Personality Disorders

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Personality disorders are long-standing patterns in how a person thinks, feels, handles stress, and relates to others — patterns that developed for reasons, often protective ones, and that now cause more difficulty than they prevent.

They can show up as unstable relationships, intense or rapidly shifting emotions, fear of abandonment, an unsteady sense of identity, impulsivity, chronic emptiness, difficulty trusting people, or rigid patterns that make ordinary life harder than it needs to be.

A word about the diagnosis

These diagnoses carry more stigma than almost any other in psychiatry, including from clinicians, and people are sometimes given one as a way of being dismissed. That is a failure of care, not a feature of the diagnosis.

A personality disorder is not a statement about your character or your worth. It describes patterns — and patterns can change. Borderline personality disorder in particular has strong evidence for substantial improvement with proper treatment, including full remission for many people.

Paranoid Personality Disorder

• Persistent distrust and suspicion of others.
• Suspects others may exploit, harm, or deceive them without sufficient evidence.
• Questions the loyalty or trustworthiness of others.
• Hesitant to confide in others due to fear information will be used against them.
• May interpret harmless comments or events as threatening.
• Tends to hold grudges.
• May quickly perceive attacks on their character and react defensively.
• May have recurrent suspicions about a partner's faithfulness.
• Diagnosis generally requires 4 or more characteristic features.

Schizoid Personality Disorder

• Persistent detachment from social relationships and limited emotional expression.
• Little or no desire for close relationships.
• Usually prefers solitary activities.
• Limited interest in sexual experiences with others.
• Takes pleasure in few activities.
• Has few close friends or confidants.
• Appears indifferent to praise or criticism.
• May appear emotionally cold, detached, or restricted in emotional expression.
• Diagnosis generally requires 4 or more characteristic features.

Schizotypal Personality Disorder

• Significant discomfort with close relationships along with unusual thinking, perceptions, or behavior.
• Ideas of reference.
• Unusual beliefs or magical thinking.
• Unusual perceptual experiences.
• Odd or unusual speech and thinking.
• Suspiciousness or paranoid thinking.
• Inappropriate or restricted emotional expression.
• Odd or eccentric behavior or appearance.
• Few close friends or confidants.
• Excessive social anxiety that does not improve with familiarity.
• Diagnosis generally requires 5 or more characteristic features.

Antisocial Personality Disorder

• Persistent disregard for and violation of the rights of others.
• Repeatedly disregards laws or social norms.
• Deceitfulness or repeated lying.
• Impulsivity or difficulty planning ahead.
• Irritability or aggressiveness.
• Reckless disregard for personal or others' safety.
• Consistent irresponsibility.
• Lack of remorse after harming or mistreating others.
• Diagnosis generally requires 3 or more characteristic features.
• The individual must be at least 18 years old, with evidence of conduct disorder before age 15.

Borderline Personality Disorder

• Persistent instability in relationships, self-image, emotions, and impulse control.
• Strong efforts to avoid real or perceived abandonment.
• Intense and unstable relationships.
• Unstable sense of identity or self-image.
• Impulsive behaviors that may be harmful.
• Recurrent suicidal behavior, threats, gestures, or self-harm.
• Rapid or intense changes in mood.
• Chronic feelings of emptiness.
• Intense or difficult-to-control anger.
• Temporary stress-related paranoia or significant dissociative symptoms.
• Diagnosis generally requires 5 or more characteristic features.

Histrionic Personality Disorder

• Persistent pattern of excessive emotionality and attention-seeking.
• Uncomfortable when not the center of attention.
• May interact with others in an inappropriately seductive or provocative manner.
• Rapidly changing or shallow emotional expression.
• Uses appearance to attract attention.
• Speech may be impressionistic and lacking in detail.
• Dramatic or exaggerated expression of emotions.
• Easily influenced by others or circumstances.
• May perceive relationships as more intimate than they actually are.
• Diagnosis generally requires 5 or more characteristic features.

Narcissistic Personality Disorder

• Persistent pattern of grandiosity, need for admiration, and difficulty with empathy.
• Exaggerated sense of self-importance.
• Preoccupation with fantasies of success, power, beauty, brilliance, or ideal love.
• Belief that they are uniquely special or should associate with high-status individuals.
• Requires excessive admiration.
• Sense of entitlement.
• May exploit others for personal gain.
• Difficulty recognizing or responding to the feelings and needs of others.
• May envy others or believe others envy them.
• Arrogant behaviors or attitudes.
• Diagnosis generally requires 5 or more characteristic features.

Avoidant Personality Disorder

• Persistent social inhibition, feelings of inadequacy, and sensitivity to criticism or rejection.
• Avoids activities involving significant interpersonal contact due to fear of criticism or rejection.
• Reluctant to become involved with others unless certain of being liked.
• Restrained in close relationships due to fear of embarrassment or ridicule.
• Preoccupied with criticism or rejection.
• Inhibited in new social situations because of feelings of inadequacy.
• Views themselves as socially inadequate, unappealing, or inferior.
• Reluctant to take personal risks or try new activities because of possible embarrassment.
• Diagnosis generally requires 4 or more characteristic features.

Dependent Personality Disorder

• Excessive need to be cared for, resulting in submissive or dependent behavior and fears of separation.
• Difficulty making everyday decisions without reassurance.
• Needs others to assume responsibility for important areas of life.
• Difficulty expressing disagreement due to fear of losing support.
• Difficulty initiating projects or doing things independently.
• May go to excessive lengths to obtain care and support.
• Feels uncomfortable or helpless when alone.
• Urgently seeks another supportive relationship when a close relationship ends.
• Unrealistically preoccupied with fears of being left to care for themselves.
• Diagnosis generally requires 5 or more characteristic features.

Obsessive-Compulsive Personality Disorder (OCPD)

• Persistent preoccupation with orderliness, perfectionism, and control.
• Preoccupied with details, rules, lists, organization, or schedules.
• Perfectionism may interfere with completing tasks.
• Excessively devoted to work or productivity at the expense of leisure and relationships.
• Overly conscientious or inflexible regarding morality, ethics, or values.
• Difficulty discarding worn-out or worthless objects.
• Reluctant to delegate unless others follow their exact approach.
• May be overly restrictive with spending or money.
• Rigidity and stubbornness.
• Diagnosis generally requires 4 or more characteristic features.

OCPD is different from OCD. OCD involves intrusive, unwanted thoughts and/or repetitive behaviors performed to reduce distress, while OCPD primarily involves enduring patterns of perfectionism, orderliness, and control.

Therapy is the foundation of treatment for personality disorders, with the strongest evidence supporting structured approaches such as Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Schema-Focused Therapy. 

When appropriate, we can help connect patients with therapists who specialize in these approaches.

While medication does not directly treat the underlying personality disorder, it can be an important part of comprehensive care. Medication may help manage co-occurring concerns such as depression, anxiety, mood instability, sleep difficulties, and impulsivity. 

Addressing these symptoms can improve overall well-being and make it easier to engage meaningfully in therapy.

Our approach is transparent and collaborative. We focus on treating symptoms that may benefit from medication while recognizing that psychotherapy remains central to long-term treatment. When possible, we also coordinate with therapists and other members of the care team to provide consistent, supportive care.