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10 Types of Personality Disorders

Cluster a personality disorders, cluster b personality disorders, cluster c personality disorders, other dsm-5 personality disorders.

Personality disorders (PDs) are characterized by patterns of thinking , feeling, behaving, and interacting that deviate from cultural expectations and cause significant distress and difficulty functioning.

Personality refers to the way a person behaves, thinks, and feels, and is influenced by genetic and environmental factors. People can develop a personality disorder in adolescence or early adulthood.

This article discusses 10 personality disorders, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). They are grouped within one of three clusters, and the disorders within each cluster share similar characteristics.

Fiordaliso / Getty Images

Cluster A personality disorders are characterized by odd and eccentric behavior, and include:

• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

The personality disorders that fall under this category share not only similar symptoms but similar genetic and environmental risk factors as well. The prevalence of this cluster of personality disorders is estimated to be 2% to 5%.

Paranoid Personality Disorder

The characteristics of paranoid personality disorder (PPD) include paranoia, relentless mistrust, and suspicion of others without adequate reason to be suspicious. People are often unable to form close relationships and often project their feelings of paranoia as anger.

A person is diagnosed with PPD if they have more than four of the following:

• Unjustified suspicion that others are exploiting, injuring, or deceiving them
• Preoccupation with unjustified doubts about the reliability of others
• Reluctance to confide in others for fear that the information will be used against them
• Misinterpretation of benign remarks or events as having hidden belittling, hostile, or threatening meaning
• Holding grudges against others for insults, injuries, or slights
• Often thinking that their character or reputation has been attacked, and quick to react angrily or to counterattack
• Recurrent, unjustified suspicions of spousal infidelity

PPD affects 2.3% of the general U.S. population.

Schizoid Personality Disorder

People with schizoid personality disorder (ScPD) have a lifelong pattern of indifference toward others and social isolation. Those with ScPD do not have paranoia or hallucinations (cognitive or perceptual disturbances) like people with schizophrenia do.

A diagnosis of ScPD is made if more than four of the following are present:

• No desire for or enjoyment of close relationships
• Strong preference for solitary activities
• Little, if any, interest in sexual activity with others
• Enjoyment of few, if any, activities
• Lack of close relationships, except possibly first-degree relatives
• Apparent indifference to praise or criticism
• Emotional coldness, detachment, or flattened affect

The prevalence of schizoid personality disorder is 3.1% to 4.9% in the general U.S. population.

Schizotypal Personality Disorder

People with schizotypal personality disorder prefer to keep their distance from others and are uncomfortable being in relationships. They sometimes have odd speech or behavior, and they have an odd or limited range of emotions. It typically begins early in adulthood.

Schizotypal personality disorder is in the middle of a spectrum of related disorders, with schizoid personality disorder on the milder end and schizophrenia on the more severe end. It is unclear why some develop more severe forms of the disorder.

A diagnosis of schizotypal personality disorder is made if a person has more than five of the following:

• Ideas of reference (notions that everyday occurrences have special meaning or significance personally intended for or directed to themselves)
• Odd beliefs or magical thinking (e.g., believing in clairvoyance, telepathy, or a sixth sense)
• Unusual perceptual experiences (e.g., hearing a voice whispering their name)
• Odd thoughts and speech (e.g., speech that is vague, metaphorical, excessively elaborate, or stereotyped)
• Suspicions or paranoid thoughts
• Incongruous or limited affect
• Odd, eccentric, or peculiar behavior and appearance
• Lack of close friends or confidants, except for first-degree relatives
• Excessive social anxiety that does not improve with familiarity and is associated with paranoid fears rather than negative judgments about self

It is estimated that about 3.3% of the U.S. population has this personality disorder.

Classification of personality disorders is challenging and has evolved over time. Some PD trait distributions have been found to be quite unlike what is presented in the DSM-5, and many people with personality disorders often fit into more than one diagnosis.

Cluster B personality disorders are characterized by issues with impulse control and emotional regulation. People with personality disorders in this cluster are usually described as dramatic, emotional, and erratic, and are often involved in interpersonal conflicts.

