Personality disorders types, treatment for 10 marks
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Personality Disorders: Types and Treatment
Definition
A personality disorder is an enduring, inflexible pattern of inner experience and behaviour that deviates from cultural expectations. It begins by adolescence or early adulthood, is stable over time, and causes distress or impairment in social, occupational, or interpersonal functioning.
Types of Personality Disorders
DSM classification divides them into three clusters:
| Cluster | Features | Disorders |
|---|---|---|
| A: Odd or eccentric | Suspicious, detached, unusual behaviour | 1. Paranoid 2. Schizoid 3. Schizotypal |
| B: Dramatic, emotional, erratic | Impulsive, unstable emotions and relationships | 4. Antisocial 5. Borderline 6. Histrionic 7. Narcissistic |
| C: Anxious or fearful | Fearful, dependent, perfectionistic | 8. Avoidant 9. Dependent 10. Obsessive-compulsive personality disorder |
Brief features
- Paranoid: Pervasive distrust and suspiciousness.
- Schizoid: Social detachment and restricted emotional expression.
- Schizotypal: Eccentric behaviour, odd beliefs, perceptual distortions.
- Antisocial: Disregard for others' rights, deceitfulness, impulsivity, lack of remorse.
- Borderline: Unstable relationships, affective instability, fear of abandonment, impulsivity, self-harm.
- Histrionic: Excessive emotionality and attention-seeking.
- Narcissistic: Grandiosity, need for admiration, lack of empathy.
- Avoidant: Social inhibition, feelings of inadequacy, hypersensitivity to criticism.
- Dependent: Excessive need to be cared for, submissive behaviour, fear of separation.
- Obsessive-compulsive personality disorder: Preoccupation with orderliness, perfectionism, control and rules. It differs from OCD because true obsessions and compulsions are absent.
Treatment
1. Psychotherapy: Main treatment
Psychotherapy is the treatment of choice and often needs to continue for months or years.
- Supportive psychotherapy: Builds coping skills, improves relationships and functioning.
- Cognitive behavioural therapy (CBT): Identifies and modifies maladaptive thoughts and behaviours. Useful especially in avoidant and obsessive-compulsive personality disorders.
- Dialectical behaviour therapy (DBT): Particularly useful in borderline personality disorder. It teaches emotion regulation, distress tolerance, mindfulness and interpersonal skills; reduces self-harm and suicidal behaviour.
- Schema-focused therapy: Addresses longstanding maladaptive patterns or schemas.
- Mentalization-based therapy: Helps patients understand their own and others' feelings and intentions, especially in borderline personality disorder.
- Group therapy/therapeutic community: Can improve social skills and interpersonal functioning, if properly structured.
2. Pharmacotherapy
No medicine cures the underlying personality disorder. Drugs are used for associated symptoms or comorbid conditions.
- SSRIs/antidepressants: For depression, anxiety, irritability or impulsivity.
- Mood stabilizers: For mood lability, aggression or impulsive behaviour.
- Low-dose antipsychotics: For transient psychotic symptoms, severe anger, suspiciousness or cognitive-perceptual symptoms.
- Treat associated disorders such as substance-use disorder, depression, anxiety disorder, bipolar disorder or psychosis.
Medication should be used cautiously, avoiding unnecessary polypharmacy and dependence-producing drugs.
3. General management
- Establish a consistent, empathetic therapeutic relationship with clear boundaries.
- Assess risk of suicide, self-harm, aggression, substance misuse and exploitation.
- Involve family where appropriate.
- Treat comorbid psychiatric and medical illnesses.
- Encourage vocational rehabilitation, social-skills training and regular follow-up.
- Brief hospitalization may be needed for acute suicidal risk, severe self-harm, psychosis or crisis.
Conclusion
Personality disorders are classified into clusters A, B and C, comprising ten main types. Long-term structured psychotherapy is the cornerstone of treatment, while medications are used only for symptoms and associated mental disorders. The NHS similarly describes talking therapies as the usual treatment, with medicines mainly used for coexisting depression, anxiety or psychotic symptoms (NHS overview).
