Understanding and Treating Personality Disorders

• Paranoid Personality Disorder — Pervasive distrust and suspicion of other people, often perceiving others’ intentions and motivations as having malice or ill intent even if there is no clear evidence of this.
• Schizoid Personality Disorder — Detachment from social interactions and displaying a limited range of emotions. People with this disorder generally prefer to engage in independent activities.
• Schizotypal Personality Disorder — An aversion toward forming close relationships. Individuals with schizotypal personality disorder often demonstrate cognitive and perceptual distortions and may express odd thoughts and behaviors.

• Antisocial Personality Disorder — Consistent disregard and violation of others’ rights through actions including dishonesty, acting on impulse, and showing little remorse about their behavior.
• Borderline Personality Disorder (BPD) — Intense emotional dysregulation, unstable relationships, chronic emptiness, fear of abandonment, and self-harm or suicidal behavior.
• Histrionic Personality Disorder — Characterized by excessive emotionality and attention-seeking behavior
• Narcissistic Personality Disorder — People with this disorder display an inflated sense of self-importance, require constant admiring attention, and show little concern for others along with a fragile self-image.

• Avoidant Personality Disorder — Pervasive social inhibition, hypersensitivity to criticism and negative feedback, and feelings of inadequacy
• Dependent Personality Disorder — Excessive need for others to care for them, submissive behavior, and severe anxiety when separated from those they rely on.
• Obsessive-Compulsive Personality Disorder (OCPD) — Preoccupation with order, perfection, and maintaining control at the expense of flexibility and efficiency

While symptoms can vary depending on which specific personality disorder is involved and from person to person, some common signs across most include:

• Persistent, inflexible patterns of thought, emotion, and behavior that are very different from cultural expectations
• Difficulty with interpersonal relationships across multiple contexts
• Unstable or distorted self-image
• Impulsive behaviors or difficulty regulating emotions
• Mood swings and emotional reactivity that is disproportionate to the situation
• Lack of coping skills that often lead to negative and unhelpful responses to stress
• Self-harm behaviors or suicide attempts, particularly in BPD
• Patterns that the individual may not recognize as problematic, even when they cause significant distress to themselves and to others

The specific content of these patterns, the particular distortions, the specific relational difficulties, the characteristic emotional responses, vary by disorder and by individual, which is why accurate diagnosis and individualized treatment planning are so essential.

There are multiple genetic, biological, and environmental factors that contribute to the development of personality disorders. Some of the most common include:

• Childhood experiences — Adverse childhood experiences such as physical or sexual abuse, neglect, psychological or physical trauma, unstable caregiving, and separation from an attachment figure in early life can lead to the development of many forms of personality disorders, especially Cluster B; the association between childhood trauma and BPD has been one of the most documented.[5]
• Genetic and neurobiological factors — There is a strong genetic component to developing personality disorders. Temperament characteristics related to emotional sensitivity and reactivity, impulse control, and negative affectivity that make people vulnerable to developing personality disorders also have a partial genetic basis; neurobiological differences in emotion regulation pathways are present across many personality disorders.[6]
• Developmental factors — Personality disorders usually begin in late adolescence or early adulthood as a result of the combination of a person’s inherited temperament and their experiences in early environments during the critical period for personality formation.[7]
• Psychological factors — Maladaptive early schemas, or long-standing ideas about ourselves and those around us that develop during childhood, form and maintain personality disorder behaviors and are a major focus of treatment.[8]

At Agape, the first step in developing an appropriate treatment plan for your personality disorder is conducting a comprehensive clinical evaluation. This includes an examination of possible diagnoses — there is considerable overlap between personality disorders and other types of mental illnesses — as well as determining if any co-occurring conditions are present. 

Key elements of Agape’s treatment plans include:

• DBT (Dialectical Behavior Therapy) — DBT is widely recognized as a well-researched supported treatment available for BPD.[9] Developed by Marsha Linehan, Ph.D., DBT teaches patients four sets of skills that address the primary characteristics of BPD: emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. DBT is the foundation of Agape’s personality disorder treatment program.
• CBT (Cognitive Behavioral Therapy) — Aims to identify and correct negative cognitive patterns that are characteristic of personality disorders. CBT has demonstrated particular effectiveness in treating Cluster C personality disorders, including avoidant and obsessive-compulsive presentations.[10]
• Psychodynamic Therapy  — Focuses on examining the early relational experiences and internalized schemas that lead to a person’s patterns of thought, feeling, and action. Psychotherapy is long-term, insight-focused, and well-suited to personality disorders.