The prevalence of this cluster of personality disorders has been estimated to vary between 1% and 6%.

Antisocial Personality Disorder

People with antisocial personality disorder (ASPD) have a long-term pattern of manipulating, exploiting, or violating the rights of others without any remorse. This behavior may cause problems in relationships or at work.

Violent or aggressive acts involving or targeting others (such as setting fires and animal cruelty) without a sense of regret or guilt are often warning signs of ASPD.

Behaviors characteristic of ASPD must have been evidenced as conduct disorder or a phase before the age of 15, but are recognized as part of ASPD if they continue until the age of 18.

A person is diagnosed with ASPD if they have three or more of the following:

• Failure to conform to social norms with respect to lawful behaviors, which is indicated by repeatedly performing acts that are grounds for arrest
• Being deceitful (lying repeatedly, using aliases, or conning others for personal gain or pleasure)
• Acting impulsively or failing to plan ahead
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults
• Reckless disregard for the safety of self or others
• Consistently acting irresponsibly (e.g., quitting jobs with no plans or not paying bills)
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another person

ASPD affects less than 1% of the general U.S. population.

Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by an ongoing pattern of instability in self-image, varying moods, impulsive behaviors, and problems with relationships.

A diagnosis of BPD is made if five or more of the following are present:

• Desperate efforts to avoid abandonment (real or imagined)
• A pattern of unstable and intense relationships that alternate between idealizing and devaluing the other person
• Markedly unstable self-image or sense of self
• Impulsivity in at least two areas that are potentially self-damaging (e.g., condomless sex, binge eating, reckless driving)
• Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
• Rapid changes in mood, lasting usually only a few hours and rarely more than a few days
• Persistent feelings of emptiness
• Inappropriate, intense anger or problems controlling anger
• Temporary paranoid thoughts or severe dissociative symptoms triggered by stress

The prevalence of BPD is estimated to be 1.6% in the general U.S. population but may be much higher in certain settings.

Histrionic Personality Disorder

People with histrionic personality disorder (HPD) act in a very emotional and dramatic way that draws attention to themselves. People with this disorder may be high-functioning and successful at work and in relationships. 

A diagnosis of HPD is made if five or more of the following are present:

• Feels uncomfortable in situations where they are not the center of attention
• Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
• Has rapidly shifting and shallow expression of emotions
• Consistently uses physical appearance to draw attention to self
• Has a style of speech that is excessively impressionistic and lacking in detail
• Self-dramatization, theatricality, and exaggerated expressions
• Is suggestible (easily influenced by others)
• Considers relationships as more intimate than they really are

The prevalence of HPD ranges from less than 1% to 3%.

Narcissistic Personality Disorder

People with narcissistic personality disorder (NPD) have an excessive sense of self-importance, an extreme preoccupation with themselves, and a lack of empathy for others.

People diagnosed with NPD also have significant physical and mental health comorbidities, including substance abuse, mood, and anxiety disorders.

A diagnosis of NPD is made if five or more of the following are present:

• Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
• Preoccupied with fantasies of unlimited success, influence, power, intelligence, beauty, or ideal love
• Believes they are uniquely special and should only associate with, or can only be understood by, other special or high-status people
• Requires excessive admiration
• Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)
• Exploits others to achieve their own goals
• Lacks empathy and is unwilling to recognize or identify with the feelings and needs of others
• Envies others and believes that others envy them
• Exhibits an arrogant and haughty attitude

NPD affects 1% of the general U.S. population.

Cluster C personality disorders are characterized by intense anxiety and fear to the point where they affect a person’s ability to function in everyday life. These personality disorders are the most common of the three clusters, with a prevalence of 6%.

Avoidant Personality Disorder

People with avoidant personality disorder (AVPD) experience extreme social inhibitions fueled by fear of rejection and feelings of inadequacy.

