Psychiatrists and psychologists use various methods to categorize mental health disorders, and these categories change over time as research leads to new understandings. For example, Axis II disorders used to refer to personality disorders and intellectual disorders. However, with the publication of the most recent version of The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, the axis system of classification of mental disorders was discarded. Nonetheless, the personality disorders formerly classified according to the Axis 2 designation still exist and are still treated by mental health professionals. 

Types of personality disorders

Each disorder has its characteristic symptoms requiring a different treatment approach. Personality disorders can significantly affect the way a person lives their life and interacts with other people. By seeking treatment, a person can reduce the harmful effects of these disorders for themselves and those around them.

Below is a list of the currently recognized personality disorders, once called Axis II disorders, and a brief description of each:

Paranoid personality disorder

A deep level of suspiciousness and mistrust of other people tends to characterize this disorder. Someone with paranoid personality disorder may believe others are disloyal or seek to harm them. As a result, they may quickly become hostile or defensive even when there is no objective reason for this reaction. They may perceive criticism or malicious intent in everyday conversations and have difficulty working with others because of their mistrust. As a result, they tend to become isolated and detached from those around them.

Schizoid personality disorder

A lack of interest in social relationships tends to characterize schizoid personality disorder. These individuals usually prefer to be alone and tend to lack emotion when interacting with others. They often have difficulty forming attachments to people but may have extensive fantasies about others. This disorder is not the same as schizophrenia or schizotypal personality disorders, though it is similar in some ways.

Schizotypal personality disorder

Someone who has schizotypal personality disorder tends to avoid social interaction and activities. These individuals usually have an intense level of social anxiety and unconventional beliefs about forming relationships with others. As a result, they tend to have difficulty with relationships because they believe people have negative thoughts about them. They may also have superstitious beliefs and strange manners of speech and dress.

Antisocial personality disorder

People with antisocial personality disorder tend to disregard the rights of others. Individuals with this disorder may lack a conscience or have few moral values. They may have a criminal history related to their impulsive behaviors and aggression and may be more likely to commit crimes than the general population. 

Borderline personality disorder

Individuals with borderline personality disorder often demonstrate instability in relationships, sense of self, and emotional control. They may fear abandonment and frequently feel empty inside. They may also engage in dangerous activities and self-harm or act out after everyday events and experiences. Many individuals with this disorder have substance use disorders, depression, eating disorders, and a higher-than-average risk for suicide.*

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Histrionic personality disorder

Someone with this disorder often craves attention and does anything to get it. They also often exhibit seductive or inappropriate behavior toward others. They can be extremely dramatic, enthusiastic, and lively, becoming loud or sexually provocative. The behavior of individuals with histrionic personality disorders may be perceived as self-indulgent and selfish, and their manner of behaving and dressing may be viewed by many as inappropriate. They also tend to exaggerate whatever emotions they feel. 

Narcissistic personality disorder

People with narcissistic personality disorder usually have a strong need for admiration, a lack of empathy, and a grandiose idea of their importance. They tend to require attention and believe they are more important than others. They also tend to feel entitled and often take advantage of other people without remorse.

Avoidant personality disorder

Individuals with avoidant personality disorder tend to feel inadequate and inferior to others. They often have extreme sensitivity to criticism and fear humiliation and rejection, which leads them to avoid social interaction unless they feel sure of being liked and accepted. They tend to have a strong desire to be accepted and loved and want to form intimate relationships, even though this can be challenging for them. Those with a history of neglect may have a higher chance of developing this disorder.

Dependent personality disorder

Clinginess, submissiveness, and dependence on someone else are typical manifestations of dependent personality disorder. An individual with this disorder typically forms a strong emotional and physical reliance on a specific person, requiring that person to make decisions for them. As a result, even minor decision-making can be challenging for a person with this condition.

Obsessive-compulsive personality disorder

Symptoms of obsessive-compulsive personality disorder include a preoccupation with perfection, control, and order. A person with this condition typically spends excessive time on scheduling and attending to details in whatever they do, often to the exclusion of making time for friends and family. In addition, they may have a strict moral code and excessively high personal values. It is important to note that obsessive-compulsive personality disorder differs from obsessive-compulsive disorder, or OCD. People with OCD tend to have intrusive thoughts and feelings that lead them to engage in compulsive behaviors, such as repeated handwashing, to relieve their anxiety and distress.

Personality disorder not otherwise specified

Some people have subclinical symptoms of the above personality disorders, which may lead to a diagnosis of “personality disorder not otherwise specified,” or PD-NOS. In addition, the DSM-5 has a classification called “personality disorder – trait specified,” or PD-TS, which may be used when a clinician identifies impairments in specific personality traits that do not fit another personality disorder diagnosis.

Diagnosis of personality disorders

Research shows that over 9% of people have a personality disorder. Each personality disorder has separate diagnostic criteria that a clinician must identify to make a diagnosis. Only a psychiatrist or clinical psychologist with training in personality disorders can diagnose someone with one of these conditions. 

To do so, the mental health professional conducts an extensive interview with the person and possibly with other people who know them well. They tend to look for long-established behavioral differences in how the person perceives themselves compared to what is typical for their culture. The clinician usually examines the person’s emotional responses, the quality of their interpersonal relationships, and any difficulty with impulse control. They usually must also rule out other mental health conditions, such as substance use disorder, depression, and anxiety, as the cause of the person’s behavior.

Treatment of personality disorders

There are many kinds of treatment for personality disorders. Untreated mental health conditions can lead people to feel stigmatized or isolated, which can worsen their condition, making it essential that people with personality disorders find the help they need and deserve. Treatment options include:

• Cognitive behavioral therapy (CBT)
• Behavior modification
• Psychiatric treatment
• Counseling and psychotherapy
• Support groups
• Medication

Psychiatrists, psychologists, psychiatric nurses, social workers, and primary care physicians with training in treating personality disorders can all play a role in helping someone with one of these conditions. In addition, talk therapy is often a helpful method for people to understand their condition and express their thoughts and emotions as they learn more effective ways of coping in life, such as receiving training in social skills. Families of those with a personality disorder can also benefit from therapy.

While there are no medications specifically designed to treat personality disorders, some medications can help, including:

• Antidepressants
• Antipsychotics
• Mood stabilizers 
• Anti-anxiety medications

For some people with severe personality disorders, hospitalization or residential care may be an appropriate option.

In addition, people with a personality disorder diagnosis can often benefit from counseling and therapy provided through an online mental health platform like BetterHelp. Personality disorders often accompany other mental health conditions, such as anxiety and depression, which often respond well to the type of talk therapy available through online mental health platforms.

Online therapy has been shown by many research studies to be as effective as seeing a therapist in person for many mental health conditions. In addition, talking to someone online, over the phone, or via email or text messaging can alleviate the stress of commuting and interacting with people when you need psychological support. With BetterHelp, you can contact your therapist in between sessions with questions or concerns via in-app messaging, and they’ll get back to you as soon as they can.