Overview

• A personality disorder can affect how you cope with life, manage relationships, how you behave, and how you feel.
• There are different types of personality disorders.
• There is no single cause of personality disorder. It can be a combination of reasons, including genetic and environmental causes.
• Talking therapies are recommended as treatment for personality disorders.
• You can have a personality disorder alongside other mental health problems, such as anxiety and depression.

About

What are personality disorders?

Everyone has different ways of thinking, feeling, and behaving. It’s these thoughts, feelings, and behaviours that make up our personality. These are often called our traits. They shape the way we view the world, the way we relate to others and how we behave. By the time we’re adults they will make us part of who we are.

You can think of your traits as sitting along a scale. For example, everyone may feel emotional, get jealous, or want to be liked at times. But if these traits cause significant problems for you and others, you may be diagnosed as having a personality disorder.

A personality disorder can affect your emotions, how you cope with life, and manage relationships. You may find that your beliefs and ways of dealing with day-to-day life are different from others. You might find it difficult to change them.

You may find your emotions confusing, tiring, and hard to control. This can be distressing for you and others. Because it’s distressing, you may find that you develop other mental health problems like depression or anxiety.

You may also do other things like use alcohol or drugs, or self-harm, to cope with distressing emotions.

Research has suggested that around 1 in 20 people live with a personality disorder.

For more information see our webpages on the following:

• Anxiety disorders, and
• Depression

Types & Causes

What are the different types of personality disorders and how are they diagnosed?

How are personality disorders diagnosed?

Doctors use guidelines for diagnosing mental health problems. The main guidelines used are the:

• International Classification of Diseases (ICD-11) produced by the World Health Organisation (WHO), and
• Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association.

When making a diagnosis your doctor will:

• think about your symptoms and behaviours, and
• compare them to the guidelines.

A doctor will ask you questions about your life and what feelings, emotions, and behaviours you have. This is called an ‘assessment’. The doctor should be a psychiatrist, a specialist mental health doctor.

It might take a while for a psychiatrist to reach a firm diagnosis. They might need to speak to you and assess you more than once.

Problems with diagnosis are explored in more detail in the section below.

What are the different types of personality disorders?

Personality disorders diagnoses are grouped into 3 groups, A, B, and C.

Group A personality disorders

People who live with group A personality disorders can find it hard to relate to other people. Their behaviour might seem odd or eccentric. They may have issues in social situations.

Paranoid personality disorder
If you have been diagnosed with paranoid personality disorder, you may be suspicious of others without good reason. This can make you feel that other people are being unpleasant to you, even though this isn’t true. You might feel easily rejected or hold grudges.

Schizoid personality disorder
If you live with schizoid personality disorder, you may have few social relationships and might prefer to be alone. You may not enjoy or want to be part of a close relationship. This might include being part of a family. You might appear cold and removed from situations.

Schizotypal personality disorder
If you live with schizotypal personality disorder, you may have problems with starting and keeping relationships with other people. You might have strange thoughts, feel paranoid and have odd behaviour or appearance. You might have an inappropriate display of feelings.

Group B personality disorders

People with group B personality disorders can find it hard to control their emotions.

Antisocial personality disorder (ASPD)
Being diagnosed with antisocial personality disorder may mean you are impulsive and reckless. It might mean you don’t think about how your actions affect other people.

You may get easily frustrated, aggressive and be prone to violence. You may lie to get what you want. Others may see this as acting selfishly and without guilt. You may blame others for problems you are having in your life.

Borderline personality disorder (BPD)
You may have strong emotions, mood swings, and feelings you can’t cope if you live with BPD. You may feel anxious and distressed a lot of the time.

You might have problems with how you see yourself and your identity. You may self-harm or use drugs and alcohol to cope with these feelings. This can affect the relationships you have with other people.

BPD is also known as emotionally unstable personality disorder (EUPD) and emotional intensity disorder (EID).

See our webpage on Borderline personality disorder for more information.

Histrionic personality disorder
If you live with histrionic personality disorder, you may like being the centre of attention. You may feel anxious about being ignored. This can cause you to be lively and over-dramatic.

You may become bored with normal routines, worry a lot about your appearance and want to be noticed. You might be easily influenced by others.

This can sometimes lead to experiencing depression.

Narcissistic personality disorder
Narcissistic personality disorder can mean you have a high sense of self-importance. You may fantasise about unlimited success and want attention and admiration.

You may feel you’re more entitled to things than other people are. You might act selfishly to gain success and be unwilling or unable to acknowledge the feelings or needs of others.

You may also find that you’re very sensitive to criticism or comments that others make about you.