A person is diagnosed with AVPD if they have four or more of the following:

• Avoids job-related activities that involve interpersonal contact because of fear of criticism or rejection
• Is unwilling to get involved with people unless they are sure of being liked
• Shows restraint in close relationships because they fear ridicule or humiliation
• Is preoccupied with being criticized or rejected in social situations
• Is inhibited in new social situations because they feel inadequate
• Views self as socially inept, unappealing, or inferior to others
• Is reluctant to take risks or participate in new activities because they fear embarrassment

AVPD is suggested to occur at a prevalence of about 2.4% of the general U.S. population.

Dependent Personality Disorder

People with dependent personality disorder (DPD) often feel helpless, submissive, and incapable of taking care of themselves. They may have trouble making simple decisions and often depend on others too much for their physical and emotional needs.

A diagnosis of DPD is made if five or more of the following are present:

• Difficulty making daily decisions without consulting others
• Needs others to be responsible for most important aspects of their life
• Difficulty expressing disagreement (due to fearing loss of support or approval)
• Difficulty self-starting projects because they are not confident in their judgment and abilities
• Willingness to go to great lengths to obtain support from others
• Feels uncomfortable or helpless when they are alone (fearing they cannot take care of themselves)
• Urgent need to establish a new relationship to gain care and support when a close relationship ends
• Unrealistic preoccupation with fears of being left to take care of themselves

DPD affects 0.6% of the general U.S. population.

Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder (OCPD) is characterized by preoccupation with orderliness, rules, control, and perfectionism. People with this disorder are unwilling to compromise and unable to change their views, which could jeopardize their relationships or careers as a result.

Black-or-white thinking is common in people with OCPD: There is no acceptance of gray areas and anything left to chance.

A person is diagnosed with OCPD if they have four or more of the following:

• Preoccupation with details, rules, schedules, organization, and lists
• Striving to do something perfectly that interferes with the completion of the task
• Excessive devotion to work and productivity (not due to financial necessity), resulting in neglect of leisure activities and friends
• Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values
• Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value
• Reluctance to delegate or work with other people unless those people agree to do things exactly as the patients want
• A miserly approach to spending for themselves and others because they see money as something to be saved for future disasters
• Rigidity and stubbornness

The prevalence of OCD among U.S. adults is estimated to be 2.3%.

Three personality patterns don’t meet the DSM-5 diagnostic criteria for the 10 recognized personality disorders:

• Personality change due to another medical condition : Changes from a previous personality pattern are the result of a general medical condition and cannot be better explained by another mental disorder (such as dementia ).
• Other specified personality disorder : This disorder can be considered a mixed personality disorder or a “catch-all” for people with symptoms that span across and don’t neatly fit one specific personality disorder.
• Unspecified personality disorder (a.k.a., personality disorder not otherwise specified, or NOS) : A person has symptoms but doesn’t meet the criteria of any one personality disorder or there is insufficient information to make a more specific diagnosis.

People with personality disorders show patterns of thinking, feeling, behaving, and interacting that deviate from cultural expectations and cause significant distress and difficulty functioning. These behaviors often disrupt their personal, professional, and social lives.

If you have the traits of any one or more of the above personality disorders or are experiencing changes to your usual sense of self and behavior patterns, talk with an experienced mental health professional for an assessment.

With the right treatment, you can manage symptoms and cope better with a personality disorder.

Johns Hopkins Medicine. Personality disorders .

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . Arlington, VA: American Psychiatric Association. 

Harvard University. National Comorbidity Survey Replication Part II .

Angstman KB, Rasmussen NH. Personality disorders: review and clinical application in daily practice . Am Fam Physician .

Harvard Health Publishing. Schizotypal personality disorder .

Mulder R, Tyrer P. Diagnosis and classification of personality disorders: novel approaches . Curr Opin Psychiatry . 2019 Jan;32(1):27-31. doi:10.1097/YCO.0000000000000461. 

Kacel EL, Ennis N, Pereira DB. Narcissistic personality disorder in clinical health psychology practice: case studies of comorbid psychological distress and life-limiting illness . Behav Med . 2017;43(3):156-164. doi:10.1080/08964289.2017.1301875

Rowland TA, Jainer AK, Panchal R. Living with obsessional personality . BJPsych Bull . 2017;41(6):366-367. doi:10.1192/pb.41.6.366a

National Institute of Mental Health. Obsessive-compulsive disorder (OCD) .

