By Timothy Tunner, PhD, MSW

Every interpersonal relationship between two people is unique in its own ways, and many different factors are involved in determining how well each relationship works. What people rarely know about, or even understand, is when one or both persons have a personality disorder. Yet when a person does have such a disorder, this will dramatically change the ways in which they interact with other people. Such disorders can cause problems in every area of a person’s life, and it is important to seek therapy for treatment.

Personality disorders fit into a distinct category of mental health concerns. Common symptoms of some personality disorders, such as having explosive fits of anger, may be easily recognizable, though such behaviors may not be easily distinguished from similar behaviors displayed by other people from time to time. Most symptoms of personality disorders, though, are not even easy to identify, as they involve problems in interpersonal relationships. Therefore, personality disorders are usually considered more difficult to diagnose than other mental health concerns. While a problem such as anorexia can be diagnosed using a person’s weight, or a substance use disorder can be diagnosed based on the use of certain amounts of substances, personality disorders must be diagnosed through a pattern of behaviors over a period of time.

Types of Personality Disorders

There are ten different types of personality disorders, including Antisocial, Avoidant, Borderline, Dependent, Histrionic, Narcissistic, Obsessive-Compulsive, Paranoid, Schizoid, Schizotypal, plus a general category of “Not otherwise specified.” Often, a personality disorder will co-occur with one or more other mental and/or physical illnesses, including other personality disorders.

Category 1: Odd or Eccentric Behaviors

• Schizoid Personality Disorder: Individuals with schizoid personalities tend to be introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others.
• Paranoid Personality Disorder: People with paranoid personality disorder are often untrusting, unforgiving, and prone to angry or aggressive outbursts without justification, because they perceive others as unfaithful, disloyal, condescending, or deceitful. This type of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally “cold” or excessively serious.
• Schizotypal Personality Disorder: These people may have odd or eccentric manners of speaking or dressing. Strange, outlandish, or paranoid beliefs and thoughts are common. They may react inappropriately or not react at all during a conversation, or they may talk to themselves. They can also display signs of “magical thinking” by saying they can see into the future or read other people’s minds.

Category 2: Dramatic, Emotional, or Erratic Behavior

• Antisocial Personality Disorder: People with antisocial personality disorder characteristically act out their conflicts and ignore normal rules of social behavior. These individuals are impulsive, irresponsible, and callous. These people are at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability, and boredom.
• Borderline Personality Disorder: People with borderline personality disorder are unstable in several areas, including interpersonal relationships, behavior, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and self-destructive actions characterize the person with borderline personality disorder. These individuals generally have great difficulty with their own sense of identity.
• Narcissistic Personality Disorder: People with narcissistic personality have an exaggerated sense of self-importance, are absorbed by fantasies of unlimited success, and seek constant attention. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships.

Category 3: Anxious, Fearful Behavior

• Avoidant Personality Disorder:  People with avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality.
• Dependent Personality Disorder: People with dependent personality disorder may exhibit a pattern of dependent and submissive behavior, relying on others to make decisions for them. They require excessive reassurance and advice, and are easily hurt by criticism or disapproval. They have a strong fear of rejection.
• Obsessive-Compulsive Personality: Individuals with compulsive personalities are excessively conscientious and have high levels of aspiration, but they also strive for perfection. Never satisfied with their achievements, people with compulsive personality disorder take on more and more responsibilities. They are reliable, dependable, orderly, and methodical, but their inflexibility often makes them incapable of adapting to changed circumstances.

Seeking Therapy

Many people who receive therapy for a personality disorder do not enter therapy because they think they have interpersonal problems. They may see a clinician because they have another co-occurring disorder, such as a drug problem, depression, anxiety, etc. Or, absent another mental health concern, they may enter therapy because they do not understand why other people seem to have so many problems—not recognizing that their behaviors are largely causing the problems. For example they may believe, and not understand, why every person they date is dysfunctional, or why everyone in the office avoids them socially.

Many people with personality disorders will never seek therapy, because they do not recognize the need. Some will also have successful careers, because of jobs where their abilities to complete work tasks (or to ensure that others complete tasks) override their needs to interact well with others. An important criterion for a personality disorder to be present, though, is that a person’s interpersonal interactions must create significant functional difficulties or stress for themselves, and possibly others. This does not mean that an impersonal boss, or one who drives employees to work hard has a personality disorder. Neither does it mean that a person who annoys you by their talk, a “nosey” person, or simply a person with whom you or others do not get along, has a personality disorder. Furthermore, another important diagnostic criterion for a personality disorder to be present is that the behaviors and resulting stress must occur in multiple areas of life. Having particular trouble or stress at work, school, or elsewhere does not mean a person has a personality disorder. When they have consistent, and otherwise unexplainable troubles in several areas over a period of many months or years, then there may be something about which to be concerned.

Many people with personality disorders actually wind up (perhaps subconsciously) surrounding themselves with people or jobs that minimize the negative aspects of their behaviors. For example, a person with a Narcissistic Personality Disorder and a person with a Dependent Personality Disorder might end up working together or married. They may still wind up with stress and/or arguments, but their underlying dysfunctional personality traits may synchronize so that they function well together. Another person with an Avoidant Personality Disorder, for example, may end up in a job and with a home life that requires minimal social interaction.

Multiple Personality Disorder

An important point to know is that “Multiple Personality Disorder” is not a personality disorder, but rather it is classified as a Dissociative Disorder. The term “Multiple Personality Disorder” was originally used because it seems to accurately describe the disorder, where several different people seem to exist in the mind of one individual. The term has especially been popularized through books and movies. However, the proper name of the disorder was reclassified as “Dissociative Identity Disorder” several years ago, because of the confusion of people thinking it was a personality disorder. Due to its popularity through the media, however, the term “Multiple Personality Disorder” is still more commonly recognized, understood, and utilized than the disorder’s correct name.

Finally, it is important not to mistake as a personality disorder, problems that a person is experiencing because of attempts to adapt to new cultural, religious, or other situations. An immigrant to a new country, for example, may be struggling with the expression of customs or behaviors that were normal in his or her old country, but which are considered dysfunctional or unusual by new neighbors or coworkers.

If you believe that you or someone you care about has unusual difficulty in interacting with others, seek out a therapist for help. There may be a relatively minor adjustment issue, or a personality disorder may be involved. Personality disorders are very treatable through therapy (though it may require extensive therapy with a specialist), and often without the use of medications.