Group C personality disorders

People with group C personality disorders have strong feelings of fear or anxiety.

Dependent personality disorder
If you live with dependent personality disorder, you may allow other people to take responsibility for parts of your life. You might not have much self-confidence or be unable to do things alone. You may find that you put your own needs after the needs of others and feel hopeless or fear being alone or abandoned. You might also feel abandoned by others or let them make decisions for you.

Avoidant personality disorder
If you live with avoidant personality disorder, you may feel anxious, tense, insecure and inferior. This can cause you to feel uncomfortable in social situations. You might not like criticism or worry a lot and have low self-esteem. You may want affection but worry that you will be rejected.

It can also be known as Anxious personality disorder.

Obsessive-compulsive personality disorder
This is also known as anankastic personality disorder.

If you live with this condition, you may feel anxious about things that seem unorganised or ‘messy’. Everything you do must be just right, and nothing can be left to chance. You may be very cautious about things and think a lot about small details. You might have problems completing tasks due to your own high standards. Others may see you as being controlling.

Obsessive-compulsive personality disorder is different to obsessive-compulsive disorder (OCD). If you have obsessive-compulsive personality disorder, you may believe your actions are justified. People with OCD tend to realise that their behaviour isn’t rational.

See our webpage on Obsessive-compulsive disorder (OCD) for more information.

What causes personality disorders?

It isn’t clear what causes personality disorders to develop. It is thought that a mix of factors can mean some people develop personality disorders.

These can include:

• biological factors, when it is passed on through your genes, and
• the environment around you when you were growing up.

Many people diagnosed with personality disorders have experience of trauma. This might include difficulties growing up, including childhood neglect or physical, emotional, or sexual abuse.

When you are growing up, you learn to cope with emotional changes and make relationships with other people. Children who are abused or neglected often don’t learn these things. So, they may find it more difficult to manage how they feel when they are adults. You might develop ways of coping that might lead to further difficulties.

This doesn’t mean that all people who experience trauma will develop personality disorders. But they are more likely to.

Treatment

How are personality disorders treated?

Personality disorders are usually treated with psychological treatments or talking therapies. Below we explain more about the different types of therapies.

Treatment can help you to be able to have a meaningful life or cope better with your condition.

The options for treating personality disorders are continuously developing.

You and your doctor or healthcare team should agree on a treatment plan that works best for you.

If your GP feels you have a complex personality disorder, they may refer you to a:

• an NHS community mental health team, or
• a specialist NHS personality disorder service if there is one locally.

You can search on the internet to see if there’s a specialist NHS personality disorder service locally. Use a search term like ‘NHS personality disorder service [area where you live].’

These services are made up of professionals such as psychologists, psychiatrists, and therapists. They will have experience in helping people with personality disorders. Sometimes you can contact these services yourself to get help.

It’s always worth asking why a certain treatment is being offered. And if there are other things that could help you to get better.

When thinking about what treatment to offer you professionals should consult guidelines NICE guidelines, if relevant. NICE stands for The National Institute for Health and Care Excellence. The NICE guidelines recommend treatment for conditions.

For personality disorders NICE only have guidelines for:

• Borderline personality disorder (BPD), and
• Anti-social personality disorder.

You can find these online, at the links below:

• Borderline personality disorder: www.nice.org.uk/guidance/cg78
• Anti-social personality disorder: www.nice.org.uk/guidance/cg77

Therapy for personality disorders is usually long term and often involves some group therapy. You might have to complete the full course of therapy to get the most out of it, to aid your recovery. If you are struggling with your therapy for any reason, you can tell your therapist this.

In some areas, services use pre-therapy preparation to help people understand the link between emotions and decisions. The aim is to help you recognise your emotions before starting therapy, and hopefully finish your sessions.

The following treatments can help if you have a personality disorder.

What is dialectical behaviour therapy (DBT)?

DBT can help you learn to spot and control your emotions and behaviour.

It helps you recognise then change unhelpful behaviour by learning new skills. Unhelpful behaviour might include thinking about suicide, self-harming, drinking alcohol or using drugs to cope with your emotions.

DBT usually involves weekly individual and group sessions. You should be given an out-of-hours contact number to call if your symptoms get worse.

DBT is based on teamwork. You'll be expected to work with your therapist and the other people in your group sessions.

The National Institute for Health and Care Excellence (NICE) says DBT can be helpful if you have borderline personality disorder.

A course of DBT usually takes place over 18 months.

You can read more about DBT here: www.nhs.uk/mental-health/conditions/borderline-personality-disorder/treatment

What is cognitive analytical therapy (CAT)?