By Michelle Pugle Pulge is a freelance health writer focused on mental health content. She is certified in mental health first aid.

Overview of Personality Disorders

• Types of Personality Disorders |
• Symptoms and Signs |
• Diagnosis |
• Treatment |
• Key Points |

Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. Many gradually become less severe with age, but certain traits may persist to some degree after the acute symptoms that prompted the diagnosis of a disorder abate. Diagnosis is based on clinical criteria. Treatment is with psychosocial therapies and sometimes with medications.

Personality traits represent patterns of thinking, perceiving, reacting, and relating that are relatively stable over time.

Personality disorders exist when these traits become so pronounced, rigid, and maladaptive that they impair work and/or interpersonal functioning. These social maladaptations can cause significant distress in people with personality disorders and in those around them. For people with personality disorders (unlike many others who seek counseling), the distress caused by the consequences of their socially maladaptive behaviors is usually the reason they seek treatment, rather than any discomfort with their own thoughts and feelings. Thus, clinicians must initially help patients see that their personality traits are the root of the problem.

Personality disorders usually start to become evident during late adolescence or early adulthood, although sometimes signs are apparent earlier (during childhood). Traits and symptoms vary considerably in how long they persist; many resolve with time.

The Diagnostic and Statistical Manual of Mental Disorders , 5th ed, Text Revision (DSM-5-TR) lists 10 types of personality disorders , although most patients who meet criteria for one type also meet criteria for one or more others. Some types (eg, antisocial , borderline ) tend to lessen or resolve as people age; others (eg, obsessive-compulsive , schizotypal ) are less likely to do so.

About 9% of the general population ( 1 ) and up to half of psychiatric patients in hospital units and clinics have a personality disorder ( 2 ). Overall, there are no clear distinctions in terms of sex, socioeconomic class, and race. However, for antisocial personality disorder, males outnumber females 3:1 ( 3 ). In borderline personality disorder, females outnumber males 3:1 (but only in clinical settings, not in the general population) ( 4 ).

For most personality disorders, levels of heritability are about 50%, which is similar to or higher than that of many other major psychiatric disorders. This degree of heritability argues against the common assumption that personality disorders are character flaws primarily shaped by an adverse environment.

The direct health care costs and indirect costs of lost productivity associated with personality disorders, particularly borderline and obsessive-compulsive personality disorder, are significantly greater than similar costs associated with major depressive disorder or generalized anxiety disorder .

Types of Personality Disorders

DSM-5-TR groups the 10 types of personality disorders into 3 clusters (A, B, and C), based on similar characteristics. However, the clinical usefulness of these clusters has not been established.

Cluster A is characterized by appearing odd or eccentric. It includes the following personality disorders with their distinguishing features:

Paranoid : Mistrust and suspicion

Schizoid : Disinterest in others

Schizotypal : Eccentric ideas and behavior

Cluster B is characterized by appearing dramatic, emotional, or erratic. It includes the following personality disorders with their distinguishing features:

Antisocial : Social irresponsibility, disregard for others, deceitfulness, and manipulation of others for personal gain

Borderline : Inner emptiness, unstable relationships, and emotional dysregulation

Histrionic : Attention seeking and excessive emotionality

Narcissistic : Self-grandiosity, need for admiration, and lack of empathy

Cluster C is characterized by appearing anxious or fearful. It includes the following personality disorders with their distinguishing features:

Avoidant : Avoidance of interpersonal contact due to rejection sensitivity

Dependent : Submissiveness and a need to be taken care of

Obsessive-compulsive : Perfectionism, rigidity, and obstinacy

General references

1. Lenzenweger MF, Lane MC, Loranger AW, et al : DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry  62(6):553-564, 2007. doi: 10.1016/j.biopsych.2006.09.019

