From the Guidelines
A personality disorder is a mental health condition characterized by persistent problems in functioning of aspects of the self and/or interpersonal dysfunction, which can be diagnosed through a comprehensive psychological evaluation by a qualified mental health professional. According to the most recent classification system, ICD-11, personality disorders are no longer divided into discrete categories, but rather are characterized by a single diagnosis with varying levels of severity, ranging from mild to severe 1. This shift towards a dimensional approach acknowledges that psychopathology is continuously graded in severity and allows for a more nuanced understanding of the disorder.
The diagnosis of a personality disorder in ICD-11 involves assessing problems in functioning of aspects of the self, such as identity, and/or interpersonal dysfunction, such as managing conflict in relationships 1. The diagnosis may also be specified by the presence of one or multiple maladaptive personality traits, including negative affectivity, detachment, dissociality, disinhibition, anankastia, and borderline pattern. The evaluation of personality disorders should consider the individual's long-term patterns of behavior and functioning across different situations, distinguishing between temporary reactions to stressful events and persistent personality traits.
Some key characteristics of personality disorders include:
- Persistent problems in functioning of aspects of the self and/or interpersonal dysfunction
- Varying levels of severity, ranging from mild to severe
- Presence of one or multiple maladaptive personality traits
- Emergence in adolescence or early adulthood, continuing throughout life
- Impact on how individuals perceive themselves and others, manage emotions, relate to others, and control behavior
Treatment of personality disorders typically involves psychotherapy approaches, such as dialectical behavior therapy or cognitive behavioral therapy, rather than medication, although medications may be used to manage specific symptoms like anxiety or depression 1. Early intervention and consistent treatment can help individuals develop healthier patterns of thinking and behavior, improving their overall quality of life.
From the Research
Definition of Personality Disorder
- A personality disorder is a pervasive pattern of maladaptive behaviors, thoughts, and emotions that often go unrecognized and can wreak havoc in the patient's interpersonal life 2
- It is characterized by instability of self-image, interpersonal relationships, and affects, as well as impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms 3
- Personality disorders are heritable and biologically based, with neurobiological, metabolic, and brain structural differences existing in individuals with these disorders 4
Diagnosis of Personality Disorder
- Diagnosis of a specific personality disorder may be difficult to make, but identification of dysfunctional personality structures can provide opportunity for better management of an individual patient's medical and psychological needs 2
- The Temperament and Character Inventory (TCI) is a personality instrument that explicitly distinguishes personality style and disordered functioning, and can be used to detect the presence of personality disorder 5
- Self-directedness and Cooperativeness are two character dimensions that predict the presence of personality disorder and have a moderate diagnostic utility 5
Types of Personality Disorders
- Borderline Personality Disorder (BPD) is characterized by instability of self-image, interpersonal relationships, and affects, as well as impulsivity, intense anger, and feelings of emptiness 3
- Narcissistic Personality Disorder (NPD) is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment 6
- Other personality disorders include depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders 3
Treatment of Personality Disorder
- Psychotherapy is the treatment of choice for personality disorders, with various approaches having been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy 3
- Pharmacotherapy may be useful for discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, but there is no evidence that any psychoactive medication is efficacious for the core features of personality disorder 3