Personality disorders are mental health conditions characterized by long-lasting, deep-seated patterns of thinking, perceiving, reacting, and relating to others. These patterns lead to significant distress for the individual, impairing their ability to function in daily life. A practical definition described it as follows: Personality disorder occurs when a personality structure is so strongly accentuated by certain traits that it results in significant distress or conflicts.
A personality disorder is diagnosed when the individual’s personality traits become so extreme, rigid, and inflexible that they experience difficulties at work, in school, and in their interactions with others.
The term “personality disorder” is now used as a neutral umbrella term for all personality development deviations that require treatment. There are fluid boundaries between mental health on one side and mental or emotional illnesses on the other.
In recent years, the modern term “personality disorder” has become established and categorized in the diagnostic statistic manuals like ICD-10 and DSM 5.
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Prevalence of Personality Disorders
The problems and peculiarities of people with personality disorders usually begin in childhood and adolescence. However, the diagnosis can only be confirmed after reaching adulthood. The boundaries between an accentuated personal style and a personality disorder are often blurred.
Approximately 9 percent of people suffer from a personality disorder. These disorders generally affect men and women equally, although some types are more common in one gender than the other. For example, antisocial personality disorder is three times more common in men.
A personality disorder is often not the only mental disorder and frequently occurs alongside other mental illnesses. For example, 50% of people with schizophrenia were diagnosed with preexistent personality disorder. Also, depression, anxiety disorders, addiction, and eating disorders often co-occur with a personality disorder.
It is not uncommon to observe that prominent personality traits and behaviours diminish with age and experience, allowing individuals to function better. This means that a personality disorder diagnosis is not an unchangeable sentence.
What is a Personality?
When speaking about personality disorders, it’s important to understand the core of the concept of “personality.” In everyday language, personality is often equated with character or temperament, typically used in a moral or educational context. For instance, people might say someone “has a personality” or “is a person of character,” which often involves moral aspects.
Psychiatrists and psychologists define personality as “the sum of all psychological traits and behavioural tendencies that make someone uniquely individual.” They also define personality through the qualities of an individual’s “temperament” and “character.”
- Temperament mainly refers to the drive or vitality in a person, often expressed in emotional, or instinctual life.
- Character, on the other hand, is defined as the relationships with others focussing on moral attitudes, adherence to norms, conscience, and societal values.
Combining these concepts, a more scientific definition can be constructed, one used in Anglo-Saxon regions (USA, UK, and affiliated scientific communities). It states that personality is “the more or less stable and enduring organization of a person in terms of character, temperament, intellect, and physicality,” shaping their unique adaptation to the environment.
Such definitions include:
- Character: the stable and enduring system of relationship to others called “volitional behaviour.”
- Temperament: the stable and enduring system of emotional behaviour (affectivity).
- Intellect: the stable and enduring system of cognitive behaviour (intelligence).
- Physicality: the stable and enduring system of physical and neuroendocrine system.
What Is a Personality Disorder
A personality disorder was once understood as deeply rooted maladaptive behaviour, leading to interpersonal and societal conflicts. According to a practical definition, personality disorder happens when certain traits strongly emphasize a personality structure to the point where it causes significant distress or conflicts.
The number of subgroups has been significantly reduced. The most frequently used diagnoses included hyperthymic, paranoid, schizoid, hysterical, depressive, sensitive, asthenic, obsessive, excitable, passive-aggressive personality disorders, and – although only conditionally comparable – sociopathy or antisocial personality disorder.
As for its course, personality disorders often first appear in adolescence and may fade in middle or older age, though not always. This largely depends on the specific form of the disorder. Some individuals may “calm down” (from the perspective of their environment), but this often means a reduction in vitality and increased psychosocial restriction (withdrawal, isolation). Others remain just as pronounced or even become more accentuated, meaning more troublesome or even unbearable, potentially dangerous. More details can be found in the specific chapters on personality disorders.
Causes of Personality Disorders
There is no clear, singular cause for personality disorders. Considering how different the various personality disorders are, it is understandable that they cannot all stem from the same cause. The general consensus is that there are numerous causes of personality disorders.
Psychosocial factors are the most prominent: unfavourable attachment styles of the parents, psychological problems of the parents, ineffective parenting styles, lack of social support, and critical or traumatic events are key triggers increasing the vulnerability.
Genetic and biological causes are found only in some personality disorders, particularly in antisocial personality disorder.
Overall, it can be said that the combination of unfavourable environmental conditions and a certain personal instability contributes to the development of a personality disorder. The exact factors and why they lead to personality disorders in individual cases are not fully understood.
Some people are born with a genetic predisposition to develop a personality disorder. In such individuals, environmental factors like experiences or environments can either suppress or amplify this predisposition.
Models for Development of Personality Disorders (PD)
There are distinct models strongly related to the schools of psychotherapy trying to explain how personality disorders develop.
Depth-Psychological Model
Personality disorders are seen as “character neuroses.” Character forms through defensive processes between intrapsychic forces and interpersonal threats. Defense mechanisms reduce psychological tension. Fixation on needs shapes character (e.g., anal, oral-retentive). Primitive defenses arise from early disturbances in ego development, while more mature defenses emerge later. Personality development, initially focused on drive-defense processes, is now described through the adaptation of intrapsychic representations of the self and others.
Interpersonal Model
Personality is a relatively stable pattern of recurring interpersonal situations. Self-schemas guide how interpersonal relationships are perceived, interpreted, and expressed. Subjective and objective realities interact through patterns such as control/interdependence and affection. Self and environment influence each other through circular causality.
Cognitive-Behavioral Model
Responses are driven by cognitive interpretations, which reflect stable schemas influenced by emotions. Dysfunctional core beliefs—whether overdeveloped or underdeveloped—tend to confirm themselves in interpersonal contexts, hindering learning processes.
Dimensional and Neurobiological Model
Personality consists of traits shaped partly by genetics and partly by environmental interaction, identified through factor analysis. Eysenck proposed three dimensions: introversion/extraversion, neuroticism/stability, and psychoticism/impulse control. The Big Five model measures extraversion, agreeableness, conscientiousness, neuroticism, and openness. Traits like exploratory behavior (dopaminergic), harm avoidance (serotonergic), and activity (noradrenergic) can be neurobiologically approximated, though not fully explained etiologically.
Similar to the dimensional model, personality is defined by multiple dimensions (typically three) shaping social interaction. Genetic predispositions are modified through overlapping developmental stages involving learning processes.
- Sensory attachment (first year): Interaction with the mother leads to pleasure-seeking and fear-avoidant behavior.
- Sensory-motor autonomy (toddlerhood): Adjusting to social demands.
- Pubertal gender identity (adolescence): Developing gender identity and needs orientation.
- Intercortical integration (ages 4-18): Balancing emotional and rational capacities.
Diagnosis of Personality Disorders
The DSM-5 diagnostic system describes six criteria for a general personality disorder. These criteria outline the fundamental conditions that must be met in each individual case before a specific personality disorder diagnosis can be made.
Criteria required in the DSM-5
A persistent pattern of inner experience and behaviour that significantly deviates from the expectations of the individual’s sociocultural environment.
This pattern is evident in at least two of the following areas
- Cognition: The way the individual perceives and interprets themselves, other people, and events.
- Affectivity: The range, intensity, variability, and appropriateness of emotional responses.
- Interpersonal functioning: How relationships with others are managed.
- Impulse control: The ability to regulate impulses.
- The persistent pattern leads to clinically significant distress or impairments in social, occupational, or other important areas of functioning.
- The pattern is stable and long-lasting, with its onset traceable back to adolescence or early adulthood.
- The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
- The pattern is not due to the physiological effects of a substance (e.g., drug use) or a medical condition (e.g., brain injury).
- The pattern is inflexible and pervasive across a broad range of personal and social situations.
Types of Personality Disorders
There are 10 types of personality disorders, each defined by characteristic problems with how individuals see themselves and how they respond to others and stressful situations.
The 10 types of personality disorders can be divided into three groups (Clusters A, B, and C). The disorders in each cluster share certain characteristics, but each disorder also has its own distinct traits.
Cluster A Personality Disorders
People with Cluster A disorders tend to appear odd or eccentric. Cluster A includes the following personality disorders, each with its own distinguishing features:
Paranoid type: Distrustful and suspicious.
Schizoid type: Disinterested in others.
Schizotypal type: Strange or eccentric ideas and behaviours.
Cluster B Personality Disorders
People with Cluster B disorders show dramatic, emotional, or erratic behaviour. Cluster B includes the following personality disorders, each with its own distinguishing features:
Antisocial type: Fails to take responsibility, lacks concern for others, deceives, and manipulates for personal gain.
Borderline type: Experiences inner emptiness, fears abandonment in relationships, has unstable relationships, struggles with emotional control, and exhibits impulsive behaviour.
Histrionic type: Seeks attention through dramatic behaviour.
Narcissistic type: Craves admiration, lacks empathy, and has an inflated sense of self-importance (grandiosity).
Cluster C Personality Disorders
People with Cluster C disorders tend to appear anxious or fearful. Cluster C includes the following personality disorders, each with its own distinguishing features:
Avoidant type: Avoids interpersonal contact due to fear of rejection.
Dependent type: Submissive and reliant on others (due to a need to be cared for).
Obsessive-compulsive type: Displays perfectionism, rigidity, and stubbornness.
ICD-11 versus DSM 5
The differentiation of personality disorders is very difficult for psychologists and psychiatrist whom don’t deal daily with these health conditions. The decades-long and increasing dissatisfaction with the categories of personality disorders led the World Health Organization’s to a revolution in ICD-10 diagnostics. The revision of WHO statistics manual, ICD-11, shifted personality categories towards a dimensional classification system one that is much more grounded in empirical psychological research.
Five Personality Domains in ICD-11
The ICD-11 has endorsed a dimensional assessment of personality across five domains: “Negative Affectivity,” “Detachment,” “Dissociality,” “Disinhibition,” and “Anankastia,” as a radical alternative to the previous ICD-10 categories.
Three Levels of Severity
In the ICD-11, which has been in effect since January 1, 2022, the structural differentiation of personality disorders takes a backseat. Instead, under the code “ICD-11: 6D10 Personality Disorder,” three levels of severity are indicated: mild, moderate, and severe, along with the option “Personality disorder, severity not specified.”
Under the code “6D11,” ICD-11 describes the most pronounced specific structural traits of personality. Multiple traits can be specified if needed to describe the personality functioning comprehensively.
In the DSM-5, such changes did not take place, as the dimensional model remained the same.
Categories of Personality Disorders in ICD-11
With the implementation of the ICD-11 classification, a new diagnostic system is introduced, focusing on the functional impairments in patients’ daily lives. The introduction of ICD-11 changed fundamentally the diagnostic approach compared to ICD-10. The classification into traditional categories or types is abandoned in favour of using essential criteria. If these diagnostic criteria are met, the personality disorder can be classified into various severity levels, with additional personality traits described.
Essential Criteria
The following criteria must be met for diagnosis:
- Persistent functional impairments of self (identity, self-esteem, self-evaluation, etc.), causing problems in interpersonal relationships.
- Present for an extended period (e.g., 2 years).
- Maladaptive patterns in cognition, emotional experience/expression, and behavior are noticeable.
- The disorder manifests in various personal and social situations, not limited to specific events or relationships.
- Symptoms cannot be attributed to substance use, other illnesses, or social/cultural context.
- Individuals suffer significant impairments in personal, familial, social, educational/occupational, or other vital functional areas.
Severity
Depending on whether and to what extent the personality disorder causes stress and impairments in the individual’s daily life, the disorder can be classified as mild, moderate, or severe. The following aspects are considered:
- (In-)Stability of identity, self-esteem, and the (in-)ability for self-regulation.
- Extent of interpersonal dysfunction (interest in relationships, empathy, conflict resolution).
- Presence and extent of emotional, cognitive, and behavioral manifestations of the personality disorder.
- Emotions: appropriate emotional reactions, recognition of and dealing with difficult or unwanted feelings.
- Cognition: appropriate/accurate assessment of situations, functional decision-making.
- Behavior: impulse control, adjustment to specific situations.
Personality Traits
Additionally, personality disorders can be further characterized using five traits. The personality traits most strongly pronounced and significantly contributing to the disorder are:
- Negative affectivity
- Detachment
- Dissociality
- Disinhibition
- Compulsivity
Borderline personality: If applicable, this can also be listed as a trait, as clinical/therapeutic specifics may arise.
Challenges in Treatment of Personality Disorders
The main obstacle in treatment of individuals with personality disorders is their reduced introspective abilities. They are often unable to adequately contribute to understanding their own problems or how the environment reacts to them through self-critical reflection. This can result in a complex and sometimes unclear overall condition.
Therefore, an external history is important, meaning a targeted interview with relatives or close acquaintances. This is especially significant for assessing social conflicts.
During the actual examination, attention should be given to temporary mood swings, to self- and other-straining behaviours such as being irritable, moody, grumpy, envious, short-tempered, and aggressive.
The other important characteristic is elaborating psychosis-like phenomena with temporary disruptions in reality control.
Finally, personality disorders should be distinguished from behavioural changes caused by early brain damage, intoxications, i.e., poisoning from alcohol, nicotine, or drug abuse, or by physical conditions such as cardiovascular damage due to brain strokes. For this reason, a neurological and internal medical examination and diagnostics are necessary.
Psychotherapy for Personality Disorders
In psychotherapy, the choice of approach depends on the specific type of personality disorder and its severity, as well as any accompanying mental illnesses. The most recognized therapies in this area are Cognitive-Behavioral Therapy (CBT), along with psychodynamic psychotherapy or disorder-specific treatments. In all cases, the therapist-patient relationship must work particularly well, which is true for all psychotherapy but especially essential for patients with personality disorders.
Educational and psychoeducational methods, which combine psychological and pedagogical approaches, are also used, with a focus on fostering self-awareness and self-directed changes.
Couple and Group Therapy
Couple therapy may be helpful when problems are focused on a partnership. Group therapy can also be effective for many (but not all) patients, particularly for those not too severely disordered. In group settings, learning by example is key: seeing others with similar negative or troubling behaviours can lead to the realization that they, too, behave similarly. Group therapy can be effective when patients learn to not only give but also accept criticism and use it constructively (positive feedback). The therapy helps them strengthen the positive behaviours and reduce the disruptive ones.
These therapies usually require longer timeframes, often more than typical psychotherapies for other conditions. The long treatment time for personality disorders is necessary due to the necessity of slow, gradual, but lasting, reshaping of the negative traits, such as emotional lability, and social behaviour. However, also shorter crisis interventions can be helpful, especially in acute interpersonal conflicts (family, work, neighbourhood) that could escalate into serious social problems.
Adjusting the Psychotherapy to the Personality Structure
It’s helpful to distinguish between at least two groups of patients with personality disorders:
- The first group includes personality disorders such as obsessive-compulsive, dependent, avoidant, and schizoid by a rigid super-ego, i.e. a strict internal control and punishment system. This group tends to self-punish, internalize conflicts, and conform anxiously and submissively to their environment. Therapy for these individuals focuses on reducing inhibitions and excessive self-criticism caused by an overactive conscience, strengthening self-confidence, and improving conflict-resolution skills.
- The second group consists of personality disorders with more expansive, irritable traits, belonging mostly to cluster B, such as histrionic, narcissistic and antisocial personality disorders. These individuals tend to externalize conflicts, exhibit unrestrained aggression, dramatize situations, and act on impulses. They also frequently blame others for their problems and demand that others adapt to them rather than the other way around. In therapy, they must learn to lower their demands, practice self-restraint, adapt to their environment, and recognize their problems. It’s crucial for them to accept and work through the insights gained in therapy.
Treatment Prognosis for Personality Disorders
The prognosis for personality disorders is more individualized than for other mental disorders, and outcomes vary depending on the subtype:
Better prognosis
Histrionic, obsessive-compulsive, dependent, and avoidant personality disorders tend to have a more favourable outlook. Borderline and narcissistic personality disorders, once considered pessimistic, are also showing better treatment outcomes under modern therapy conditions.
Less favourable prognosis
Schizoid, paranoid, schizotypal, and especially antisocial personality disorders are more difficult to influence.
The prognosis improves when patients are willing to give up externalizing blame (“it’s always someone else’s fault”), view disruptive traits, and allow themselves to feel the distress they previously tried to avoid by blaming others. This distress becomes the basis for self-reflection and reorientation in interpersonal, familial, and professional relationships.
However, this may come at the cost of emotional strain, such as resignation, depression, anxiety, feelings of inferiority, and self-doubt. Yet these symptoms, during subsequent supportive therapy, can create a favourable starting point and improve long-term recovery prospects.
Most Important Personality Disorders as per DSM 5 (and ICD-10)
The American DSM-V classification and the older version of WHO classification system, ICD-10, divides personality disorders into clusters A,B,C:
A: refers to personality disorders with “odd and eccentric behaviours,” including paranoid, schizoid, and schizotypal personality disorders.
B: contains personality disorders with “dramatic, emotional, and unpredictable behaviours” and includes antisocial, borderline, histrionic, and narcissistic personality disorders.
C: encloses personality disorders with “anxious and avoidant behaviours” and includes paranoid, schizoid, and schizotypal personality disorders.
The diagnosis of Passive-Aggressive Personality Disorder is a controversial diagnosis, rarely made. It is not listed in DSM, but ICD-10 categorizes it under “other personality disorders.”
Cluster A Personality Disorders
People with these personality disorders are suspicious, odd, eccentric, and seem emotionally cold. When they feel insulted or threatened, their mood can quickly turn to anger. They live in isolation and have few interpersonal relationships.
Paranoid Personality Disorder
Paranoid personality disorder is characterized by a persistent and unjustified tendency to interpret the actions of others as deliberately threatening, combined with distrust and a readiness to respond aggressively.
Symptoms of Paranoid Personality Disorder
People with paranoid personality disorder constantly feel attacked in terms of their person, performance, or reputation. Even neutral or friendly interactions are interpreted as hostile or offensive; harmless remarks or events are seen as secretly threatening or demeaning. Their distrust, particularly regarding others’ malicious motives, extends to areas such as the partnership, working place, and neighbourhood.
The paranoid personality disorder’s specific delusional thinking style is marked by an unrelenting, exhausting search for hidden meanings, usually negative ones. This leads to constant psychological strain, which can eventually result in exhaustion, though the individual may not show it.
These individuals are hypersensitive to criticism and, due to their excessive need for autonomy (“I am independent and need no one”), they may slowly adopt a chronic oppositional stance. They may create enemies and, eventually, real adversaries, reacting aggressively toward perceived or actual foes.
Sudden aggressive outbursts can occur as justified responses to perceived hostility from the environment. Over time, these individuals may experience exhaustion with depressive reactions (“who can endure constant hostility and harassment?”).
Treatment of Paranoid Personality Disorder
In therapy, the focus is on establishing an open, trusting relationship to address the tendency for misinterpreting situations, which arises from their delusional readiness to react. The goal is to help the individual feel less isolated (moving away from the “friend-enemy” mindset: “me against the world”). Antipsychotic medications, particularly neuroleptics, can be part of an overall treatment plan, especially when delusions block interpersonal connections from the outset.
Special forms of paranoid personality disorder, where there is a tendency for fanatic or querulous reactions, can be treated with mood stabilizers. Behavioural therapy aims to reduce sensitivity to criticism using similar methods to those used in treating anxiety disorders, such as relaxation exercises paired with a hierarchy of critical statements (“I remain calm, criticism doesn’t affect me”).
Schizoid Personality Disorder
Schizoid personality disorder (schizoid, resembling traits of schizophrenia) is primarily characterized by social withdrawal and limited emotional expression and experience. For more details, refer to the chapters on schizophrenia, schizoaffective disorders, delusional disorders, and the specific sections on schizoid personality disorder.
Symptoms of Schizoid Personality Disorder
Individuals with schizoid personality disorder often prefer social isolation and tend to lead solitary lives. They have few, if any, close relationships outside their immediate family and often do not seek them. They may appear indifferent to social norms and even to praise or criticism. Common pleasures or activities hold little to no interest for them, and when they do participate, it is usually only when they can do so alone.
Interpersonally, they appear cold, emotionally distant, and unapproachable. Their limited capacity for emotional expression, whether in facial expressions, gestures, or body language, often seems outwardly uninviting. However, they can still function competently in their professional lives and, to some extent, within their families.
The schizoid behavior pattern is consistent, as is typical for all personality disorders, but it is less pronounced than in schizotypal forms. The combination of schizoid and antisocial personality traces can be particularly problematic. Such individuals blend poor social bonds with lack of empathy, which is devastating, in interpersonal relationships.
Treatment of Schizoid Personality Disorder
The therapeutic approach for schizoid personality disorder is similar to that for schizotypal disorder (see below). However, schizoid patients are more likely to benefit from group therapy. Schizoid patients are rarely involved in social conflicts seeking less likely specialized treatment, especially if their difficulties are “only” related to emotional deficits.
Schizotypal Personality Disorder
Schizotypal (or schizotype) personality disorder is characterized by:
Symptoms of Schizotypal Personality Disorder
People with schizotypal personality disorder show peculiarities in thinking, appearance, and behaviour, along with deficits in interpersonal relationships. There are close connections to schizophrenic psychoses, both in terms of symptoms and hereditary factors. This has been confirmed through adoption studies. The separated siblings—one raised by schizophrenic parents and the other by healthy families—were both affected by similar issues, if not schizophrenia itself, then schizotypal personality disorder. There are also significant overlaps with borderline personality disorder.
Treatment of Schizotypal Personality Disorder
As with paranoid and schizoid personality disorders, therapy for schizotypal personality disorder first focuses on carefully building a stable relationship. This is particularly challenging because schizotypal personality disorders involve the most severe interpersonal impairments.
A key factor is the strong fear of intimacy and attachment, which means that the therapeutic relationship must be gradually strengthened and deepened. The therapist must learn to understand the patient’s often “strange” emotions and reactions and help them become increasingly aware of and able to discuss these feelings.
Once a certain level of trust is established, the focus can shift to the patient’s relationships with others. Ultimately, this is the core issue: the therapist-patient relationship is temporary while forming and maintaining connections with society.
From a behavioral therapy perspective, the focus is on training social skills (how to handle everyday tasks and basic interactions) and improving cognitive abilities. It’s also important to practice dealing with fear-based (avoidant) reactions in social settings, such as with family, neighbours, or at work.
Treatment with Medication
Medications used for treatment typically include antipsychotics. In some cases, antidepressants may also be used, especially in cases of anhedonia (the inability to experience pleasure) in typically pleasurable activities.
Cluster B Personality Disorders
Personality disorders in cluster B involve mood swings, impulsivity, intense anger, and inability to control it. Behaviour in relationships tends to alternate between idealization and devaluation, with difficulties in closeness. Self-harming and suicidal behaviours are common in certain forms, sometimes also outward aggression. A low self-esteem underlies all Cluster B personality disorders, causing anger, shame, or humiliation with criticism.
Antisocial personality disorder (previously known as sociopathy) is generally one of the easiest to diagnose. This is largely due to the often striking (and negative) behaviors associated with it.
Antisocial personality disorder is marked by irresponsible and antisocial behavior that violates societal rules, starting in childhood and continuing into adulthood. Individuals with this disorder seem therapeutically difficult to influence due to their impulsivity (acting spontaneously, often excessively and without control), unreliability, inability to form attachments, egocentrism, and lack of guilt.
Additional problems, whether health-related or social, often arise from the simultaneous abuse of alcohol, drugs, tobacco, or medications. Consequently, the prognosis for recovery is generally unfavorable.
Given this negative introduction, it’s no surprise that treatment efforts, mostly group therapy, are typically conducted within correctional facilities, or forensic psychiatric units (for legally convicted mentally ill individuals treated in specialized psychiatric hospital departments).
There are no specific medication treatments for antisocial personalities. Irritability and aggression are, as much as possible, managed with antipsychotics or mood stabilizers like lithium and carbamazepine.
From a behavioral therapy standpoint, one challenging realization is that antisocial personality disorder is difficult to “train away,” especially for many individuals. These “sociopaths” are less responsive to punishment as a conditioning tool and struggle to learn from painful experiences, even when those experiences should lead to behavioral correction. Furthermore, their risk-taking and addiction tendencies often exceed average levels.
Ultimately, treatment often requires a comprehensive plan involving psychotherapy, conditioning techniques, rewards, and influence from parents or close relationships, alongside medications. Unfortunately, the overall success of these treatments remains limited.
Borderline Personality Disorder
Borderline personality disorder has been named based on the misinterpreted assumption that individuals with such personality are placed somewhere in the spectrum between psychosis and neurotic disorders.
Characteristics (Sympoms) of Borderline Personality Disorder
The American Psychiatric Association (APA) describes borderline personality disorder in the DSM-V as a pattern of instability in self-image (who am I?), mood, and interpersonal relationships. Key features include:
Identity Disturbances
Pronounced and persistent instability of self-image or self-perception, including uncertainty about sexual orientation, career goals, friendships, or values (who am I?). Patients struggle to say who they are or what they believe. Often adopt the opinions of others (“I tend to be whomever I’m with”). Chronic feelings of emptiness and boredom. Despite this, they can appear charming, funny, and sociable. “Borderlines can describe themselves for five hours without giving a clear picture of who they are.” (Kernberg)
Emotions
Impulsivity in potentially self-damaging areas: spending, sexuality, substance abuse (alcohol, drugs), reckless driving, binge eating, and more. Affective regulation is impaired—too intense, too fast, and too long (“hypersensitivity”). Mood swings are short (minutes to hours) but intense and uncontrollable. Inadequate differentiation between anger, disappointment, and fear. Strong reactions, especially to non-verbal cues. Emotional amnesia: “Borderline individuals are so completely in each mood, they struggle to recall what it’s like to feel otherwise.” (Linehan)
Behavior
repeated self-harm attempts, suicidal thoughts, threats, or multiple suicidal actions, sometimes triggered by delusional ideas. These provide temporary relief in emotional crises but can also be manipulative, aiming at rescue. Risky behaviors like substance abuse, binge shopping, gambling, eating disorders, theft, reckless driving, and compulsive sexual activity. Tendency to immediate reword. The individuals with BPD have difficulties maintaining actions and complete tasks if they are not immediately reworded.
Primitive Defense Mechanisms
Splitting—viewing others as entirely good or bad, with frequent shifts. Lack of object constancy—people are judged as though there is no past or consistency. Use of magical thinking, omnipotence, and projection of negative traits onto others. Projective identification—evoking personal feelings in others.
Relationship Problems
Instability of relationships. People with this disorder engage in intense but unstable relationships, often leading to emotional or social crises. One reason for this constant instability is the inclination to idealize or devalue others.Relationships are unstable, chaotic, and emotionally exhausting for the patient. Intense fear of abandonment coexists with mistrust towards others and self (“I hate you, don’t leave me”). Hypersensitivity to criticism, with chronic fear of rejection and panic when alone. High demands on others, followed by quick disappointment. Poor social adaptation, including violating rules at work or in school.
Reality Perception
Reality testing remains intact. Stress may trigger transient paranoia or dissociation, sometimes leading to pseudopsychotic symptoms like thought disorders, rare hallucinations, derealization, or depersonalization.
Borderline personality disorder overlaps frequently with schizotypal, histrionic (formerly hysterical), and antisocial personality disorders, which are also commonly observed.
Treatment of Borderline Personality Disorder
Treatment outcomes are limited. However, the prognosis is not as bleak as it once was, thanks to recent scientific studies and therapeutic experiences. There are now specialized borderline treatment units, though they are still limited in number and capacity.
Specific approaches in individual and group therapy focus on improving relationship dynamics (a core issue for borderline patients), especially with primary contacts such as partners, parents, siblings, children, and even neighbours or coworkers.
Therapists must maintain a constant sense of “alertness,” allowing for understanding and closeness while also setting clear boundaries, especially to resist the well-known manipulative behavior of borderline patients (e.g., today, the therapist is “the best doctor ever,” but tomorrow, they are “the biggest disappointment”).
The best results are achieved through long-term psychotherapy such as Transference Focused Psychotherapy (TFP) or Dialectical Behavior Therapy (DBT), lasting several years, with sessions spaced out to address the ever-changing but consistently distressing issues that arise in everyday life (relationships, family, neighbors, work, social circle).
Transference Focused Psychotherapy (TFP)
Transference Focused Psychotherapy (TFP) has been developed as the psychotherapeutic method of choice for treatment of people with Borderline Personality Disorder (BPD). TFP is rooted in Freud‘s psychoanalytic theory. TPF differs from traditional psychoanalysis. While traditional psychoanalysis focusses on how past experiences influence the present, TFP centers on “here and now,” analyzing the behaviour of the patient in interaction with the psychotherapist. In Transference Focused Psychotherapy the psychotherapist is more active in guiding the sessions.
Patients suffering from Borderline Personality Disorder utilize so-called primitive defence mechanisms, such as denial, projective identification, and splitting. TFP deals with the transference patients develop towards their therapists and the defence mechanisms used by them during the session. The most typical defence mechanism in Borderline individuals is “splitting” or black-and-white thinking about themselves and others. The main goal of TFP is to integrate these split parts of the patient’s personality to help them develop a more cohesive sense of self. This approach aims not just to change behavior but to shift how the patient feels and understands themselves emotionally.
Dialectical Behavioural Therapy (DBT)
DBT is primarily cognitive-behaviora. The foundation of DBT, like all psychotherapy, is a solid patient-therapist relationship. To prevent burnout, therapists receive support within a DBT team. Therapists do not assume responsibility for self-harm behavior, avoiding reinforcement of these tendencies (“life-enhancement treatment instead of suicide prevention”).
The characteristic “black-and-white thinking” of borderline patients is addressed through dialogical interventions, encouraging a shift from “either-or” thinking to a more flexible “both-and” approach. This can ease the rigid, self-destructive, and uncompromising reactions that are common in borderline personality disorder.
DBT is rooted in a biosocial theory of Borderline Personality Disorder assuming that the disorder results from the clash between an emotionally vulnerable individual and a stressfull environment. This environment fails to acknowledge the child’s emotions, valuing only self-control and independence. From this interaction, three fundamental dilemmas arise, pulling the patient between extremes:
Emotional vulnerability
↔ Self-invalidation (internalizing the environment’s invalidating response)
Chronic crisis (endless relationship crises from intense emotional reactions)
↔ Inhibited grief (inability to learn from negative experiences)
Active passivity (facing problems helplessly, relying on others for solutions)
↔ Apparent competence (seeming functional, yet showing fluctuating abilities)
Following Hegelian dialectics, DBT aims to synthesize opposing traits and tensions in therapy:
Validation ↔ Behavior change
Empathic understanding ↔ Confrontation (reciprocal communication)
Core components of DBT include introspection and validation in individual therapy, as well as skill-building in four areas:
- Core mindfulness (awareness techniques similar to Zen practices)
- Interpersonal effectiveness (asserting needs, setting boundaries, maintaining relationships, self-confidence)
- Emotion modulation (changing emotional responses)
- Distress tolerance (accepting and managing emotions)
Medication is used alongside therapy if needed.
Structure of DBT
- Pre-treatment phase: Diagnosis, information, goal setting, and motivation.
- Stage I: Reducing self-harm and behaviors that threaten therapy or quality of life.
- Stage II: Confronting traumatic experiences and processing grief.
- Stage III: Integrating experiences into the self-concept and pursuing personal goals.
Therapy spans at least one year and includes individual sessions, group therapy, phone support (for skill application, not crisis intervention), and consultation.
Common components in TFP and DBT
Through exploring the evolving dynamic between the patient and therapist, both therapy methods, TFP and DBT, address the underlying personality structures that lead to unhealthy patterns, ultimately helping patients improve their functioning in key areas of their life. The common components are:
- Clear therapeutic bondaries
- Focus on splitting
- Problem-solving and skills training
- Emotional exposure
- Contingency management
- Cognitive techniques to identify and change dysfunctional thought patterns (e.g., “I’m hopeless, nothing will work”).
Medication in Treatment of BPD
In treatment of borderline patients’ medication is used cautiously. Tranquillizers are problematic due to the risk of abusing them and can be used only in the crisis. If symptoms lean more towards psychosis neuroleptics may be used; for those suffering from cooccurring depression, antidepressants will be the choice. However, the use of medication in borderline patients might be difficult as they are often highly sensitive to side effects.
For chronic mood instability and extreme impulsivity or aggression, which can also be harmful socially, mood stabilizers can be the best choice.
Overview of the Historical Development of the Borderline Personality Disorder Concept
Historically, Borderline Personality Disorder (BPD) has been seen as existing on the border between psychosis and neurosis. The term “borderline” was coined in the late 1930s by American psychoanalyst Adolph Stern. It is based on a psychoanalytic model that considers a continuum between neurotic and psychotic disorders. The term characterises psychological impairments that lie on the boundary between neurotic and psychotic conditions, which cannot be clearly assigned to either category.
Between 1920 and 1965, there was a trend among scientists to associate borderline disorders with the schizophrenia spectrum. It wasn’t until Otto Kernberg‘s work in 1975 that the diverse concepts surrounding the term “borderline” were narrowed down. In his effort to unify descriptions of the borderline disorder within the psychoanalytic tradition, Kernberg introduced the concept of “borderline personality organisation.”
This refers to a specific personality structure characterised by three psychological features:
- Identity disturbances
- Primitive defence mechanisms
- Intact reality testing
Kernberg suggested that individuals with borderline disorder could develop psychotic episodes under extreme stress or conditions that promote regression. However, they possess stable personality traits. When psychotic symptoms appear, they tend to be brief, well-defined, and usually accompanied by good reality. Kernberg placed borderline disorders between neurotic and psychotic personality organisations.
A year after Kernberg’s conception of BPD, the publication “The Borderline Syndrome” by Grinker et al. (1968) gained significant attention. This work described the difficulties faced by borderline patients. Building on this, Gunderson and Kolb (1978) identified seven criteria that could distinguish patients with BPD from other clinical groups with high accuracy.
Spitzer and colleagues (1979) added the criterion of “unstable identity,” as described by Kernberg, to these seven criteria. Together, these eight formed the diagnostic criteria of the DSM-III. The DSM-IV later included the criteria of stress-related paranoid experiences and dissociative states. The ICD-10 classification system (WHO, 1992) largely adopted the phenomenological description of BPD from the DSM-III but grouped BPD with the “impulsive type” under the broader term “emotionally unstable personality disorder.” While the classification of BPD underwent significant changes in the ICD-11, the DSM-5 retained the previous categories.
Dimensional Models
Dimensional models of personality disorders have been developed to better define them. These models are more in line with the concept of a continuum between “healthy” and “ill,” assuming that personality disorders are an exaggerated manifestation of normal personality traits. Research findings indicate that dimensional models provide a more accurate representation of personality disorders. Empirical evidence supports the theoretical assumption of the continuous distribution of personality traits and shows that dysfunctions tend to increase with the severity of symptoms.
Risks and Comorbidities of BPD
Theories on the causes of BPD often suggest a combination of biological predispositions, psychological elements, and environmental factors. One theory links neurobiological development to disrupted early attachments and subsequent trauma, which might lead to a hyper-responsive attachment system. Individuals with BPD commonly have a history of abuse, and some researchers believe that broken home and childhood abuse can lead to its development. Other theories propose an inherent difficulty in handling stress, which might make affected individuals increase their vulnerability to develop BPD. Kernberg suggested that a constitutional inability to regulate emotions predisposes them to psychic disorganization, especially in the face of early environmental challenges.
Patients with BPD are at a higher risk for other disorders, like depression and anxiety. They are extremely sensitive to rejection, loss, and changes in attachment bonds. Kernberg noted that patients internalize early problematic relationships and maintain them through primitive defense mechanisms, such as splitting. In splitting the early child behaviour shaped by an inconsistent perception of the mother seeing her as both a loving and punishing figure is influencing patient’s social interactions resulting in “black and white” perception of other peaple.
Some researchers view BPD from a family systems perspective. They suggest that such problems as faulty boundaries and a lack of hierarchical structure within families can contribute to the disorder.
The development of BPD is complex and likely involves multiple factors. Linehan et al. proposed that it results from the interaction between a biological emotional vulnerability and an invalidating environment. More research on neurobiology, family systems, and developmental psychopathology is needed to understand how these factors combine impact individual’s development.
Histrionic Personality Disorder
Histrionic personality disorder (from the Latin histrio, meaning actor or performer) received its new, somewhat unusual name “histrionic” to avoid the negative connotations of the term “hysteria.”
Symptoms of Histrionic Personality Disorder
Individuals with histrionic personality disorder tend to display dramatic behaviour. They often captivate others with their enthusiasm and apparent openness, as well as their flirtatiousness, and seeking admiration. They may present themselves as the “life of the party.”
Attention Seeking
When they feel they are losing attention, they may resort to dramatic actions—such as making up stories or creating scenes. They often flatter authority figures, such as bosses or doctors, with gifts or focus on describing their emotional or physical complaints in exaggerated detail.
Appearance
People with histrionic personality disorder consistently use their appearance to draw attention to themselves, spending significant time, money, and energy on clothing, grooming, jewellery, and unique accessories. Compliments are welcomed and eagerly consumed, but any critical remarks are quickly met with irritation, anger, or aggression.
Behaviour
Their behaviour and appearance can be sexually inappropriate, even provocative, not just with those they are romantically interested in but also in general social or professional interactions. This behaviour is often seen as inappropriate, and their emotions tend to be superficial and change quickly. They often view their relationships as more intimate and emotionally intense than they truly are, sometimes retreating into romantic fantasies or reacting unpredictably when disappointed.
They are highly suggestible, which means that other people or even trends can easily influence their feelings and opinions. On one hand, this makes them overly trusting, especially towards important figures like authority figures or doctors (who may be seen as having “magical powers”). On the other hand, they can rapidly and harshly devalue people when their exaggerated expectations are not met.
Speech Style
Their speech style is often overly dramatic or flowery but lacks detail or substance, leaving conversations vague and superficial. Their stories and statements often seem quickly changeable or interchangeable.
Drama Tendency
A characteristic trait is their tendency to dramatise situations with theatrical behaviour and exaggerated emotional expressions. For example, they may greet someone with excessive enthusiasm or break down into uncontrollable tears over trivial matters. These emotions can switch on and off quickly, leading to the suspicion that they might be staged or insincere.
Treatment of Histrionic Personality Disorder
Psychotherapy, both individual and group, is the primary approach. The goal is for patients to learn more appropriate interpersonal interactions and to move away from their previous histrionic relationship style. Similar to borderline personality disorder, therapists must be watchful to prevent falling prey to their patients’ frequently subtle and cunning behaviour.
Medications should generally be avoided in the treatment of histrionic personality disorder. In cases of “hysteroid dysphoria” (chronic mood instability common in these patients), antidepressants can be used.
Narcissistic Personality Disorder
In Greek mythology, Narcissus was a young man who fell in love with his own reflection. To this day, a person excessively in love with themselves is often referred to as a narcissist. Narcissism is a blend of self-love, self-centeredness, self-admiration, and therefore, egotism.
Symptoms of Narcissistic Personality Disorder
Unrealistic fantasies of greatness lead to self-centered behaviour and hypersensitivity to others’ opinions. What stands out most is a lack of empathy—an inability to understand or care about others’ feelings.
Modern definitions, especially from the APA’s DSM-V, describe a deeply ingrained pattern of grandiosity (in thoughts or behaviour) along with a constant need for admiration—yet without empathy for others. Key criteria include:
- A grandiose sense of self-importance (exaggerates achievements and talents), expecting to be recognized as superior without commensurate achievements.
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Belief in being special and unique, and that they can only be understood by or associated with other special or high-status people or institutions.
- A constant need for excessive admiration, coupled with a sense of entitlement (e.g., unreasonable expectations of favourable treatment or automatic compliance with their expectations).
- Exploitative behavior in interpersonal relationships, meaning they take advantage of others without regard for their feelings or needs.
- Envy of others or the belief that others are envious of them.
- Arrogant, haughty behaviors or attitudes, often unaware that they are being socially excluded because of this.
A particular issue with narcissistic personality disorder is the tendency toward self-harm (through alcohol, drugs, or other unhealthy behaviors), sometimes even leading to serious suicidal impulses—especially when they feel deeply insulted or humiliated.
Due to their high demands and low willingness to give, narcissistic individuals are often unpopular in their social circles, which can create a vicious cycle of isolation and bitterness.
Treatment Narcissistic Personality Disorder
Narcissistic personality disorder is a challenging character structure that can only be influenced, if at all, through targeted psychotherapeutic interventions. Given their low tolerance for frustration and quick sensitivity to criticism, individual therapy is usually more effective, especially in the early stages of treatment.
Psychotherapeutic techniques used in the treatment are TFT, DBT, or CBT.
Therapy should quickly determine:
- How much confrontation (i.e., addressing the problematic traits and trying to change them constructively) and,
- How much supportive care is necessary or possible—depending on the patient’s emotional resilience.
Medications are generally used sparingly. However, antidepressants (such as SSRIs) may be recommended for persistent anxious-depressive moods, and in cases of extreme mood swings (emotional instability), mood stabilisers may be used occasionally.
Cluster C Personality Disorders
People with Cluster C personality disorders are described as anxious and fearful. Their key emotions include tension, worry, helplessness, and dependency. They are easily hurt by criticism or rejection and suffer from intense separation anxiety. Excessive conscientiousness makes them inflexible and prone to passive aggression.
Avoidant Personality Disorder
Avoidant personality disorder (also known as anxious avoidant personality disorder) affects individuals who, due to a fear of rejection or criticism, avoid interpersonal relationships unless they are certain of success or acceptance.
Symptoms of Avoidant Personality Disorder
For individuals with avoidant personality disorder, “greatest wish in life” might be to receive more attention from others. They come across as incompetent in social interactions due to their insecurity, shines, anxiousness, and their feeling of being socially inferior and unattractive. This leads them to stay hidden, not daring to come out of their shell.
They reluctantly take on new or risky tasks, even when others see them as harmless or routine, because their fear of making mistakes and being humiliated feels so overwhelming that they may indeed make those mistakes. As a result, they often avoid taking on such challenges altogether.
This pattern leads to avoiding social or professional activities and the drying up of interpersonal contacts out of fear of criticism, disapproval, or rejection. Ultimately, it results in a restricted lifestyle, shaped by an exaggerated need for security.
There are many similarities and overlaps between avoidant personality disorder and social phobia (see that section).
Treatment of Avoidant Personality Disorder
Patients with avoidant personality disorder would like to break this vicious cycle, but their personality traits—especially low self-esteem (“I can’t do it anyway”) and fear of disappointment, rejection, and criticism (“What will people expect from me?”)—hinder the needed to achieve this.
Therefore, individual therapy is initially recommended, focusing on supportive care to help the patient gradually build trust and develop some emotional resilience. Behavioural therapy in group settings has also proven useful, where individuals can support and help each other.
If anxious-depressive moods dominate, medications—particularly antidepressants—can be considered in individual cases.
Dependent Personality Disorder
The term “dependent” comes from the Latin dependere, meaning “to hang upon.” Dependent personality disorder, also known as asthenic personality disorder, is characterised by a feeling of inability to lead one’s life independently.
People with this disorder see themselves as weak and helpless, relying heavily on others, particularly their partner, close relatives, friends, or neighbours, for support in all life situations. They are also constantly plagued by an overwhelming fear of separation, helplessness, and incompetence, with their sense of powerlessness manifesting either mentally or emotionally.
As a result, individuals with dependent personality disorder are often unwilling to take responsibility for themselves, even when given the opportunity. In relationships, they have a constant fear of loss or being left alone.
Treatment of Dependent Personality Disorder
Although the dependent personality traits negatively affect their ability to assert themselves in social situations, they are advantageous when it comes to establishing a therapeutic relationship. Patients are usually eager to accept help and are adaptable and reliable in following through with psychotherapy.
However, there is a risk that the treatment situation might create a new dependency. Therefore, the main goal of therapy is to improve self-confidence and autonomy. Gradually, the positive traits of dependent personality disorder—such as good social integration and a strong willingness to perform (often used to gain the approval of others)—can be harnessed.