2. Zimmerman M, Chelminski I, Young D : The frequency of personality disorders in psychiatric patients. Psychiatr Clin North Am 31(3):405-220, 2008 vi. doi: 10.1016/j.psc.2008.03.015

3. Alegria AA, Blanco C, Petry NM, et al : Sex differences in antisocial personality disorder: Results from the National Epidemiological Survey on Alcohol and Related Conditions. Personal Disord 4(3):214-222, 2013. doi: 10.1037/a0031681

4. Sansone RA, Sansone LA : Gender patterns in borderline personality disorder. Innov Clin Neurosci 8(5):16-20, 2011. PMID: 21686143

Symptoms and Signs of Personality Disorders

According to DSM-5-TR, personality disorders are primarily problems with

Self-identity

Interpersonal functioning

Self-identity problems may manifest as an unstable self-image (eg, people fluctuate between seeing themselves as kind or cruel) or as inconsistencies in values, goals, and appearance (eg, people are deeply religious while in church but profane and disrespectful elsewhere).

Interpersonal functioning problems typically manifest as failing to develop or sustain close relationships and/or being insensitive to others (eg, unable to empathize).

People with personality disorders often seem inconsistent, confusing, and frustrating to people around them (including clinicians). These people may have difficulty knowing the boundaries between themselves and others. Their self-esteem may be inappropriately high or low. They may have inconsistent, detached, overemotional, abusive, or irresponsible styles of parenting, which can lead to physical and mental problems in their spouse and/or children.

People with personality disorders often lack insight regarding the impact of their behavior on interpersonal relationships.

Diagnosis of Personality Disorders

Diagnostic and Statistical Manual of Mental Disorders , 5th ed, Text Revision (DSM-5-TR) criteria

Personality disorders are underdiagnosed. When people with personality disorders seek treatment, their chief complaints are often of depression or anxiety rather than of the manifestations of their personality disorder. Once clinicians suspect a personality disorder, they evaluate cognitive, affective, interpersonal, and behavioral tendencies using specific diagnostic criteria. More sophisticated and empirically rigorous diagnostic tools are available for more specialized and academic clinicians.

Diagnosis of a personality disorder requires a persistent, inflexible, pervasive pattern of maladaptive traits involving ≥ 2 of the following ( 1 ) :

Cognition (ie, ways of perceiving and interpreting self, others, and events)

Affectivity (ie, range, intensity, lability, and appropriateness of emotional response)

Impulse control

The persistent pattern of maladaptive traits must cause significant distress or impaired functioning in social, occupational, and other important areas

The pattern is stable and has an early onset (traced back to at least adolescence or early adulthood)

Also, other possible causes of the symptoms (eg, other mental health disorders, substance use , head trauma ) must be excluded.

For a personality disorder to be diagnosed in patients < 18 years, the pattern must have been present for ≥ 1 year, except for antisocial personality disorder , which cannot be diagnosed in patients < 18 years.

Because many patients with a personality disorder lack insight into their condition, clinicians may need to obtain history from other clinicians who have treated these patients previously, family members, friends, or others who have contact with them.

Diagnosis reference

1. American Psychiatric Association:  Diagnostic and Statistical Manual of Mental Disorders , 5th ed, Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022, pp. 733-737.

Treatment of Personality Disorders

Psychotherapy

Sometimes medications for specific symptoms or coexisting psychiatric disorders

The gold standard of treatment for personality disorders is psychotherapy. Both individual and group psychotherapy are effective for many of these disorders if the patient is seeking treatment and is motivated to change.

Typically, personality disorders are not very responsive to medications, although some medications can effectively target specific symptoms (eg, depression, anxiety).

Disorders that often coexist with personality disorders (eg, depressive disorders , anxiety , substance-related disorders, somatic symptom disorders, and eating disorders ) can make treatment challenging, lengthening time to remission, increasing risk of relapse, and decreasing response to otherwise effective treatment. For treatments typically used for each disorder, see table Treatment of Personality Disorders .

