Overview of personality disorders
- Andrew Skodol, MD
Andrew Skodol, MD
- Section Editor — Personality Disorders
- Research Professor of Psychiatry
- University of Arizona College of Medicine
Personality consists of enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited across numerous social and personal contexts. A personality disorder is diagnosed when personality traits are so inflexible and maladaptive across a wide range of situations that they cause significant distress and impairment of social, occupational, and role functioning. The thinking, displays of emotion, impulsivity, and interpersonal behavior of the individual must deviate markedly from the expectations of the individual's culture in order to qualify as a personality disorder.
Patients with personality disorders can significantly strain the doctor-patient relationship. Clinicians frequently lack training in how to recognize and manage personality disorders.
This topic provides an overview of the personality disorders. Borderline, antisocial, narcissistic, schizotypal personality disorders are reviewed in detail separately. Challenges to maintaining a therapeutic alliance in the treatment of patients with personality disorders and pathological personality traits are also discussed separately. (See "Borderline personality disorder: Epidemiology, clinical features, course, assessment, and diagnosis" and "Treatment of borderline personality disorder" and "Narcissistic personality disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Treatment of narcissistic personality disorder" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis" and "Treatment of antisocial personality disorder" and "Schizotypal personality disorder: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Establishing and maintaining a therapeutic relationship in psychiatric practice" and "Approaches to the therapeutic relationship in patients with personality disorders".)
DSM-5 includes 10 personality disorders grouped into three clusters based upon descriptive similarities :
●Cluster A characteristics – Individuals may appear odd and eccentricTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Torgersen S. Prevalence, sociodemographics, and functional impairment. In: American Psychiatric Publishing Textbook of Personality Disorders, 2nd ed, Oldham JM, Skodol AE, Bender DS (Eds), American Psychiatric Publishing, Arlington 2014. p.109.
- Torgersen S. Epidemiology. In: The Oxford Handbook of Personality Disorders, Widiger TA (Ed), Oxford University Press, New York 2012. p.186.
- Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry 2005; 162:1911.
- Langbehn DR, Pfohl BM, Reynolds S, et al. The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview. J Pers Disord 1999; 13:75.
- King-Casas B, Sharp C, Lomax-Bream L, et al. The rupture and repair of cooperation in borderline personality disorder. Science 2008; 321:806.
- Dumais A, Lesage AD, Boyer R, et al. Psychiatric risk factors for motor vehicle fatalities in young men. Can J Psychiatry 2005; 50:838.
- Cadoret RJ, Leve LD, Devor E. Genetics of aggressive and violent behavior. Psychiatr Clin North Am 1997; 20:301.
- Caspi A, Begg D, Dickson N, et al. Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study. J Pers Soc Psychol 1997; 73:1052.
- Soloff PH, Fabio A. Prospective predictors of suicide attempts in borderline personality disorder at one, two, and two-to-five year follow-up. J Pers Disord 2008; 22:123.
- Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999; 56:617.
- Zanarini MC, Parachini EA, Frankenburg FR, et al. Sexual relationship difficulties among borderline patients and axis II comparison subjects. J Nerv Ment Dis 2003; 191:479.
- Daley SE, Burge D, Hammen C. Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity. J Abnorm Psychol 2000; 109:451.
- Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2007; 64:830.
- Huang Y, Kotov R, de Girolamo G, et al. DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry 2009; 195:46.
- Newton-Howes G, Tyrer P, Johnson T. Personality disorder and the outcome of depression: meta-analysis of published studies. Br J Psychiatry 2006; 188:13.
- Hansen B, Vogel PA, Stiles TC, Götestam KG. Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder. Cogn Behav Ther 2007; 36:145.
- Jansson I, Hesse M, Fridell M. Personality disorder features as predictors of symptoms five years post-treatment. Am J Addict 2008; 17:172.
- Gabbard GO, Simonsen E. The impact of personality and personality disorders on the treatment of depression. Personal Ment Health 2007; 1:161.
- Bieling PJ, Green SM, Macqueen G. The impact of personality disorders on treatment outcome in bipolar disorder: A review. Personal Ment Health 2007; 1:2.
- Quirk SE, El-Gabalawy R, Brennan SL, et al. Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol 2015; 50:807.
- Quirk SE, Berk M, Chanen AM, et al. Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review. Personal Disord 2016; 7:136.
- Fok ML, Hayes RD, Chang CK, et al. Life expectancy at birth and all-cause mortality among people with personality disorder. J Psychosom Res 2012; 73:104.
- Skodol AE. Impact of personality pathology on psychosocial functioning. Curr Opin Psychol 2017; 21:33.
- Skodol AE, Morey LC, Bender DS, Oldham JM. The Alternative DSM-5 Model for Personality Disorders: A Clinical Application. Am J Psychiatry 2015; 172:606.
- Lequesne ER, Hersh RG. Disclosure of a diagnosis of borderline personality disorder. J Psychiatr Pract 2004; 10:170.
- Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003; 160:1223.
- Leichsenring F, Rabung S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008; 300:1551.
- Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am 2010; 33:657.
- CLINICAL MANIFESTATIONS
- Manifestations in clinical care
- IMPACT OF DISORDER
- Personality disorder
- APPROACH TO MANAGEMENT
- Referral to a mental health professional
- Discussing the diagnosis
- The clinician-patient relationship
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS