Personality disorder#DSM-5

The two latest editions of the major systems of classification are:

• the International Classification of Diseases (11th revision, ICD-11) published by the World Health Organization
• the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, DSM-5) by the American Psychiatric Association.

The ICD is a collection of alpha-numerical codes which have been assigned to all known clinical states, and provides uniform terminology for medical records, billing, statistics and research. The DSM defines psychiatric diagnoses based on research and expert consensus. Both have deliberately aligned their diagnoses to some extent, but some differences remain. For example, the ICD-10 included narcissistic personality disorder in the group of other specific personality disorders, while DSM-5 does not include enduring personality change after catastrophic experience. The ICD-10 classified the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other.{{cite journal | vauthors = Widiger TA | title = Personality disorder diagnosis | journal = World Psychiatry | volume = 2 | issue = 3 | pages = 131–135 | date = October 2003 | pmid = 16946918 | pmc = 1525106 | author-link = Thomas Widiger }} Dissociative identity disorder, previously known as multiple personality as well as multiple personality disorder, has always been classified as a dissociative disorder and never was regarded as a personality disorder.{{cite web |url= http://www.who.int/classifications/icd/en/GRNBOOK.pdf |publisher=World Health Organization |title=The ICD-10 Classification of Mental and Behavioural Disorders }}
{{Cite book |url= https://apps.who.int/iris/bitstream/handle/10665/37108/9241544554.pdf|title=The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research|publisher=World Health Organization |year=1993|isbn=92-4-154455-4|location=Geneva|pages=104|oclc=29457599}}
{{Cite book| url=https://apps.who.int/iris/bitstream/handle/10665/37958/9241544228_eng.pdf|title=The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines.|date=1992|publisher=World Health Organization |isbn=92-4-154422-8|location=Geneva|pages=160|oclc=28294867}}
{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R|publisher=American Psychiatric Association|year=1987|isbn=0-89042-018-1|location=Washington, D.C.|pages=269–272}}

{{See also|DSM-5#Personality disorders}}

The most recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders stresses that a personality disorder is an enduring and inflexible pattern of long duration leading to significant distress or impairment and is not due to use of substances or another medical condition. The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.[http://www.medscape.com/viewarticle/803884_8 A Guide to DSM-5: Personality Disorders] Medscape Psychiatry, Bret S. Stetka, MD, Christoph U. Correll, 21 May 2013 DSM-5 lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive–compulsive personality disorder. The DSM-5 chapter on personality disorders also contains three diagnoses for conditions not matching these ten disorders,{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |title-link=DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |edition=5th |location=Washington, D.C |pages=682–684 |chapter=Personality Disorders}} which nevertheless exhibit characteristics of a personality disorder:

• Personality change due to another medical condition{{dash}}personality disturbance due to the direct effects of a medical condition{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |title-link=DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |edition=5th |location=Washington, D.C |page=683 |quote=The essential feature of a personality change due to another medical condition is a persistent personality disturbance that is judged to be due to the direct pathophysiological effects of a medical condition.}}
• Other specified personality disorder{{dash}}used when recording the presence of personality disorder along with the reasons for the condition not being classified as one of the specific personality disorders.
• Unspecified personality disorder{{dash}}used when a patient presents with personality disorder symptoms that cause distress or impairment, but the clinician either chooses not to indicate the specific reason these criteria are not met for any one disorder, or there isn’t enough information available to make a more precise diagnosis.

The specific personality disorders are grouped into the following three clusters based on descriptive similarities:

Cluster A personality disorders are often associated with schizophrenia. People with these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships.

• Paranoid personality disorder{{dash}}pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
• Schizoid personality disorder{{dash}}cold affect and detachment from social relationships, apathy, and restricted emotional expression
• Schizotypal personality disorder{{dash}}pattern of extreme discomfort interacting socially, and distorted cognition and perceptions

Significant evidence suggests a small proportion of people with Cluster A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders. These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder.{{cite journal | vauthors = Esterberg ML, Goulding SM, Walker EF | title = Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence | journal = Journal of Psychopathology and Behavioral Assessment | volume = 32 | issue = 4 | pages = 515–528 | date = December 2010 | pmid = 21116455 | pmc = 2992453 | doi = 10.1007/s10862-010-9183-8 }}

Cluster B personality disorders are characterized by dramatic, impulsive, self-destructive, emotional behavior and sometimes incomprehensible interactions with others.{{cite web|url=https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463|title=Personality disorders - Symptoms and causes|website=Mayo Clinic|access-date=26 January 2019}}

• Antisocial personality disorder{{dash}}pervasive pattern of disregard for and violation of the rights of others, lack of empathy, lack of remorse, callousness, bloated self-image, and manipulative and impulsive behavior
• Borderline personality disorder{{dash}}pervasive pattern of abrupt emotional outbursts, fear of abandonment, unhealthy attachment, altered empathy,{{cite journal | vauthors = Niedtfeld I | title = Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processing | journal = Psychiatry Research | volume = 253 | pages = 58–63 | date = July 2017 | pmid = 28351003 | doi = 10.1016/j.psychres.2017.03.037 | s2cid = 13764666 }} and instability in relationships, self-image, identity, behavior and affect, often leading to self-harm and impulsivity
• Histrionic personality disorder{{dash}}pervasive pattern of attention-seeking behavior, including excessive emotions, an impressionistic style of speech, inappropriate seduction, exhibitionism, and egocentrism
• Narcissistic personality disorder{{dash}}pervasive pattern of grandiosity, haughtiness, intense anger towards criticism, overwhelming envy, need for admiration, deceptive and vindictive tendencies, and lack of empathy (and, in more severe expressions, criminal behavior {{em|with}} remorse).{{cite journal | vauthors = Lenzenweger MF, Clarkin JF, Caligor E, Cain NM, Kernberg OF | title = Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study | journal = Psychopathology | volume = 51 | issue = 5 | pages = 318–325 | year = 2018 | pmid = 30184541 | doi = 10.1159/000492228 | s2cid = 52160230 }}

Cluster C personality disorders are characterised by a consistent pattern of anxious thinking or behavior.

• Avoidant personality disorder{{dash}}pervasive feelings of social inhibition and inadequacy, and extreme sensitivity to negative evaluation
• Dependent personality disorder{{dash}}pervasive psychological need to be cared for by other people
• Obsessive–compulsive personality disorder{{dash}}rigid conformity to rules, perfectionism, and control to the point of exclusion of leisurely activities and friendships (distinct from obsessive–compulsive disorder)

Both the DSM-5 and the ICD-11{{Citation needed|date=April 2025}} diagnostic systems provide a definition and six criteria for a general personality disorder. These criteria should be met by all personality disorder cases before a more specific diagnosis can be made. The DSM-5 indicates that any of its ten personality disorder diagnoses{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |editor-last=American Psychiatric Association |edition=5th |location=Washington, D.C |pages=645–649 |chapter=Personality Disorders |quote=This chapter begins with a general definition of personality disorder that applies to each of the 10 specific personality disorders. |editor-last2=American Psychiatric Association}} is subject to the following criteria for General Personality Disorder:

• There is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
• Cognition (i.e., ways of perceiving and interpreting self, other people, and events)
• Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
• Interpersonal functioning
• Impulse control
• The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
• The enduring pattern leads to clinically significant distress, or impairment in functioning, in social, occupational, or other important areas.
• The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
• The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
• The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

{{Main|Alternative DSM-5 model for personality disorders}}

The Alternative DSM-5 Model for Personality Disorders (AMPD) presents a dimensional approach to diagnosis, contrasting with traditional categorical systems. It aims to address several limitations of categorical systems, particularly the issues imprecision of excessive comorbidity. This model evaluates personality pathology through two fundamental components: impaired personality functioning and pathological personality traits.{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |editor-last=American Psychiatric Association |edition=5th |location=Washington, D.C |pages=761–763 |editor-last2=American Psychiatric Association}}

Personality functioning is assessed across self and interpersonal domains. The self domain encompasses identity and self-direction, while the interpersonal domain includes capacity for empathy and intimacy. Clinicians rate the degree of impairment using the Level of Personality Functioning Scale (LPFS), which ranges from 0 (little or no impairment) to 4 (extreme impairment).

The model identifies five broad trait domains that characterize pathological personality expression: Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. These domains are further divided into 25 specific trait facets that provide detailed characterization of individual presentations.

For diagnosis, the AMPD requires that these difficulties must be pervasive across situations and stable over time, typically emerging in adolescence or early adulthood. The disturbances cannot be better explained by other mental disorders, substance use, medical conditions, or attributed to developmental stages or sociocultural contexts.

The AMPD includes six specific personality disorders: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal. It excludes four personality disorder categories (dependent, histrionic, paranoid, and schizoid) that are present in the standard model. For cases that don't meet criteria for specific disorders but still show significant impairment, the model provides the Personality Disorder-Trait Specified (PD-TS) category, which documents the particular pattern of functional impairment and pathological traits.{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |editor-last=American Psychiatric Association |edition=5th |location=Washington, D.C |pages=770–771 |quote=The current diagnoses of paranoid, schizoid, histrionic, and dependent personality disorders are represented also by the diagnosis of PD-TS; these are defined by moderate or greater impairment in personality functioning and can be specified by the relevant pathological personality trait combinations.}}

{{See also|ICD-11#Personality disorder}}

The ICD-11 personality disorder section differs substantially from the previous edition, ICD-10. All distinct PDs have been merged into one: personality disorder ({{ICD11|6D10}}), which can be coded as mild ({{ICD11|6D10.0}}), moderate ({{ICD11|6D10.1}}), severe ({{ICD11|6D10.2}}), or severity unspecified ({{ICD11|6D10.Z}}). Severity is determined by the level of distress experienced and degree of impact on day to day activities which results from difficulties in fuctioning aspects of self, (i,e, identity and agency) and interpersonal relationships. There is also an additional category called personality difficulty ({{ICD11|QE50.7}}), which can be used to describe personality traits that are problematic, but do not meet the diagnostic criteria for a PD. A personality disorder or difficulty can be specified by one or more prominent personality traits or patterns ({{ICD11|6D11}}). The ICD-11 uses five trait domains:

1. Negative affectivity ({{ICD11|6D11.0}}) – including anxiety, separation insecurity, distrustfulness, worthlessness and emotional instability
2. Detachment ({{ICD11|6D11.1}}) – including social detachment and emotional coldness
3. Dissociality ({{ICD11|6D11.2}}) – including grandiosity, egocentricity, deception, exploitativeness and aggression
4. Disinhibition ({{ICD11|6D11.3}}) – including risk-taking, impulsivity, irresponsibility and distractibility
5. Anankastia ({{ICD11|6D11.4}}) – including rigid control over behaviour and affect and rigid perfectionism

Listed directly underneath is borderline pattern ({{ICD11|6D11.5}}), a category similar to borderline personality disorder. This is not a trait in itself, but a combination of the five traits in certain severity. In the ICD-11, any personality disorder must meet all of the following criteria:{{Cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/941859884 | publisher= |website= icd.who.int| date= |access-date=2022-04-28}}

• There is an enduring disturbance characterized by problems in functioning of aspects of the self (e.g., identity, self-worth, accuracy of self-view, self-direction), and/or interpersonal dysfunction (e.g., ability to develop and maintain close and mutually satisfying relationships, ability to understand others' perspectives and to manage conflict in relationships).
• The disturbance has persisted over an extended period of time (e.g., lasting 2 years or more).
• The disturbance is manifest in patterns of cognition, emotional experience, emotional expression, and behaviour that are maladaptive (e.g., inflexible or poorly regulated).
• The disturbance is manifest across a range of personal and social situations (i.e., is not limited to specific relationships or social roles), though it may be consistently evoked by particular types of circumstances and not others.
• The symptoms are not due to the direct effects of a medication or substance, including withdrawal effects, and are not better accounted for by another mental disorder, a disease of the nervous system, or another medical condition.
• The disturbance is associated with substantial distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
• Personality disorder should not be diagnosed if the patterns of behaviour characterizing the personality disturbance are developmentally appropriate (e.g., problems related to establishing an independent self-identity during adolescence) or can be explained primarily by social or cultural factors, including socio-political conflict.

The ICD-10 lists these general guideline criteria:{{Cite book |title=The ICD-10 Classification of Mental and Behavioural Disorders – Clinical descriptions and diagnostic guidelines |publisher=WHO (2010) |pages=157–58 |chapter=Disorders of adult personality and behaviour (F60–F69) |chapter-url=https://www.who.int/classifications/icd/en/bluebook.pdf}}

• Markedly disharmonious attitudes and behavior, generally involving several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
• The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
• The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
• The above manifestations always appear during childhood or adolescence and continue into adulthood;
• The disorder leads to considerable personal distress but this may only become apparent late in its course;
• The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations." Chapter V in the ICD-10 contains the mental and behavioral disorders and includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks, and feels, particularly in relating to others.WHO (2010) [http://apps.who.int/classifications/icd10/browse/2010/en#/F60 ICD-10: Specific Personality Disorders]

The specific personality disorders are: paranoid, schizoid, schizotypal, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, narcissistic, anankastic, anxious (avoidant) and dependent.[https://web.archive.org/web/20181210205620/http://behaviouralsciences.net/classifications/icd10/browse/2010/en#/F60-F69 "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)"]. Apps.who.int. Retrieved on 16 April 2013. Besides the ten specific PD, there are the following categories:

• Other specific personality disorders (involves PD characterized as eccentric, haltlose, immature, narcissistic, passive–aggressive, or psychoneurotic).
• Personality disorder, unspecified (includes "character neurosis" and "pathological personality").
• Mixed and other personality disorders (defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders).
• Enduring personality changes, not attributable to brain damage and disease (this is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness).

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. Examples include sadistic personality disorder (pervasive pattern of cruel, demeaning, and aggressive behavior) and self-defeating personality disorder or masochistic personality disorder (characterized by behavior consequently undermining the person's pleasure and goals). They were listed in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria.{{cite journal | vauthors = Fuller AK, Blashfield RK, Miller M, Hester T | title = Sadistic and self-defeating personality disorder criteria in a rural clinic sample | journal = Journal of Clinical Psychology | volume = 48 | issue = 6 | pages = 827–831 | date = November 1992 | pmid = 1452772 | doi = 10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2-1 }} Psychologist Theodore Millon, a researcher on personality disorders, and other researchers consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.Theodore Millon (2004). [http://dlia.ir/Scientific/e_book/Medicine/Internal_Medicine/RC_435_571_Psychiatry_/017437.pdf Personality Disorders in Modern Life] {{webarchive|url=https://web.archive.org/web/20170207112700/http://dlia.ir/Scientific/e_book/Medicine/Internal_Medicine/RC_435_571_Psychiatry_/017437.pdf|date=7 February 2017}}. Wiley, 2nd Edition. {{ISBN|0-471-23734-5}}. ([https://books.google.com/books?id=BZjayfSEGyQC GoogleBooks Preview]). Millon proposed the following description of personality disorders:

In addition to classifying by category and cluster, it is possible to classify personality disorders using additional factors such as severity, impact on social functioning, and attribution.Murray, Robin M. et al (2008). Psychiatry. Fourth Edition. Cambridge University Press. {{ISBN|978-0-521-60408-6}}.

This involves both the notion of personality difficulty as a measure of subthreshold scores for personality disorder using standard interviews and the evidence that those with the most severe personality disorders demonstrate a "ripple effect" of personality disturbance across the whole range of mental disorders. In addition to subthreshold (personality difficulty) and single cluster (simple personality disorder), this also derives complex or diffuse personality disorder (two or more clusters of personality disorder present) and can also derive severe personality disorder for those of greatest risk.

There are several advantages to classifying personality disorder by severity:

• It not only allows for but also takes advantage of the tendency for personality disorders to be comorbid with each other.
• It represents the influence of personality disorder on clinical outcome more satisfactorily than the simple dichotomous system of no personality disorder versus personality disorder.
• This system accommodates the new diagnosis of severe personality disorder, particularly "dangerous and severe personality disorder" (DSPD).

Social function is affected by many other aspects of mental functioning apart from that of personality. However, whenever there is persistently impaired social functioning in conditions in which it would normally not be expected, the evidence suggests that this is more likely to be created by personality abnormality than by other clinical variables.{{cite journal | vauthors = Nur U, Tyrer P, Merson S, Johnson T | title = Social function, clinical symptoms and personality disturbance | journal = Irish Journal of Psychological Medicine | volume = 21 | issue = 1 | pages = 18–21 | date = March 2004 | pmid = 30308726 | doi = 10.1017/S0790966700008090 | s2cid = 52962308 }} The Personality Assessment Schedule{{cite journal | vauthors = Standage KF | title = The use of Schneider's typology for the diagnosis of personality disorders--an examination of reliability | journal = The British Journal of Psychiatry | volume = 135 | issue = 2 | pages = 238–242 | date = September 1979 | pmid = 486849 | doi = 10.1192/bjp.135.2.163 | s2cid = 3182563 }} gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder.

Many who have a personality disorder do not recognize any abnormality and defend valiantly their continued occupancy of their personality role. This group have been termed the Type R, or treatment-resisting personality disorders, as opposed to the Type S or treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment. The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others.{{cite journal | vauthors = Tyrer P, Mitchard S, Methuen C, Ranger M | title = Treatment rejecting and treatment seeking personality disorders: Type R and Type S | journal = Journal of Personality Disorders | volume = 17 | issue = 3 | pages = 263–268 | date = June 2003 | pmid = 12839104 | doi = 10.1521/pedi.17.3.263.22152 }}

Psychoanalytic theory has been used to explain treatment-resistant tendencies as egosyntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are therefore perceived to be appropriate by that individual. In addition, this behavior can result in maladaptive coping skills and may lead to personal problems that induce extreme anxiety, distress, or depression and result in impaired psychosocial functioning.{{Cite journal | vauthors = Blumenthal S |date=2014-04-03 |title=Psychoanalytic diagnosis: understanding personality structure in the clinical process | edition = 2nd |journal=Psychoanalytic Psychotherapy |volume=28 |issue=2 |pages=233–234 |doi=10.1080/02668734.2014.909673 |s2cid=144761197 |issn=0266-8734}}

There is a considerable personality disorder diagnostic co-occurrence. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another. Diagnostic categories provide clear, vivid descriptions of discrete personality types but the personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.

Sites used DSM-III-R criterion sets. Data obtained for purposes of informing the development of the DSM-IV-TR personality disorder diagnostic criteria.

Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive–Compulsive Personality Disorder, PAPD – Passive–Aggressive Personality Disorder.

The disorders in each of the three clusters may share with each other underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively. But they may also have a spectrum relationship to certain syndromal mental disorders:

• Paranoid, schizoid or schizotypal personality disorders may be observed to be premorbid antecedents of delusional disorders or schizophrenia.
• Borderline personality disorder is seen in association with mood and anxiety disorders, with impulse-control disorders, eating disorders, ADHD, ASD, or a substance use disorder.
• Avoidant personality disorder is seen with social anxiety disorder.

It is generally assumed that all personality disorders are linked to impaired functioning and a reduced quality of life (QoL) because that is a basic diagnostic requirement. But research shows that this may be true only for some types of personality disorder. In several studies, higher levels of disability and lower QoL were predicted by avoidant, dependent, schizoid, paranoid, schizotypal and antisocial personality disorders. This link is particularly strong for avoidant, schizotypal and borderline PD. However, obsessive–compulsive PD was not related to a reduced QoL or increased impairment. A prospective study reported that all PD were associated with significant impairment 15 years later, except for obsessive compulsive and narcissistic personality disorder.{{cite book|url=https://books.google.com/books?id=RwNmAgAAQBAJ&pg=PA54|title=Personality Disorders| vauthors = Emmelkamp PM |publisher=Psychology Press|year=2013|isbn=978-1-317-83477-9|pages=54–56}}

One study investigated some aspects of "life success" (status, wealth and successful intimate relationships). It showed somewhat poor functioning for schizotypal, antisocial, borderline, and dependent PD; schizoid PD had the lowest scores regarding these variables. Paranoid, histrionic and avoidant PD were average. Narcissistic and obsessive–compulsive PD, however, had high functioning and appeared to contribute rather positively to these aspects of life success.{{cite journal | vauthors = Ullrich S, Farrington DP, Coid JW | title = Dimensions of DSM-IV personality disorders and life-success | journal = Journal of Personality Disorders | volume = 21 | issue = 6 | pages = 657–663 | date = December 2007 | pmid = 18072866 | doi = 10.1521/pedi.2007.21.6.657 | s2cid = 30040457 }} There is also a direct relationship between the number of diagnostic criteria and quality of life. For each additional personality disorder criterion that a person meets there is an even reduction in quality of life.{{Cite book|chapter-url=https://books.google.com/books?id=TlKTAwAAQBAJ&pg=PA126|title=The American Psychiatric Publishing textbook of personality disorders| vauthors = Torgersen S |isbn=978-1-58562-456-0|edition=Second|location=Washington, DC|pages=122–26|chapter=Prevalence, Sociodemographics and Functional Impairment|oclc=601366312|year=2014}} Personality disorders – especially dependent, narcissistic, and sadistic personality disorders – also facilitate various forms of counterproductive work behavior, including knowledge hiding and knowledge sabotage.{{cite journal | vauthors = Serenko A | title = Personality disorders as a predictor of counterproductive knowledge behavior: the application of the Millon Clinical Multiaxial Inventory-IV | journal = Journal of Knowledge Management | pages = 2249–2282| date = 2023 | volume = 27 | issue = 8 | doi = 10.1108/JKM-10-2021-0796 | s2cid = 256187160 | url = https://www.aserenko.com/papers/JKM_Personality_Disorders.pdf }}

Personality disorders can present differently across various life contexts, including personal, social, and professional settings. The impact of these disorders may vary depending on the specific diagnosis, severity, and the environment in which an individual functions. For example, personality traits that cause challenges in interpersonal relationships may be more apparent in highly social environments, whereas perfectionistic tendencies may surface in structured or high-pressure roles. Recognizing the situational context of these traits is important in understanding the lived experiences of individuals with personality disorders.

Personality disorders can impact workplace experiences in various ways, depending on the diagnosis, severity, individual, and job context. Some individuals may experience difficulties with interpersonal relationships, communication, or stress management, which can affect workplace dynamics{{Cite book |title=The American Psychiatric Publishing textbook of personality disorders |date=2014 |publisher=American Psychiatric Publishing, a Division of American Psychiatric Association |isbn=978-1-58562-456-0 |editor-last=Oldham |editor-first=John M. |edition=Second |location=Washington, DC |editor-last2=Skodol |editor-first2=Andrew E. |editor-last3=Bender |editor-first3=Donna S. |editor-last4=American Psychiatric Publishing}}{{Cite journal |last=Serenko |first=Alexander |date=2023-10-19 |title=Personality disorders as a predictor of counterproductive knowledge behavior: the application of the Millon Clinical Multiaxial Inventory-IV |url=https://www.emerald.com/insight/content/doi/10.1108/JKM-10-2021-0796/full/html |journal=Journal of Knowledge Management |language=en |volume=27 |issue=8 |pages=2249–2282 |doi=10.1108/JKM-10-2021-0796 |issn=1367-3270}}. In addition to the direct effects of personality-related traits, indirect factors such as comorbid mental health conditions, educational challenges, or external life stressors may also influence job performance{{Cite book |url=https://www.worldcat.org/title/705888562 |title=Work accommodation and retention in mental health |date=2011 |publisher=Springer |isbn=978-1-4419-0427-0 |editor-last=Schultz |editor-first=Izabela Z. |location=New York |oclc=705888562 |editor-last2=Rogers |editor-first2=E. Sally}} {{Cite journal |last1=Ettner |first1=Susan L. |last2=Maclean |first2=Johanna Catherine |last3=French |first3=Michael T. |date=January 2011 |title=Does Having a Dysfunctional Personality Hurt Your Career? Axis II Personality Disorders and Labor Market Outcomes: Axis II Personality Disorders and Labor Market Outcomes |journal=Industrial Relations: A Journal of Economy and Society |language=en |volume=50 |issue=1 |pages=149–173 |doi=10.1111/j.1468-232X.2010.00629.x |pmc=3204880 |pmid=22053112}}.

While challenges may exist, individuals with personality disorders can also be in high level positions in the corporate world. In 2005 and again in 2009, psychologists Belinda Board and Katarina Fritzon at the University of Surrey, UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK. They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:

• Histrionic personality disorder: including superficial charm, insincerity, egocentricity and manipulation

• Narcissistic personality disorder: including grandiosity, self-focused lack of empathy for others, exploitativeness and independence.

• Obsessive–compulsive personality disorder: including perfectionism, excessive devotion to work, rigidity, stubbornness and dictatorial tendencies{{Cite journal |last1=Board |first1=Belinda Jane |last2=Fritzon |first2=Katarina |date=March 2005 |title=Disordered personalities at work |url=http://www.tandfonline.com/doi/abs/10.1080/10683160310001634304 |journal=Psychology, Crime & Law |language=en |volume=11 |issue=1 |pages=17–32 |doi=10.1080/10683160310001634304 |issn=1068-316X}}.

According to leadership academic Manfred F.R. Kets de Vries, it seems almost inevitable that some personality disorders will be present in a senior management team{{Cite journal |last=Dearlove |first=Des |date=September 2003 |title=Interview: Manfred Kets de Vries: The Dark Side of Leadership |url=https://onlinelibrary.wiley.com/doi/10.1111/1467-8616.00269 |journal=Business Strategy Review |language=en |volume=14 |issue=3 |pages=25–28 |doi=10.1111/1467-8616.00269 |issn=0955-6419}}.

{{Main|Personality development disorder}}

Diagnosing personality disorders in children is approached with caution. During childhood and adolescence, personality traits are still forming as well as ongoing cognitive and emotional development. Rather than focusing on formal diagnoses, clinicians and researchers often emphasize identifying early signs of maladaptive behavior patterns that may become more stable over time. Early stages and preliminary forms of personality disorders need a multi-dimensional and early treatment approach. Personality development disorder is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood. In addition, in Robert F. Krueger's review of their research indicates that some children and adolescents do experience clinically significant syndromes that resemble adult personality disorders, and that these syndromes have meaningful correlates and are consequential. Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual. Hence, they are less likely to encounter the first risk they described at the outset of their review: clinicians and researchers are not simply avoiding use of the PD construct in youth. However, they may encounter the second risk they described: under-appreciation of the developmental context in which these syndromes occur. That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases{{Cite journal |last1=Krueger |first1=Robert F. |last2=Carlson |first2=Scott R. |date=February 2001 |title=Personality disorders in children and adolescents |url=http://link.springer.com/10.1007/s11920-001-0072-4 |journal=Current Psychiatry Reports |language=en |volume=3 |issue=1 |pages=46–51 |doi=10.1007/s11920-001-0072-4 |pmid=11177759 |issn=1523-3812}}.

Additionally, diagnosing a child with a personality disorder is followed with a big stigma that can be difficult for a child to face{{Cite journal |date=2017 |title=APA Upgrades APA PsycNET Content Delivery Platform |url=https://doi.org/10.1037/e500792018-001 |access-date=2025-05-05 |website=PsycEXTRA Dataset|doi=10.1037/e500792018-001 }}.

{{See also|Big Five personality traits|Myers-Briggs Type Indicator#Personality disorders}}Personality disorders classification (DSM-5 and ICD-10) follows a categorical approach that views personality disorders as discrete entities that are distinct from each other and from normal personality. In contrast, the dimensional approach suggests that personality disorders exist on a continuum, with traits varying in degree rather than kind. This dimensional perspective may allow for more nuanced understanding and flexible diagnostic practices. Notably, psychologist Thomas Widiger has contributed extensively to the literature supporting dimensional models of personality pathology.

Thomas Widiger, a psychologist, and his collaborators have contributed to this debate significantly{{Cite journal |last=Widiger |first=Thomas A. |date=April 1993 |title=The DSM-III-R Categorical Personality Disorder Diagnoses: A Critique and an Alternative |url=http://www.tandfonline.com/doi/abs/10.1207/s15327965pli0402_1 |journal=Psychological Inquiry |language=en |volume=4 |issue=2 |pages=75–90 |doi=10.1207/s15327965pli0402_1 |issn=1047-840X}}. He discussed the constraints of the categorical approach and argued for the dimensional approach to personality disorders. Specifically, he proposed the Five Factor Model of personality as an alternative to the classification of personality disorders. For example, this view specifies that Borderline Personality Disorder can be understood as a combination of emotional lability (i.e., high neuroticism), impulsivity (i.e., low conscientiousness), and hostility (i.e., low agreeableness). Many studies across cultures have explored the relationship between personality disorders and the Five Factor Model{{Cite book |title=Personality disorders and the five-factor model of personality |date=2002 |publisher=American Psychological Association |isbn=978-1-55798-826-3 |editor-last=Costa |editor-first=Paul T. |edition=2nd |location=Washington, DC |editor-last2=Widiger |editor-first2=Thomas A.}}. This research has demonstrated that personality disorders largely correlate in expected ways with measures of the Five Factor Model{{Cite journal |last1=Samuel |first1=D |last2=Widiger |first2=T |date=December 2008 |title=A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis☆ |journal=Clinical Psychology Review |language=en |volume=28 |issue=8 |pages=1326–1342 |doi=10.1016/j.cpr.2008.07.002 |pmc=2614445 |pmid=18708274}}(63) and has set the stage for including the Five Factor Model within DSM-5{{Cite journal |last1=Samuel |first1=D |last2=Widiger |first2=T |date=December 2008 |title=A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis☆ |journal=Clinical Psychology Review |language=en |volume=28 |issue=8 |pages=1326–1342 |doi=10.1016/j.cpr.2008.07.002 |pmc=2614445 |pmid=18708274}}.

In clinical settings, personality disorders are typically diagnosed through comprehensive interviews conducted by psychiatrists or clinical psychologists. These assessments often include a mental status examination and may be informed by collateral reports from family members or close acquaintances.

One structured approach to diagnosis involves standardized interviews accompanied by scoring systems. Patients respond to a series of questions, and trained clinicians evaluate their answers based on predefined diagnostic criteria. Although effective, this method is often time-consuming and resource-intensive, which may limit its practicality in some clinical settings.{{sort under}} {{sticky table start}}

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Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive–Compulsive Personality Disorder, PAPD – Passive–Aggressive Personality Disorder, DpPD – Depressive Personality Disorder, SDPD – Self-Defeating Personality Disorder, SaPD – Sadistic Personality Disorder, and n/a – not available.

As of 2002, there were over fifty published studies relating the five factor model (FFM) to personality disorders.Widiger TA, Costa PT., Jr. (2002) "Five-Factor model personality disorder research", pp. 59–87 in Costa Paul T, Jr, Widiger Thomas A. (eds.) Personality disorders and the five-factor model of personality. 2nd ed. Washington, DC: American Psychological Association. {{ISBN|978-1-55798-826-3}}. Since that time, quite a number of additional studies have expanded on this research base and provided further empirical support for understanding the DSM personality disorders in terms of the FFM domains.Mullins-Sweatt SN, Widiger TA (2006). "The five-factor model of personality disorder: A translation across science and practice", pp. 39–70 in Krueger R, Tackett J (eds.). Personality and psychopathology: Building bridges. New York: Guilford. In her seminal review of the personality disorder literature published in 2007, Lee Anna Clark asserted that "the five-factor model of personality is widely accepted as representing the higher-order structure of both normal and abnormal personality traits".{{cite journal | vauthors = Clark LA | title = Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization | journal = Annual Review of Psychology | volume = 58 | pages = 227–257 | year = 2007 | pmid = 16903806 | doi = 10.1146/annurev.psych.57.102904.190200 | s2cid = 2728977 | url = https://zenodo.org/record/1134186 }} The five factor model has been shown to significantly predict all 10 personality disorder symptoms and outperform the Minnesota Multiphasic Personality Inventory (MMPI) in the prediction of borderline, avoidant, and dependent personality disorder symptoms.{{cite journal| vauthors = Bagby RM, Sellbom M, Costa PT, Widiger TA |year=2008|title=Predicting Diagnostic and Statistical Manual of Mental Disorders-IV personality disorders with the five-factor model of personality and the personality psychopathology five|journal=Personality and Mental Health|volume=2|issue=2|pages=55–69|doi=10.1002/pmh.33 }}

Research results examining the relationships between the FFM and each of the ten DSM personality disorder diagnostic categories are widely available. For example, in a study published in 2003 titled "The five-factor model and personality disorder empirical literature: A meta-analytic review",{{cite journal | vauthors = Saulsman LM, Page AC | title = The five-factor model and personality disorder empirical literature: A meta-analytic review | journal = Clinical Psychology Review | volume = 23 | issue = 8 | pages = 1055–1085 | date = January 2004 | pmid = 14729423 | doi = 10.1016/j.cpr.2002.09.001 }} the authors analyzed data from 15 other studies to determine how personality disorders are different and similar, respectively, with regard to underlying personality traits. In terms of how personality disorders differ, the results showed that each disorder displays a FFM profile that is meaningful and predictable given its unique diagnostic criteria. With regard to their similarities, the findings revealed that the most prominent and consistent personality dimensions underlying a large number of the personality disorders are positive associations with neuroticism and negative associations with agreeableness.

{{Main|Openness to experience}}

At least three aspects of openness to experience are relevant to understanding personality disorders: cognitive distortions, lack of insight (means the ability to recognize one's own mental illness) and impulsivity. Problems related to high openness that can cause problems with social or professional functioning are excessive fantasising, peculiar thinking, diffuse identity, unstable goals and nonconformity with the demands of the society.{{cite journal | vauthors = Piedmont RL, Sherman MF, Sherman NC | title = Maladaptively high and low openness: the case for experiential permeability | journal = Journal of Personality | volume = 80 | issue = 6 | pages = 1641–1668 | date = December 2012 | pmid = 22320184 | doi = 10.1111/j.1467-6494.2012.00777.x }}

High openness is characteristic to schizotypal personality disorder (odd and fragmented thinking), narcissistic personality disorder (excessive self-valuation) and paranoid personality disorder (sensitivity to external hostility). Lack of insight (shows low openness) is characteristic to all personality disorders and could help explain the persistence of maladaptive behavioral patterns.{{cite journal | vauthors = Piedmont RL, Sherman MF, Sherman NC, Dy-Liacco GS, Williams JE | title = Using the five-factor model to identify a new personality disorder domain: the case for experiential permeability | journal = Journal of Personality and Social Psychology | volume = 96 | issue = 6 | pages = 1245–1258 | date = June 2009 | pmid = 19469599 | doi = 10.1037/a0015368 }}

The problems associated with low openness are difficulties adapting to change, low tolerance for different worldviews or lifestyles, emotional flattening, alexithymia and a narrow range of interests. Rigidity is the most obvious aspect of (low) openness among personality disorders and that shows lack of knowledge of one's emotional experiences. It is most characteristic of obsessive–compulsive personality disorder; the opposite of it known as impulsivity (here: an aspect of openness that shows a tendency to behave unusually or autistically) is characteristic of schizotypal and borderline personality disorders.

Currently, there are no definitive proven causes for personality disorders. However, there are numerous possible causes and known risk factors supported by scientific research that vary depending on the disorder, the individual, and the circumstance. Overall, findings show that genetic disposition and life experiences, such as trauma and abuse, play a key role in the development of personality disorders.

Child abuse and neglect consistently show up as risk factors to the development of personality disorders in adulthood.{{cite journal | vauthors = Cohen P, Brown J, Smaile E | title = Child abuse and neglect and the development of mental disorders in the general population | journal = Development and Psychopathology | volume = 13 | issue = 4 | pages = 981–999 | year = 2001 | pmid = 11771917 | doi = 10.1017/S0954579401004126 | s2cid = 24036702 }} A study looked at retrospective reports of abuse of participants that had demonstrated psychopathology throughout their life and were later found to have past experience with abuse. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, and told them that they did not love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children (who did not experience such verbal abuse) to have borderline, narcissistic, obsessive–compulsive or paranoid personality disorders in adulthood.{{cite web|title=What Causes Psychological Disorders? |work=American Psychological Association|year= 2010|url=http://apa.org/topics/personality/disorders-causes.aspx|archive-url=https://web.archive.org/web/20101120002217/http://apa.org/topics/personality/disorders-causes.aspx|archive-date=20 November 2010}} The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong correlation with the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood.

Socioeconomic status has also been looked at as a potential cause for personality disorders. There is a strong association with low parental/neighborhood socioeconomic status and personality disorder symptoms.{{cite journal | vauthors = Cohen P, Chen H, Gordon K, Johnson J, Brook J, Kasen S | title = Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms | journal = Development and Psychopathology | volume = 20 | issue = 2 | pages = 633–650 | date = April 2008 | pmid = 18423098 | pmc = 3857688 | doi = 10.1017/S095457940800031X }} In a 2015 publication from Bonn, Germany, which compared parental socioeconomic status and a child's personality, it was seen that children who were from higher socioeconomic backgrounds were more altruistic, less risk seeking, and had overall higher IQs.{{Cite journal| vauthors = Deckers T |date=February 2015|title=How does Socio-Economic Status Shape a Child's Personality?|url= https://econresearch.uchicago.edu/sites/econresearch.uchicago.edu/files/Deckers_Falk_etal_2016_SES-child-personality.pdf |journal=Human Capital and Economic Opportunity Global Working Group|access-date=9 August 2017|archive-date=5 November 2018|archive-url= https://web.archive.org/web/20181105062454/https://econresearch.uchicago.edu/sites/econresearch.uchicago.edu/files/Deckers_Falk_etal_2016_SES-child-personality.pdf|url-status=dead}} These traits correlate with a low risk of developing personality disorders later on in life. In a study looking at female children who were detained for disciplinary actions found that psychological problems were most negatively associated with socioeconomic problems.{{cite journal | vauthors = Van Damme L, Colins O, De Maeyer J, Vermeiren R, Vanderplasschen W | title = Girls' quality of life prior to detention in relation to psychiatric disorders, trauma exposure and socioeconomic status | journal = Quality of Life Research | volume = 24 | issue = 6 | pages = 1419–1429 | date = June 2015 | pmid = 25429824 | doi = 10.1007/s11136-014-0878-2 | s2cid = 28876461 }} Furthermore, social disorganization was found to be positively correlated with personality disorder symptoms.{{cite journal | vauthors = Walsh Z, Shea MT, Yen S, Ansell EB, Grilo CM, McGlashan TH, Stout RL, Bender DS, Skodol AE, Sanislow CA, Morey LC, Gunderson JG | title = Socioeconomic-status and mental health in a personality disorder sample: the importance of neighborhood factors | journal = Journal of Personality Disorders | volume = 27 | issue = 6 | pages = 820–831 | date = December 2013 | pmid = 22984860 | pmc = 4628287 | doi = 10.1521/pedi_2012_26_061 | author9-link = Andrew E. Skodol }}

Evidence shows personality disorders may begin with parental personality issues. These cause the child to have their own difficulties in adulthood, such as difficulties reaching higher education, obtaining jobs, and securing dependable relationships. By either genetic or modeling mechanisms, children can pick up these traits. Additionally, poor parenting appears to have symptom elevating effects on personality disorders. More specifically, lack of maternal bonding has also been correlated with personality disorders. In a study comparing 100 healthy individuals to 100 borderline personality disorder patients, analysis showed that BPD patients were significantly more likely not to have been breastfed as a baby (42.4% in BPD vs. 9.2% in healthy controls).{{cite journal | vauthors = Schwarze CE, Hellhammer DH, Stroehle V, Lieb K, Mobascher A | title = Lack of Breastfeeding: A Potential Risk Factor in the Multifactorial Genesis of Borderline Personality Disorder and Impaired Maternal Bonding | journal = Journal of Personality Disorders | volume = 29 | issue = 5 | pages = 610–626 | date = October 2015 | pmid = 25248013 | doi = 10.1521/pedi_2014_28_160 }} These researchers suggested "Breastfeeding may act as an early indicator of the mother-infant relationship that seems to be relevant for bonding and attachment later in life". Additionally, findings suggest personality disorders show a negative correlation with two attachment variables: maternal availability and dependability. When left unfostered, other attachment and interpersonal problems occur later in life ultimately leading to development of personality disorders.{{cite journal |title=The role of maternal care in borderline personality disorder and dependent life stress |author=Ericka Ball Cooper, Amanda Venta, Carla Sharp |journal=Borderline Personality Disorder and Emotion Dysregulation |year=2018 |volume=5 |page=5 |doi=10.1186/s40479-018-0083-y |doi-access=free |pmid=29588857 |pmc=5861727 |language=en}}

Currently, genetic research for the understanding of the development of personality disorders is severely lacking. However, there are a few possible risk factors currently in discovery. Researchers are currently looking into genetic mechanisms for traits such as aggression, fear and anxiety, which are associated with diagnosed individuals. More research is being conducted into disorder specific mechanisms.{{Cite web|url=http://www.apa.org/topics/personality/disorders-causes.aspx|title=What causes personality disorders?|website=American Psychological Association|language=en|archive-url=https://web.archive.org/web/20100313134730/http://www.apa.org/topics/personality/disorders-causes.aspx|archive-date=13 March 2010|url-status=dead|access-date=9 August 2017}}

Research shows that several brain regions are altered in personality disorders, particularly: hippocampus up to 18% smaller, a smaller amygdala, malfunctions in the striatum-nucleus accumbens and the cingulum neural pathways connecting them and taking care of the feedback loops on what to do with all the incoming information from the multiple senses; so what comes out is anti-social – not according to what is the social norm, socially acceptable and appropriate.{{cite journal | vauthors = Nunes PM, Wenzel A, Borges KT, Porto CR, Caminha RM, de Oliveira IR | title = Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis | journal = Journal of Personality Disorders | volume = 23 | issue = 4 | pages = 333–345 | date = August 2009 | pmid = 19663654 | doi = 10.1521/pedi.2009.23.4.333 }}{{cite journal | vauthors = Kaya S, Yildirim H, Atmaca M | title = Reduced hippocampus and amygdala volumes in antisocial personality disorder | journal = Journal of Clinical Neuroscience | volume = 75 | pages = 199–203 | date = May 2020 | pmid = 32334739 | doi = 10.1016/j.jocn.2020.01.048 | s2cid = 210711736 }}

There are many different forms (modalities) of treatment used for personality disorders:Magnavita, Jeffrey J. (2004) [https://books.google.com/books?id=jhtvBV3i0rkC Handbook of personality disorders: theory and practice], John Wiley and Sons, {{ISBN|978-0-471-48234-5}}.

• Individual psychotherapy has been a mainstay of treatment. There are long-term and short-term (brief) forms.
• Family therapy, including couples therapy.
• Group therapy for personality dysfunction is probably the second most used.
• Psychological-education may be used as an addition.
• Self-help groups may provide resources for personality disorders.
• Psychiatric medications for treating symptoms of personality dysfunction or co-occurring conditions.
• Milieu therapy, a kind of group-based residential approach, has a history of use in treating personality disorders, including therapeutic communities.
• The practice of mindfulness that includes developing the ability to be nonjudgmentally aware of unpleasant emotions appears to be a promising clinical tool for managing different types of personality disorders.{{cite journal | vauthors = Sng AA, Janca A | title = Mindfulness for personality disorders | journal = Current Opinion in Psychiatry | volume = 29 | issue = 1 | pages = 70–76 | date = January 2016 | pmid = 26651010 | doi = 10.1097/YCO.0000000000000213 | s2cid = 235472 }}{{cite journal | vauthors = Creswell JD | title = Mindfulness Interventions | journal = Annual Review of Psychology | volume = 68 | pages = 491–516 | date = January 2017 | pmid = 27687118 | doi = 10.1146/annurev-psych-042716-051139 | df = dmy-all | doi-access = free }}

There are different specific theories or schools of therapy within many of these modalities. They may, for example, emphasize psychodynamic techniques, or cognitive or behavioral techniques. In clinical practice, many therapists use an 'eclectic' approach, taking elements of different schools as and when they seem to fit to an individual client. There is also often a focus on common themes that seem to be beneficial regardless of techniques, including attributes of the therapist (e.g. trustworthiness, competence, caring), processes afforded to the client (e.g. ability to express and confide difficulties and emotions), and the match between the two (e.g. aiming for mutual respect, trust and boundaries).

Despite the lack of evidence supporting the benefit of antipsychotics in people with personality disorders, 1 in 4 who do not have a serious mental illness are prescribed them in UK primary care. Many people receive these medication for over a year, contrary to NICE guidelines.{{Cite journal |date=2022-11-10 |title=Antipsychotics are commonly prescribed to people with personality disorders, contrary to guidelines |url=https://evidence.nihr.ac.uk/alert/antipsychotics-commonly-prescribed-people-personality-disorders-contrary-guidelines/ |journal=NIHR Evidence |language=en |doi=10.3310/nihrevidence_54520|s2cid=253467990 }}{{cite journal | vauthors = Hardoon S, Hayes J, Viding E, McCrory E, Walters K, Osborn D | title = Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database | journal = BMJ Open | volume = 12 | issue = 3 | pages = e053943 | date = March 2022 | pmid = 35264346 | pmc = 8968526 | doi = 10.1136/bmjopen-2021-053943 }}

The management and treatment of personality disorders can be a challenging and controversial area, for by definition the difficulties have been enduring and affect multiple areas of functioning. This often involves interpersonal issues, and there can be difficulties in seeking and obtaining help from organizations in the first place, as well as with establishing and maintaining a specific therapeutic relationship. On the one hand, an individual may not consider themselves to have a mental health problem, while on the other, community mental health services may view individuals with personality disorders as too complex or difficult, and may directly or indirectly exclude individuals with such diagnoses or associated behaviors.{{cite journal| vauthors = Davison SE |title=Principles of managing patients with personality disorder|journal=Advances in Psychiatric Treatment|year=2002|volume=8|issue=1|pages=1–9|doi=10.1192/apt.8.1.1|s2cid=6874579 |doi-access=free}} The disruptiveness that people with personality disorders can create in an organisation makes these, arguably, the most challenging conditions to manage.

Apart from all these issues, an individual may not consider their personality to be disordered or the cause of problems. This perspective may be caused by the patient's ignorance or lack of insight into their own condition, an ego-syntonic perception of the problems with their personality that prevents them from experiencing it as being in conflict with their goals and self-image, or by the simple fact that there is no distinct or objective boundary between 'normal' and 'abnormal' personalities. There is substantial social stigma and discrimination related to the diagnosis.

The term 'personality disorder' encompasses a wide range of issues, each with a different level of severity or impairment; thus, personality disorders can require fundamentally different approaches and understandings. While some disorders or individuals are characterized by continual social withdrawal and the shunning of relationships, others may cause fluctuations in forwardness. The extremes are worse still: at one extreme lie self-harm and self-neglect, while at another extreme some individuals may commit violence and crime. There can be other factors such as problematic substance use or dependency or behavioral addictions.

Therapists in this area can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be perceived as negative, rejecting, demanding, aggressive or manipulative. This has been looked at in terms of both therapist and client; in terms of social skills, coping efforts, defense mechanisms, or deliberate strategies; and in terms of moral judgments or the need to consider underlying motivations for specific behaviors or conflicts. The vulnerabilities of a client, and indeed a therapist, may become lost behind actual or apparent strength and resilience. It is commonly stated that there is always a need to maintain appropriate professional personal boundaries, while allowing for emotional expression and therapeutic relationships. However, there can be difficulty acknowledging the different worlds and views that both the client and therapist may live with. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable have the same effect on clients. As an example of one extreme, people who may have been exposed to hostility, deceptiveness, rejection, aggression or abuse in their lives, may in some cases be made confused, intimidated or suspicious by presentations of warmth, intimacy or positivity. On the other hand, reassurance, openness and clear communication are usually helpful and needed. It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address a client's issues.McVey, D. & Murphy, N. (eds.) (2010) [http://www.routledge.com/books/details/9780415404808/ Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs], {{ISBN|0-203-84115-8}}

The prevalence of personality disorder in the general community was largely unknown until surveys starting from the 1990s. In 2008 the median rate of diagnosable PD was estimated at 10.6%, based on six major studies across three nations. This rate of around one in ten, especially as associated with high use of cocaine, is described as a major public health concern requiring attention by researchers and clinicians.{{cite journal | vauthors = Lenzenweger MF | title = Epidemiology of personality disorders | journal = The Psychiatric Clinics of North America | volume = 31 | issue = 3 | pages = 395–403, vi | date = September 2008 | pmid = 18638642 | doi = 10.1016/j.psc.2008.03.003 }} The prevalence of individual personality disorders ranges from about 2% to 8% for the more common varieties, such as obsessive-compulsive, schizotypal, antisocial, borderline, and histrionic, to 0.5–1% for the least common, such as narcissistic and avoidant.{{cite journal | vauthors = Schulte Holthausen B, Habel U | title = Sex Differences in Personality Disorders | journal = Current Psychiatry Reports | volume = 20 | issue = 12 | pages = 107 | date = October 2018 | pmid = 30306417 | doi = 10.1007/s11920-018-0975-y | s2cid = 52959021 }}

A screening survey across 13 countries by the World Health Organization using DSM-IV criteria, reported in 2009 a prevalence estimate of around 6% for personality disorders. The rate sometimes varied with demographic and socioeconomic factors, and functional impairment was partly explained by co-occurring mental disorders.{{cite journal | vauthors = Huang Y, Kotov R, de Girolamo G, Preti A, Angermeyer M, Benjet C, Demyttenaere K, de Graaf R, Gureje O, Karam AN, Lee S, Lépine JP, Matschinger H, Posada-Villa J, Suliman S, Vilagut G, Kessler RC | title = DSM-IV personality disorders in the WHO World Mental Health Surveys | journal = The British Journal of Psychiatry | volume = 195 | issue = 1 | pages = 46–53 | date = July 2009 | pmid = 19567896 | pmc = 2705873 | doi = 10.1192/bjp.bp.108.058552 }} In the US, screening data from the National Comorbidity Survey Replication between 2001 and 2003, combined with interviews of a subset of respondents, indicated a population prevalence of around 9% for personality disorders in total. Functional disability associated with the diagnoses appeared to be largely due to co-occurring mental disorders (Axis I in the DSM).{{cite journal | vauthors = Lenzenweger MF, Lane MC, Loranger AW, Kessler RC | title = DSM-IV personality disorders in the National Comorbidity Survey Replication | journal = Biological Psychiatry | volume = 62 | issue = 6 | pages = 553–564 | date = September 2007 | pmid = 17217923 | pmc = 2044500 | doi = 10.1016/j.biopsych.2006.09.019 }} This statistic has been supported by other studies in the US, with overall global prevalence statistics ranging from 9% to 11%.{{cite journal | vauthors = Collins A, Barnicot K, Sen P | title = A Systematic Review and Meta-Analysis of Personality Disorder Prevalence and Patient Outcomes in Emergency Departments | journal = Journal of Personality Disorders | volume = 34 | issue = 3 | pages = 324–347 | date = June 2020 | pmid = 30307832 | doi = 10.1521/pedi_2018_32_400 | s2cid = 52963562 }}{{cite journal | vauthors = Sansone RA, Sansone LA | title = Personality disorders: a nation-based perspective on prevalence | journal = Innovations in Clinical Neuroscience | volume = 8 | issue = 4 | pages = 13–18 | date = April 2011 | pmid = 21637629 | pmc = 3105841 }}

A UK national epidemiological study (based on DSM-IV screening criteria), reclassified into levels of severity rather than just diagnosis, reported in 2010 that the majority of people show some personality difficulties in one way or another (short of threshold for diagnosis), while the prevalence of the most complex and severe cases (including meeting criteria for multiple diagnoses in different clusters) was estimated at 1.3%. Even low levels of personality symptoms were associated with functional problems, but the most severely in need of services was a much smaller group.{{cite journal | vauthors = Yang M, Coid J, Tyrer P | title = Personality pathology recorded by severity: national survey | journal = The British Journal of Psychiatry | volume = 197 | issue = 3 | pages = 193–199 | date = September 2010 | pmid = 20807963 | doi = 10.1192/bjp.bp.110.078956 | s2cid = 14040222 | doi-access = free }} Personality disorders (especially Cluster A) are found more commonly among homeless people.{{cite journal | vauthors = Connolly AJ, Cobb-Richardson P, Ball SA | title = Personality disorders in homeless drop-in center clients | journal = Journal of Personality Disorders | volume = 22 | issue = 6 | pages = 573–588 | date = December 2008 | pmid = 19072678 | doi = 10.1521/pedi.2008.22.6.573 | url = http://www.ncsinc.org/images/pdfs/JPD_article_winter_2008.pdf | access-date = 31 January 2017 | url-status = dead | quote = With regard to Axis II, Cluster A personality disorders (paranoid, schizoid, schizotypal) were found in almost all participants (92% had at least one diagnosis), and Cluster B (83% had at least one of antisocial, borderline, histrionic, or narcissistic) and C (68% had at least one of avoidant, dependent, obsessive–compulsive) disorders also were highly prevalent | df = dmy-all | archive-url = https://web.archive.org/web/20090617134208/http://www.ncsinc.org/images/pdfs/JPD_article_winter_2008.pdf | archive-date = 17 June 2009 }}

There are some sex differences in the frequency of personality disorders which are shown in the table below.{{cite book | vauthors = Widiger T |url=https://books.google.com/books?id=CTVpAgAAQBAJ |title=The Oxford Handbook of Personality Disorders |publisher=Oxford University Press |year=2012 |isbn=978-0-19-973501-3}}{{rp|206}} The known prevalence of some personality disorders, especially borderline PD and antisocial PD are affected by diagnostic bias. This is due to many factors including disproportionately high research towards borderline PD and antisocial PD, alongside social and gender stereotypes, and the relationship between diagnosis rates and prevalence rates. Since the removal of depressive PD, self-defeating PD, sadistic PD and passive-aggressive PD from the DSM-5, studies analysing their prevalence and demographics have been limited.

| {{n/a|}}

| {{n/a|}}

| Self-defeating

| Passive-aggressive (Negativistic){{rp|733}}

| Personality disorder - Trait specified

|-

| {{n/a|}}

| {{n/a|}}

| {{n/a|}}

| Sadistic

| Depressive

| {{n/a|}}

|-

|}

{{legend inline|#DFF|Introduced}} {{legend inline|#FED|Deleted}}

{{notelist|group=DSM}}

Personality disorder is a term with a distinctly modern meaning, owing in part to its clinical usage and the institutional character of modern psychiatry. The currently accepted meaning must be understood in the context of historical changing classification systems such as DSM-IV and its predecessors. Although highly anachronistic, and ignoring radical differences in the character of subjectivity and social relations, some have suggested similarities to other concepts going back to at least the ancient Greeks.{{rp|35}} For example, the Greek philosopher Theophrastus described 29 'character' types that he saw as deviations from the norm, and similar views have been found in Asian, Arabic and Celtic cultures. A long-standing influence in the Western world was Galen's concept of personality types, which he linked to the four humours proposed by Hippocrates.

In ancient India, the concept of temperament was closely related to the ideas in Ayurvedic medicine, which categorized individuals according to three doshas—Vata, Pitta, and Kapha. These doshas, or bodily humors, were believed to influence not just physical health but also the mental and emotional state of a person. Imbalances in these doshas were thought to result in behavioral abnormalities, echoing the Western notion of temperament but grounded in a more holistic, mind-body connection.

Similarly, ancient Chinese philosophy emphasized the balance of the five elements (wood, fire, earth, metal, and water), with each element corresponding to certain personality traits and emotional responses. Traditional Chinese medicine linked these elements to specific organs in the body and believed that emotional imbalances could result in physical illness. The idea that a person's emotional and behavioral state could affect both their health and their social relationships is a concept that resonates with contemporary ideas about personality disorders.

In the Arabic world, thinkers like Avicenna (Ibn Sina) incorporated Galenic ideas into their medical writings, further developing the concept of temperament. Avicenna expanded on the four humors proposed by Hippocrates and Galen, suggesting that certain personality traits—such as choleric (angry), melancholic (sad), sanguine (optimistic), and phlegmatic (calm)—were reflective of imbalances in bodily fluids. These early understandings of personality types laid the groundwork for later, more refined concepts of character in Western psychiatry.

The Celtic tradition also featured an early form of personality categorization, though more aligned with social roles and behaviors within their tribes. The Celts saw human nature as a reflection of natural forces, and individuals who exhibited extreme or deviant behaviors were often seen as outside the norms of their community, potentially deserving of spiritual or ritual intervention. This is similar to how the concept of personality disorders began to be tied to moral and social deviations rather than purely medical ones.

Such views lasted into the eighteenth century, when experiments began to question the supposed biologically based humours and 'temperaments'. Psychological concepts of character and 'self' became widespread. In the nineteenth century, 'personality' referred to a person's conscious awareness of their behavior, a disorder of which could be linked to altered states such as dissociation. This sense of the term has been compared to the use of the term 'multiple personality disorder' in the first versions of the DSM.Mental Health, AlmostReal(2025) [https://www.almostreal.org/post/the-art-of-cultivating-a-balanced-lifestyle-navigating-modernity-with-grace The Art of Cultivating a Balanced Lifestyle: Navigating Modernity with Grace]

Physicians in the early nineteenth century started to diagnose forms of insanity involving disturbed emotions and behaviors but seemingly without significant intellectual impairment or delusions or hallucinations. Philippe Pinel referred to this as ' manie sans délire ' – mania without delusions – and described a number of cases mainly involving excessive or inexplicable anger or rage. James Cowles Prichard advanced a similar concept he called moral insanity, which would be used to diagnose patients for some decades. 'Moral' in this sense referred to affect (emotion or mood) rather than simply the ethical dimension, but it was arguably a significant move for 'psychiatric' diagnostic practice to become so clearly engaged with judgments about individual's social behaviour.{{cite book |last1=Jones |first1=David W |url=https://www.routledge.com/Disordered-Personalities-and-Crime-An-analysis-of-the-history-of-moral-insanity/Jones/p/book/9780415502177?srsltid=AfmBOooWry5ffIxaOPsrHgeTqfiE03NWkojkepCx9b0GNmlCoKSe4E3n |title=Disordered personalities and Crime: An analysis of the history of moral insanity |date=2016 |publisher=Routledge |isbn=9780415502177 |location=London |access-date=23 August 2024}} Prichard was influenced by his own religious, social and moral beliefs, as well as ideas in German psychiatry.{{cite journal | vauthors = Augstein HF | title = J C Prichard's concept of moral insanity--a medical theory of the corruption of human nature | journal = Medical History | volume = 40 | issue = 3 | pages = 311–343 | date = July 1996 | pmid = 8757717 | pmc = 1037128 | doi = 10.1017/S0025727300061329 }} These categories were much different and broader than later definitions of personality disorder, while also being developed by some into a more specific meaning of moral degeneracy akin to later ideas about 'psychopaths'. Separately, Richard von Krafft-Ebing popularized the terms sadism and masochism, as well as homosexuality, as psychiatric issues.

The German psychiatrist Koch sought to make the moral insanity concept more scientific, and in 1891 suggested the phrase 'psychopathic inferiority', theorized to be a congenital disorder. This referred to continual and rigid patterns of misconduct or dysfunction in the absence of apparent "mental retardation" or illness, supposedly without a moral judgment. Described as deeply rooted in his Christian faith, his work established the concept of personality disorder as used today.{{cite journal | vauthors = Gutmann P | title = Julius Ludwig August Koch (1841-1908): Christian, philosopher and psychiatrist | journal = History of Psychiatry | volume = 19 | issue = 74 Pt 2 | pages = 202–214 | date = June 2008 | pmid = 19127839 | doi = 10.1177/0957154X07080661 | s2cid = 2223023 | url = https://hal.archives-ouvertes.fr/hal-00570903/file/PEER_stage2_10.1177%252F0957154X07080661.pdf }}

In the early 20th century, another German psychiatrist, Emil Kraepelin, included a chapter on psychopathic inferiority in his influential work on clinical psychiatry for students and physicians. He suggested six types – excitable, unstable, eccentric, liar, swindler and quarrelsome. The categories were essentially defined by the most disordered criminal offenders observed, distinguished between criminals by impulse, professional criminals, and morbid vagabonds who wandered through life. Kraepelin also described three paranoid (meaning then delusional) disorders, resembling later concepts of schizophrenia, delusional disorder and paranoid personality disorder. A diagnostic term for the latter concept would be included in the DSM from 1952, and from 1980 the DSM would also include schizoid, schizotypal; interpretations of earlier (1921) theories of Ernst Kretschmer led to a distinction between these and another type later included in the DSM, avoidant personality disorder.

In 1933 Russian psychiatrist Pyotr Borisovich Gannushkin published his book Manifestations of Psychopathies: Statics, Dynamics, Systematic Aspects, which was one of the first attempts to develop a detailed typology of psychopathies. Regarding maladaptation, ubiquity, and stability as the three main symptoms of behavioral pathology, he distinguished nine clusters of psychopaths: cycloids (including constitutionally depressive, constitutionally excitable, cyclothymics, and emotionally labile), {{not a typo|asthenics}} (including psychasthenics), schizoids (including dreamers), paranoiacs (including fanatics), epileptoids, hysterical personalities (including pathological liars), unstable psychopaths, antisocial psychopaths, and constitutionally stupid.Ганнушкин П. Б. (2000). Клиника психопатий, их статика, динамика, систематика. Издательство Нижегородской государственной медицинской академии. {{ISBN|5-86093-015-1}}. Some elements of Gannushkin's typology were later incorporated into the theory developed by a Russian adolescent psychiatrist, Andrey Yevgenyevich Lichko, who was also interested in psychopathies along with their milder forms, the so-called accentuations of character.Личко А. Е. (2010) Психопатии и акцентуации характера у подростков. Речь, {{ISBN|978-5-9268-0828-2}}.

In 1939, psychiatrist David Henderson published a theory of 'psychopathic states' that contributed to popularly linking the term to anti-social behavior. Hervey M. Cleckley's 1941 text, The Mask of Sanity, based on his personal categorization of similarities he noted in some prisoners, marked the start of the modern clinical conception of psychopathy and its popularist usage.{{cite journal| vauthors = Arrigo BA |title=The Confusion Over Psychopathy (I): Historical Considerations|journal=International Journal of Offender Therapy and Comparative Criminology|date=1 June 2001|volume=45|issue=3|pages=325–44|doi=10.1177/0306624X01453005|s2cid=145400985}}

Towards the mid 20th century, psychoanalytic theories were coming to the fore based on work from the turn of the century being popularized by Sigmund Freud and others. This included the concept of character disorders, which were seen as enduring problems linked not to specific symptoms but to pervasive internal conflicts or derailments of normal childhood development. These were often understood as weaknesses of character or willful deviance, and were distinguished from neurosis or psychosis. The term 'borderline' stems from a belief some individuals were functioning on the edge of those two categories, and a number of the other personality disorder categories were also heavily influenced by this approach, including dependent, obsessive–compulsive and histrionic,Amy Heim & Drew Westen (2004) [http://www.psychsystems.net/Publications/2005/17.%20theories%20of%20personality%20and%20personality%20disorders_Heim_textbook%20of%20pers%20disorders%202005.pdf Theories of personality and personality disorders] {{webarchive|url=https://web.archive.org/web/20120111140930/http://www.psychsystems.net/Publications/2005/17.%20theories%20of%20personality%20and%20personality%20disorders_Heim_textbook%20of%20pers%20disorders%202005.pdf |date=11 January 2012 }} the latter starting off as a conversion symptom of hysteria particularly associated with women, then a hysterical personality, then renamed histrionic personality disorder in later versions of the DSM. A passive aggressive style was defined clinically by Colonel William Menninger during World War II in the context of men's reactions to military compliance, which would later be referenced as a personality disorder in the DSM.{{cite journal| vauthors = Lane C |title=The Surprising History of Passive–Aggressive Personality Disorder|journal=Theory & Psychology|date=1 February 2009|volume=19|issue=1|pages=55–70|doi=10.1177/0959354308101419|url=http://www.christopherlane.org/documents/Lane.PAPDisorder.pdf|citeseerx=10.1.1.532.5027|s2cid=147019317}} Otto Kernberg was influential with regard to the concepts of borderline and narcissistic personalities later incorporated in 1980 as disorders into the DSM.

Meanwhile, a more general personality psychology had been developing in academia and to some extent clinically. Gordon Allport published theories of personality traits from the 1920s—and Henry Murray advanced a theory called personology, which influenced a later key advocate of personality disorders, Theodore Millon. Tests were developing or being applied for personality evaluation, including projective tests such as the Rorschach test, as well as questionnaires such as the Minnesota Multiphasic Personality Inventory. Around mid-century, Hans Eysenck was analysing traits and personality types, and psychiatrist Kurt Schneider was popularising a clinical use in place of the previously more usual terms 'character', 'temperament' or 'constitution'.

American psychiatrists officially recognized concepts of enduring personality disturbances in the first Diagnostic and Statistical Manual of Mental Disorders in the 1950s, which relied heavily on psychoanalytic concepts. Somewhat more neutral language was employed in the DSM-II in 1968, though the terms and descriptions had only a slight resemblance to current definitions. The DSM-III published in 1980 made some major changes, notably putting all personality disorders onto a second separate 'axis' along with "mental retardation", intended to signify more enduring patterns, distinct from what were considered axis one mental disorders. 'Inadequate' and 'asthenic' personality disorder' categories were deleted, and others were expanded into more types, or changed from being personality disorders to regular disorders. Sociopathic personality disorder, which had been the term for psychopathy, was renamed Antisocial Personality Disorder. Most categories were given more specific 'operationalized' definitions, with standard criteria psychiatrists could agree on to conduct research and diagnose patients.Hoermann, Simone; Zupanick, Corinne E. and Dombeck, Mark (January 2011) [http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=560&cn=8 The History of the Psychiatric Diagnostic System Continued]. mentalhelp.net. In the DSM-III revision, self-defeating personality disorder and sadistic personality disorder were included as provisional diagnoses requiring further study. They were dropped in the DSM-IV, though a proposed 'depressive personality disorder' was added; in addition, the official diagnosis of passive–aggressive personality disorder was dropped, tentatively renamed 'negativistic personality disorder.'{{cite journal| vauthors = Oldham JM |title=Personality Disorders |journal=Focus |year=2005|volume=3|issue=3 |pages=372–82 |url=http://focus.psychiatryonline.org/doi/abs/10.1176/foc.3.3.372|doi=10.1176/foc.3.3.372 }}

International differences have been noted in how attitudes have developed towards the diagnosis of personality disorder. Kurt Schneider argued they were 'abnormal varieties of psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists have also been reluctant to address such disorders or consider them on par with other mental disorders, which has been attributed partly to resource pressures within the National Health Service, as well as to negative medical attitudes towards behaviors associated with personality disorders. In the US, the prevailing healthcare system and psychoanalytic tradition has been said to provide a rationale for private therapists to diagnose some personality disorders more broadly and provide ongoing treatment for them.{{cite journal | vauthors = Kendell RE | title = The distinction between personality disorder and mental illness | journal = The British Journal of Psychiatry | volume = 180 | issue = 2 | pages = 110–115 | date = February 2002 | pmid = 11823318 | doi = 10.1192/bjp.180.2.110 | s2cid = 90434 | doi-access = free }}

{{Portal|Psychology}}

{{Reflist}}

{{refbegin}}

• {{cite book | vauthors = Marshall WL, Serin R | date = 1997 | chapter = Personality Disorders. | veditors = Turner SM, Hersen R | title = Adult Psychopathology and Diagnosis. | location = New York | publisher = Wiley | pages = 508–541 }}
• {{cite book | vauthors = Murphy N, McVey D | date = 2010 | url = http://www.pdmh-consultancy.com/publication-detail/4/ | title = Treating Severe Personality Disorder]: Creating Robust Services for Clients with Complex Mental Health Needs. | location = London | publisher = Routledge | archive-url = https://web.archive.org/web/20110715060200/http://www.pdmh-consultancy.com/publication-detail/4/ | archive-date = 15 July 2011 }}
• {{cite book | vauthors = Millon T, Davis RD | authorlink1 = Theodore Millon |title=Disorders of personality : DSM-IV and beyond |date=1996 |publisher=Wiley |location=New York |isbn=978-0-471-01186-6 |edition=2nd}}
• {{cite book| vauthors = Yudofsky SC |title=Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character|year=2005|location=Washington, DC|isbn=978-1-58562-214-6|edition=1st}}

{{refend}}

{{clear}}

{{Library resources box

|by=no

|onlinebooks=no

|others=no

|about=yes

|label=Personality disorders}}

• [http://counsellingresource.com/distress/personality-disorders/foundation/index.html Personality Disorders Foundation]
• [http://www.nmha.org/go/information/get-info/personality-disorders National Mental Health Association personality disorder fact sheet] {{Webarchive|url=https://web.archive.org/web/20101216172819/http://nmha.org/go/information/get-info/personality-disorders |date=16 December 2010 }}
• [http://www.rcpsych.ac.uk/expertadvice/problemsdisorders/personalitydisorder.aspx Personality Disorders information leaflet from The Royal College of Psychiatrists]

{{Medical condition classification and resources

| DiseasesDB = 9889

| ICD11 = {{ICD11|6D10}}

| ICD10 = {{ICD10|F60}}

| ICD9 = {{ICD9|301.9}}

| ICDO =

| OMIM =

| MedlinePlus = 000939

| eMedicineSubj = article

| eMedicineTopic = 294307

| MeshID = D010554

| SNOMED CT = 33449004

}}

{{ICD-10 personality disorders}}

{{Mental disorders}}

{{Authority control}}

Category:Mental disorders

Category:Behavioural sciences