Guidelight, we provide higher levels of care to help your personality disorder with a comprehensive, individualized treatment plan. 

Our two programs are:

Intensive Outpatient Program (IOP)

When you’re experiencing severe personality disorder symptoms that require a bit more support than your current therapy, our Intensive Outpatient Program can help. It involves programming that combines one-on-one and group sessions. It can help you work through the challenges of your personality disorder and gain confidence in your own abilities to improve. It’s a step higher than regular outpatient therapy that still allows you to continue with regular activities to maintain a sense of stability.

Guidelight’s IOP takes place over six weeks. Treatment involves programming that lasts three hours per day for three days each week.

Partial Hospitalization Program (PHP)

If you need intensive, structured support, our Partial Hospitalization Program is a great option. It allows you to return to the comfort of your home each day while receiving acute care with a combination of highly individualized one-on-one and group sessions during the day. 

At Guidelight, our PHP takes two weeks to complete. Programming takes place every weekday, leaving your weekends free for your regular routines. It requires 30hours per week, with five hours of treatment Monday through Friday.

We prioritize using several evidence-based modalities to help people with mental health conditions. Clients with personality disorders tend to respond best to dialectical behavior therapy (DBT). 

Dialectal behavior therapy is a psychotherapy approach that focuses on treating intense negative emotions that stem from various personality disorders. DBT works to help you manage those feelings and thoughts to reduce symptoms. It can help improve your productivity, your interpersonal relationships and your identity. DBT involves learning a variety of techniques to handle intense feelings, which may include emotional regulation, distress tolerance and mindfulness. These techniques can help you make adjustments to your behaviors for more positive outcomes.

Guidelight helps adults and adolescents (ages 12-17) with personality disorders. We believe in helping clients get the support they need as quickly and efficiently as possible. Guidelight doesn’t require a referral to start treatment. Whether referred by a provider or self-referred, you can receive an evaluation within 24 hours of the referral. 

Everyone has a seat at Guidelight. Contact our team today for more information or to schedule an initial evaluation.