CAT helps you recognise relationship patterns that can cause you problems and you find difficult to change. You may have learnt these patterns while growing up to cope with difficult emotions.

You and your therapist will work together to recognise these patterns and then to try and change them. It looks at your current situation and the problems you are having.

This type of therapy can usually last between 4 – 24 weeks. But on average lasts 16 weeks.

You and your therapist will agree the end goal at the start of the therapy.

What is mentalisation based therapy (MBT)?

Mentalising is about making sense of what you and other people think, need, or want. It is about being aware of what’s going on in your own mind and in the minds of others. Sometimes when you feel distressed, it can be harder to mentalise.

You would attend group and one-to-one therapy. This may help you better understand yourself and others and learn how to mentalise. Treatment programmes can last for 12 to 18 months.

What is psychodynamic or psychoanalytic therapy?

This type of long-term therapy helps patients understand and resolve their problems. It does this by increasing awareness of their inner world and its influence over relationships both past and present.

It differs from most other therapies as it aims for deep seated change in personality and emotional development.

It helps people to understand and change complex, deep-seated emotional and relationship problems.

What are therapeutic communities?

A therapeutic community is a place you would get long-term group therapy.

You would visit, or sometimes stay, for weeks or months. Sometimes you may visit for just a few days a week.

You learn from spending time with other people in the treatment group. It offers a safe place if there are any disagreements or upsets. People in a therapeutic community often have a lot of say over how the community is run.

There are only a few therapeutic communities in the UK. You can check with your local Patient Advice Liaison Service (PALS) to see if your NHS trust has one. You can search for your local PALS office here:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363

Can medication be used to treat personality disorders?

There is no recommended medication for the treatment of personality disorders.

But your doctor may offer you medication to help with symptoms of anxiety, low mood, or psychosis. These might include antidepressants or antipsychotics.

For more information see our webpages on the following:

• Antidepressants,
• Antipsychotics, and
• Psychosis

If you are offered any medication, your doctor should tell you:

• how it should help, and
• about any side effects that you might experience.

What other support is there?

Having a personality disorder may mean you have a lot of needs and need a high level of care. You might get support from an NHS mental health team.

Your GP might need to refer you to your local team if your personality disorder is having a significant effect on you and your life. This might be your local NHS personality disorder service if there is one. If not, it might be your local NHS community mental health team.

Health professionals such as psychiatrists, therapists, community psychiatric nurses (CPNs), social workers and support workers work in the NHS mental health teams. The team will look at the support you need to manage complex needs and your mental health.

See our webpage on NHS mental health teams for more information.

What if I’m not happy with my treatment or care?

How can I deal with the issue to begin with?

If you’re unhappy about any aspect of your treatment or care, you can:

• talk to someone at the NHS service to see if they can help, or
• get in touch with your local NHS Patient Advice and Liaison Service (PALS). They should help you to sort out the issue. You can search for your local service by following the below website link: www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

You can explain:

• what’s happened,
• why you aren’t happy, and
• what you’d like to happen next.

If you still can’t get the issue sorted out, you can then think about making a formal complaint.

How do I complain?

You can also complain if you’re unhappy about any aspect of your treatment or care.

See our webpage on Complaining about the NHS or social services for more information.

What is advocacy?

You might find an advocate helpful if you want to complain. You can get help from an NHS complaints advocate.

An advocate is independent from mental health services. They can help to make your voice heard when you are trying to sort out problems. They might help you write letters or support you in appointments and meetings.

See our webpage on Advocacy for more information.

Linked Problems

What problems can be linked to personality disorders?

Diagnosis

Doctors sometimes find it difficult to diagnose personality disorders. This can be because of the following.

• An overlap with other mental health problems can make it difficult to pinpoint or ‘narrow down’ symptoms. There can sometimes be similarities between symptoms of personality disorder and complex post-traumatic stress disorder (PTSD) or bipolar disorder.
• Personality disorders are complex. The symptoms may not easily fit into any one of the groups.
• If you use drugs or drink alcohol a lot, it can make it more difficult for health professionals to reach a correct diagnosis.
• Some doctors are reluctant to give this diagnosis. They might feel that it may be ‘problematic’ or make it harder for you to get help.

You may feel you have been given a diagnosis of personality disorder because a professional is unsure of your diagnosis.

You may find it an unhelpful label or that it is stigmatising. But some people find that a diagnosis can help them to understand certain things they do and help with finding the right treatment and support.

What can I do if I disagree with my diagnosis?
If you disagree with your diagnosis you can speak to your psychiatrist. You can explain why you don’t agree, giving specific reasons. You might think you don’t meet the criteria for the diagnosis in question.

