Personality disorders are diagnoses given when long-standing patterns of thinking, feeling and relating to other people cause distress or make everyday life hard to manage. The patterns usually appear from adolescence or early adulthood, across many situations rather than one.
Key points
- Personality disorder is a diagnosis for long-standing patterns of thinking, feeling and relating to others that cause distress or difficulty.
- ICD-11 rates severity as mild, moderate or severe with trait descriptions, while DSM-5-TR keeps ten named disorders in three clusters.
- Structured psychological therapy is the main treatment, and NICE says drug treatment should not be used for the disorder itself.
- NICE states nobody should be excluded from a health or social care service because of the diagnosis.
Symptoms
- Relationships that feel intense and unstable, or distant and few; difficulty trusting others.
- Strong emotions that change quickly, or emotions that feel flat; an unsteady or unclear sense of who you are.
- Acting on impulse, including self-harm in some presentations; rigid routines and a strong need for control.
Causes and risk factors
- Thought to result from a combination of inherited genes and early environmental influences, such as a distressing childhood experience.
- Frightening, neglectful or unstable experiences in childhood; inherited differences in temperament.
Treatment
- Structured psychological therapy: dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), cognitive analytic therapy, psychodynamic therapy.
- Brief interventions of less than three months should not be used for borderline personality disorder specifically.
- Drug treatment should not be used specifically for the disorder itself, though medication may treat a separate condition such as depression.
When to speak to a professional
- The same difficulties with relationships, emotions or impulses have run through your life and affect work, study or family.
- You are self-harming, having thoughts of suicide, or feel unable to keep yourself safe.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.