Make a comparison table of the 10 personality disorders
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DSM-5 personality disorders clusters paranoid schizoid schizotypal antisocial borderline histrionic narcissistic avoidant dependent obsessive compulsive
Comparison of the 10 Personality Disorders
| Cluster | Disorder | Core features | Key distinguishing point | Common management focus |
|---|---|---|---|---|
| A: Odd/eccentric | Paranoid | Distrustful, suspicious, interprets others' actions as hostile; bears grudges | Suspicion occurs without fixed delusions or frank psychosis | Supportive psychotherapy, consistent boundaries; treat comorbid anxiety/depression |
| Schizoid | Detached from social relationships; prefers solitary activities; emotionally restricted | Does not desire close relationships | Supportive therapy and social-skills work if sought; treat depression if present | |
| Schizotypal | Social anxiety, eccentric behaviour, odd speech, magical thinking, unusual perceptions | Cognitive-perceptual distortions but not persistent psychosis | Psychotherapy/social-skills work; low-dose antipsychotic may be used for severe perceptual or cognitive symptoms | |
| B: Dramatic/emotional/erratic | Antisocial | Disregard for rights of others, deceit, impulsivity, aggression, irresponsibility, lack of remorse | Requires a history of conduct disorder before age 15 years | Clear limits and structured behavioural programmes; address substance misuse, violence risk and comorbid disorders |
| Borderline | Unstable intense relationships, fear of abandonment, identity disturbance, impulsivity, self-harm, affective instability, chronic emptiness | Recurrent self-harm/suicidality with marked relationship instability | Dialectical behaviour therapy (DBT); safety planning; treat comorbid depression/anxiety or brief psychotic symptoms | |
| Histrionic | Excessive emotionality, attention-seeking, theatricality, suggestibility; rapidly shifting shallow emotions | Needs to be the centre of attention | Psychotherapy focused on relationships, emotions and self-esteem; clear professional boundaries | |
| Narcissistic | Grandiosity, need for admiration, entitlement, exploitative behaviour, lack of empathy | Fragile self-esteem beneath apparent superiority | Long-term psychotherapy; address shame, interpersonal conflict and comorbid mood disorders | |
| C: Anxious/fearful | Avoidant | Social inhibition, feelings of inadequacy, hypersensitivity to criticism or rejection | Avoids relationships due to fear of rejection, but wants closeness | CBT, graded social exposure, social-skills training; manage social anxiety/depression |
| Dependent | Excessive need to be cared for, submissiveness, difficulty making decisions, fear of separation | Relies on others to make decisions and provide reassurance | CBT/supportive therapy to build autonomy, assertiveness and decision-making | |
| Obsessive-compulsive personality disorder (OCPD) | Perfectionism, orderliness, rigidity, excessive devotion to work, reluctance to delegate | Traits are usually ego-syntonic; unlike OCD, no intrusive obsessions or ritualistic compulsions are required | CBT or cognitive therapy for perfectionism and rigidity; treat associated anxiety/depression |
High-yield differentiations
| Common confusion | Difference |
|---|---|
| Schizoid vs Avoidant | Schizoid person is detached and has little wish for relationships. Avoidant person wants relationships but avoids them because of rejection fears. |
| Schizotypal vs Schizophrenia | Schizotypal disorder has odd beliefs and perceptual experiences but lacks persistent psychotic symptoms and severe functional decline characteristic of schizophrenia. |
| Borderline vs Bipolar disorder | Borderline mood changes are often rapid and triggered by interpersonal events. Bipolar disorder has more sustained, episodic mania/hypomania and depression. |
| OCPD vs OCD | OCPD involves personality traits of orderliness and perfectionism that are often accepted by the person. OCD involves intrusive, distressing obsessions and compulsions. |
| Narcissistic vs Histrionic | Narcissistic personality is marked by grandiosity and need for admiration. Histrionic personality is marked by attention-seeking and dramatic emotional expression. |
| Paranoid personality vs Delusional disorder | Paranoid personality disorder involves pervasive suspiciousness. Delusional disorder involves fixed, false beliefs. |
The DSM-5-TR groups the disorders as Cluster A: paranoid, schizoid, schizotypal; Cluster B: antisocial, borderline, histrionic, narcissistic; and Cluster C: avoidant, dependent, obsessive-compulsive (Merck Manual classification).
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