If you’re still not happy after you have spoken to your psychiatrist, you can ask for a second opinion.

You don’t have a legal right to a second opinion. But your psychiatrist should listen to your reasons for wanting a second opinion. If you’re denied a second opinion and you’re unhappy about that, you can complain.

For more information see our webpages on the following:

• Second opinions, and
• Complaining about the NHS or social services

Services and recovery

The Department of Health says that people with personality disorders should be able to get the right care and services.

Some people aren’t always able to get the right treatment. This is because there aren’t specialist NHS personality disorder services in every area.

If this is the case:

• you should still be offered treatment for your personality disorder by NHS mental health services,
• you can speak to your GP to apply to get treated by a personality disorder service in another area, and
• you can complain.

For more information see our webpages on the following:

• NHS treatment – your rights, and
• Complaining about the NHS or social services

Self-harm

Self-harm is harming yourself on purpose. Such as by scratching, cutting, overdosing on medication, biting or burning.

Self-harm is common if you live with borderline personality disorder (BPD).

You may self-harm because you find it difficult to cope with your moods or how you feel. Everyone has their own reasons for self-harming.

See our webpage on Self-harm for more information.

Use of alcohol and drugs

People with personality disorders sometimes use drugs or drink alcohol to cope with difficult emotions and feelings.

Drinking alcohol or using drugs can lead to:

• doing things that you might not do normally,
• behaving impulsively, acting on the spur of the moment, and
• poor physical health.

Antisocial personality disorder and borderline personality disorder have the strongest links with alcohol and drugs.

Some specialist personality disorder services may have some conditions if you use drugs or drink alcohol. They may say you need to cut down or stop before you can use the service.

See our webpage on Drugs alcohol and mental health for more information.

More Information

What if I’m a loved one of someone who lives with a personality disorder?

As a loved one of someone living with a personality disorder, you might find that you also need support. Caring for someone with a personality disorder can be challenging.

Carers4PD is a voluntary service that provides information, support and advocacy for carers of people diagnosed with a personality disorder.

You can find their contact details in the Useful contacts section at the bottom of this page.

You might find the following organisations useful:

Carers UK
Carers UK run an advice line, online support carers groups throughout the UK.

Telephone: 020 7378 4999
Address: 20 Great Dover Street, London SE1 4LX
Email via contact form on website: www.carersuk.org/about-us/contact-us
Website: www.carersuk.org

Carers Trust
Their website gives practical advice about caring for someone. You can search for support in your area.

Telephone: 0300 772 9600
Address: Unit 101 164–180 Union Street London SE1 0LH
Email: info@carers.org
Website: www.carers.org

You might find the following website useful:

GOV.UK - Carers
This is a website where you can find government services and information. The link below has information on many issues related to caring for someone, including financial affairs and carers’ rights.

Website: www.gov.uk/browse/disabilities/carers

Your local council might be able to give you information on local carers groups and services in your area.

You can ask your local authority for a carer’s assessment if you feel you need more support to care for your loved one.

There are rules regarding confidentiality and carers. Unless the person you care for agrees, confidential information about them can’t be passed on to you. Professionals should ask their permission and ask what they are happy for others to know. This would also include any care plans they have.

For more information see our webpages on the following:

• Supporting someone with a mental illness
• Carers’ assessments – Under the Care Act 2014
• Confidentiality – For carers, friends and relatives

Useful Contacts

BPD World
An organisation committed to raising awareness and reducing the stigma of mental health with a focus on borderline personality disorder (BPD). It provides online information, advice and support and has an online forum.

Website: www.bpdworld.org

Tara (Treatment and Research Advancements) for BPD
An American education-based and support community for carers and families of people living with BPD.

Website: www.tara4bpd.org

Out of the Fog
They offer information on personality disorders and an online support forum.

Website: www.outofthefog.net/index.html

Carers4PD
It is a voluntary service dedicated to providing information, support, and advocacy for carers of people diagnosed with a personality disorder.

Website: www.carers4pd.co.uk
Yahoo chat group: www.uk.groups.yahoo.com/neo/groups/carers4pd/info)
Email: info@carers4pd.co.uk

Borderline Arts
Borderline Arts is a charity that uses the arts to raise awareness of borderline personality disorder. Through increasing understanding of the condition, they not only educate people, but also break down the stigma surrounding it.

Address: 119 Osmaston Road Derby DE1 2GD
Phone: 07754 806814
Email: contact@borderlinearts.org
Website: www.borderlinearts.org/aboutus

Personality Disorders UK
Information and news on personality disorders

Website: www.personalitydisorder.org.uk/