CBT
Cognitive and behavioural interventions focus on improving the patient’s ability to act independently and their trust in their own abilities. This helps them better recognise and pursue their own interests, even if it means slowly separating from former carers (whom they may not want to hurt or lose through their independence).
Role-playing and assertiveness training can be helpful, starting with individual therapy and then involving the partner (who may have contributed to the dependency through excessive support) before transitioning to group therapy.
Medication
Medications are rarely needed, but antidepressants may be used temporarily for depressive mood swings.
Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder involves an overwhelming pattern of excessive order, perfectionism, and control. People with this disorder value strict adherence to rules, procedures, order, and organisation. They obsess over minor details and check for possible errors due to their compulsive nature.
Their excessive perfectionism causes significant impairments and suffering. In striving for absolute perfection, they often focus on details and never complete tasks. They prioritise work and productivity over leisure, even without financial need or job pressure. Unplanned free time causes stress, turning hobbies into tasks demanding perfect performance.
Only tasks requiring effort and achievement have real value for them. They have rigid views on morality, believing they’re right and expecting others to follow suit. Relentlessly self-critical, they are harsh on their own mistakes. They reluctantly delegate tasks, insisting others follow their exact working style.
Detailed instructions on tasks like cleaning or mowing the lawn are common, and nothing satisfies them. They reject help and react irritably to suggestions from others. They struggle to discard broken or worthless items, thinking they might need them someday. Hoarding can cause space issues in their home.
They are often stingy, saving money for future catastrophes despite having enough.
They disregard others’ opinions, convinced they are always right. The exact causes are unclear but likely involve genetic, psychological, and environmental factors.
Differences between Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder
Obsessive-Compulsive Disorder (OCD) often develops later in life and causes significant distress. In contrast, obsessive-compulsive personality disorder symptoms are deeper-rooted and often begin in childhood.
People with obsessive-compulsive personality disorder usually don’t view their behaviours as “disordered.” In OCD, intrusive thoughts and actions, like repeated hand-washing or reciting numbers, feel compulsive and are recognised as irrational.
Treatment of Obsessive-Compulsive Personality Disorder
People with obsessive-compulsive personality disorder often start therapy when suffering from other mental disorders, typically anxiety or depression. They are usually highly motivated to complete therapy and persist through challenges.
A challenge in therapy is patients’ rigid adherence to current attitudes and behaviours. It’s essential to encourage motivation for change and to reshape areas of their lives. Patients may get lost in details; therapists should redirect discussions to current issues.
The focus is not on changing core traits like conscientiousness, which can be useful. Instead, patients learn to handle problems and conflicts better, exploring new approaches. They are encouraged to allow enjoyable activities and experiences into their lives.
While Cognitive Behavioural Therapy is the most effective for OCD, various other psychotherapeutic approaches benefit obsessive-compulsive personality disorder.
Psychoanalytic and Depth-Psychology-Based Therapy
Long-term therapy is typically considered beneficial for this disorder. Therapy should be structured, focusing on present-day topics with gentle clarification of problematic behaviours. The goal is to help patients overcome insecurities, take more risks, and make life changes. Rigid norms internalised from parents should be questioned, allowing access to emotions behind compulsive behaviours. Patients are encouraged to openly discuss thoughts and feelings.
Cognitive Behavioural Therapy (CBT)
Given patients’ preference for rational, structured approaches, a clear therapy structure is useful. Sessions are planned, with tasks assigned between sessions. Key goals include challenging perfectionism, black-and-white thinking, indecision, and hesitation. Therapy replaces rigid thoughts and behaviours with more flexible, goal-orientated ones. Patients also learn to better perceive their feelings and align actions with emotions.
Medication therapy is generally not seen as effective for treating obsessive-compulsive personality disorder. Medication is usually prescribed only for coexisting mental disorders, like depression or anxiety.
Passive-Aggressive Personality Disorder
This personality disorder is classified in ICD 10 and not in DSM 5. Taking in consideration the diagnostic shift in ICD 11, which abandoned the categories of personality disorders, the below description might have a purely historic importance.
Passive-aggressive personality disorder is primarily characterised by a deep-rooted pattern of negativistic attitudes and passive resistance to demands for performance. Negativistic, in this context, refers to a compulsive tendency to reject or oppose, meaning a persistently negative, defiant attitude similar to rebellious behaviour often seen in adolescence. However, while this behaviour can be temporary and understandable during adolescence, it is not acceptable as a permanent life stance.
Symptoms Passive-Aggressive Personality Disorder
People with passive-aggressive personality disorder often feel misunderstood by others, frequently complain about personal misfortunes (which they often create themselves), and tend to be moody and argumentative—essentially “unpleasant companions.”
They show disproportionate criticism, even contempt, towards authority figures, which doesn’t help their situation. They may respond to people who seem to have a happier life with envy, resentment, or an odd mix of hostile defiance and, at times, submissive regret.
The ambivalence in their thinking and behaviour, combined with low self-esteem (constantly devaluing others, which ultimately leads to self-devaluation), often leads to conflicts with their environment. These conflicts and personal disappointments are typically blamed on others but are actually self-provoked.
This behaviour pattern underlying passive-aggressive personality disorder is also found in various other conditions, such as borderline personality disorder, histrionic (hysterical), paranoid (delusional), dependent (reliant on others), antisocial, and avoidant personality disorders.
Personality Disorders. Conclusion and Outlook
Abnormal personalities or personality disorders typically exist in the grey area between a healthy and a disturbed mental state. These transitions are fluid and can show a wide range of variation even within a single individual’s life. To better understand this phenomenon, it is time to finally move away from the purely negative perception of personality disorders in public opinion. There are indeed advantages. There are plenty of examples where seemingly negative traits, when expressed at the right time, in the right place, and by the right person, can result in positive achievements—whether in politics, military, economics, culture, or the arts.
Changes of Personality Disorders over Time
Personality disorders are more frequently influenced by challenging life experiences and related pathological reactions than many other mental disorders. These are shaped both by the individual’s tense constitution (innate disposition and physical makeup) and their biography (life history).
This means that significant progress in understanding personality disorders will most likely come from developmental psychological research as well as neurobiological studies. This will, in turn, shape treatments, which should include not only psychotherapy and socio-therapeutic interventions but also medication as part of a comprehensive treatment plan.
This presents an opportunity for those affected, as well as their families, friends, neighbours, and colleagues. Personality disorders are psychological conditions that affect not just the individual but also, and often especially, their surroundings.