What is a personality disorder?

Personality is a unique mix of traits (characteristics or qualities), beliefs and ways of coping. These traits are usually stable and shape how you think, feel, behave and adapt to situations.

If you have a personality disorder, your thoughts, emotions and behaviours may be extreme and unhelpful. This can make it hard to cope with challenges and adapt to change. This may lead to distress and difficulties in daily life.

Personality disorders are mental health disorders. A person with a personality disorder may have:

• self-functioning difficulties — problems with self-identity, self-worth or self-direction
• interpersonal difficulties — trouble forming and keeping close relationships, understanding others' perspectives or dealing with conflict

There are different types of personality disorders. They usually start to show during the transition from childhood to adulthood.

What are the symptoms of personality disorders?

The symptoms depend on the type of personality disorder. Many symptoms can overlap.

Common signs of a personality disorder include:

• unusual or unpredictable behaviour
• feeling overly suspicious and not trusting others
• taking extreme risks
• extreme mood swings or emotional outbursts
• difficulty with relationships
• problems at school or work
• a strong need for immediate pleasure or reward

What are the types of personality disorders?

Personality disorders are grouped into 3 main categories based on common patterns in:

• thoughts
• feelings
• behaviours

Personality disorders exist on a spectrum. This means some people may show certain traits of a personality disorder without having the condition. Others may have traits of more than one personality disorder.

Cluster A

People with these disorders may think or behave in ways that seem unusual or different from others.

• Paranoid personality disorder — you may feel suspicious of others and find it hard to trust people.
• Schizoid personality disorder — you may not be interested in social relationships and show little emotion when interacting with others.
• Schizotypal personality disorder — you may struggle to form close relationships and behave in ways that seem strange to others. You may also have unusual beliefs, such as thinking your thoughts can influence events or people.

Cluster B

These disorders can affect emotions, behaviour and relationships. People in this group often struggle with intense feelings and impulsive actions.

• Antisocial personality disorder — you may not care about rules, lie often or hurt others without feeling of regret or guilt.
• Histrionic personality disorder — you may be overly dramatic, want constant attention and feel uncomfortable when you are not the centre of attention.
• Borderline personality disorder — you may have intense mood swings and a fear of being left out. You may have unstable relationships and engage in risky behaviours, such as self-harm.
• Narcissistic personality disorder — you may have a very high self-esteem and believe that you are better than others.

Cluster C

People often feel extremely anxious and fearful, which affects their thoughts and actions.

• Avoidant personality disorder — you may be very shy and avoid social situations. You may also fear criticism or rejection.
• Obsessive-compulsive personality disorder — you may be a perfectionist, heavily focussed on rules and order and struggle to relax. This is different from obsessive-compulsive disorder (OCD).
• Dependent personality disorder — you may rely heavily on others to make decisions, feel scared of being alone and constantly need reassurance.

What causes personality disorders?

Personality disorders are caused by a mix of genetics (inherited traits) and life experiences. Some people are born with a more sensitive personality. This can make them more likely to develop a personality disorder.

Certain childhood experiences can increase the risk, such as:

• growing up without emotional support or experiencing neglect
• experiencing emotional, physical or sexual abuse
• being bullied

Brain differences may also play a role. Some people have differences in brain areas linked to emotions and relationships.

When should I see my doctor?

See your doctor or mental health professional if you think you or someone you know may have a personality disorder.

You should also seek help if you are diagnosed with a personality disorder and it is causing distress.

People with personality disorders might not be aware that they have a problem. They may find it hard to seek help.

Family or friends who are caring for someone with a personality disorder may also struggle with their own mental health. If this is affecting you, seek support.

How are personality disorders diagnosed?

Doctors diagnose personality disorders by looking at:

• how a person thinks, feels and behaves over time
• whether these patterns cause problems in daily life, relationships or work
• if they have been present for many years

Your doctor may:

• ask about your life experiences, including your childhood
• see how you handle emotions, relationships and responsibilities
• talk to family members or check past medical records for more information

Personality disorders are grouped by how severe they are and which traits are most noticeable.

How are personality disorders treated?

Treatment for personality disorders usually focuses on therapy to help:

• manage emotions
• improve relationships
• develop healthier coping skills

The right treatment depends on the type and severity of the disorder.

Psychotherapy

Psychotherapy is the main treatment for personality disorders. Different types of therapy help in different ways:

• cognitive behaviour therapy (CBT) — helps people identify and change negative thought patterns
• dialectical behaviour therapy (DBT) — helps people manage emotions, reduce impulsive behaviour and improve relationships
• mentalisation-based therapy (MBT) - helps people understand their own thoughts and emotions, as well as those of others
• psychoeducation — helps people with personality disorders and their loved ones understand the condition and encourages open discussion

Medicines

There are no specific medicines to treat personality disorders. However, some medicines can help treat related symptoms, such as:

• depression
• anxiety
• impulsivity
• mood swings

For example, antidepressants may help if someone has anxiety or depression. Antipsychotic medicines or mood stabilisers are other types of medicines that may be prescribed.

Crisis management

When someone with a personality disorder is in crisis, they need support and a safe space to talk. Family or trusted people should be involved when possible.

Some people may need more support in a crisis, especially if they have suicidal thoughts or behaviours. Rarely, hospitalisation may be needed to prevent self-harm or suicide. This is usually a temporary solution to ensure the person's safety and wellbeing.

Living with and supporting someone with a personality disorder

Living with a personality disorder can be challenging. With the right support, you can manage your symptoms and improve your quality of life.

Supporting someone with a personality disorder can be difficult, but these are tips that may help you:

• be patient and compassionate
• encourage professional help
• set healthy boundaries
• prioritise your own mental well-being

What are the complications of personality disorders?

People with personality disorders may struggle with emotions, decisions and maintaining stable relationships. This can lead to:

• work or school challenges
• mental health conditions, such as anxiety or depression
• risky behaviours
• self-harm or suicide risk
• substance abuse

Early support and treatment can help manage these challenges.

Can personality disorders be prevented?

Personality disorders can't always be prevented, but early support may lower the risk.

Growing up in a safe and caring environment can help people learn how to manage emotions and relationships.

Difficult childhood experiences can increase the risk, so getting help early can make a difference.

Resources and support

If you need help, talking to your doctor is a good place to start. If you'd like to talk to someone with specific skills, these organisations can help:

• ReachOut — lists a range of support services for personality disorders.
• SANE Australia — supports people living with a mental illness and their loved ones. Call 1800 187 263.
• Beyond Blue — provides mental health support for you and your loved ones. Call 1300 22 4636 or chat online.
• Black Dog Institute — provides support and advocacy for people affected by mood disorders.
• Lifeline — offers support for anyone having a personal crisis. Call 13 11 14 or chat online.
• The Suicide Call Back Service — provides support to anyone thinking about suicide. Call 1300 659 467.

For more information about personality disorders:

• Head to Health — offers information for people living with or supporting someone with a personality disorder.
• SANE Australia — provides information about treatment for personality disorder.
• ReachOut — offers information about personality disorders.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

• Embrace Multicultural Mental Health — offers mental health resources and personal stories translated in more than 30 languages.
• Call the Telephone Interpreting Service (TIS) on 131 450 — ask the interpreter to call Lifeline on 13 11 14 for crisis support.

Looking for information for Aboriginal and/or Torres Strait Islander people?

• 13Yarn — provides a confidential, culturally safe space to yarn about your worries or concerns.
• Yarn Safe by headspace (for people aged 12 to 25 years) — chat online.
• Beyond Blue — offers videos and fact sheets about depression and anxiety for Aboriginal and/or Torres Strait Islander people.