General principles for treatment

In general, treatment of personality disorders aims to

Reduce subjective distress

Enable patients to understand that their problems are internal to themselves

Decrease significantly maladaptive and socially undesirable behaviors

Modify problematic personality traits

Reducing subjective distress (eg, anxiety, depression) is the first goal. These symptoms often respond to increased psychosocial support, which often includes moving the patient out of highly stressful situations or relationships. Pharmacotherapy may also help relieve stress. Reduced stress makes treating the underlying personality disorder easier.

An effort to enable patients to recognize that their problems are internal should be made early. Patients need to understand that their problems with work or relationships are caused by their maladaptive ways of relating to the world (eg, to tasks, to authority, or in intimate relationships). Achieving such understanding requires a substantial amount of time, patience, and commitment on the part of a clinician. Clinicians also need a basic understanding of the patient’s areas of emotional sensitivity and usual ways of coping. Family members and friends can help identify problems of which patients and clinicians would otherwise be unaware.

Maladaptive and undesirable behaviors (eg, recklessness, social isolation, lack of assertiveness, temper outbursts) should be dealt with quickly to minimize ongoing damage to jobs and relationships. Behavioral change is most important for patients with the following personality disorders:

Behavior can typically be improved within months by group therapy and behavior modification; limits on behavior must often be established and enforced. Sometimes patients are treated in a day hospital or residential setting. Self-help groups or family therapy can also help change socially undesirable behaviors. Because family members and friends can act in ways that either reinforce or diminish the patient’s maladaptive behavior or thoughts, their involvement is helpful; with coaching, they can be allies in treatment.

Modifying maladaptive personality traits (eg, dependency, distrust, arrogance, manipulativeness) typically takes > 1 year. The cornerstone for effecting such change is individual psychotherapy.

During therapy, clinicians try to identify interpersonal problems as they occur in the patient's life. Clinicians then help patients understand how these problems are related to their personality traits and provide skills training to develop new, better ways of interacting. Typically, clinicians must repeatedly point out the undesirable behaviors and their consequences before patients become aware of them. This strategy can help patients change their maladaptive behaviors and mistaken beliefs. Although clinicians should act with sensitivity, they should be aware that kindness and sensible advice by themselves do not change personality disorders.

Personality disorders involve rigid, maladaptive personality traits that are marked enough to cause significant distress or to impair work and/or interpersonal functioning.

Treatments become effective only after patients see that their problems are within themselves, not just externally caused.

Psychosocial therapy is the mainstay of treatment.

Medications help control specific symptoms only in selected cases—eg, to control significant anxiety, angry outbursts, and depression.

Personality disorders are slow to change, and may gradually become less severe over time.

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People have unique personalities made up of a complex combination of different traits. Personality traits affect how people understand and relate to the world around them, as well as how they see themselves.

Ideally, people's personality traits allow them to flexibly adapt to their changing environment in ways that lead to more healthy relationships with others and better coping strategies. When people have personality traits that are less adaptive, this leads to inflexibility and unhealthy coping. For example, they may manage stress by drinking or misusing drugs, have a hard time managing their anger, and find it hard to trust and connect with others.

Personality forms early in life. It is shaped through a blend of your:

• Genes — Your parents may pass down some personality traits to you. Sometimes these traits are called your temperament.
• Environment — This includes your surroundings, events that have happened to you and around you, and relationships and patterns of interactions with family members and others.

A personality disorder is a mental health condition where people have a lifelong pattern of seeing themselves and reacting to others in ways that cause problems. People with personality disorders often have a hard time understanding emotions and tolerating distress. And they act impulsively. This makes it hard for them to relate to others, causing serious issues, and affecting their family life, social activities, work and school performance, and overall quality of life.

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In some cases, you may not know that you have a personality disorder. That's because how you think and behave seems natural to you. You also may think others are responsible for your challenges.

There are many types of personality disorders, each with important differences. These disorders are organized into three groups, or clusters, with shared features and symptoms:

Group A personality disorders

Group A personality disorders have a consistently dysfunctional pattern of thinking and behavior that reflects suspicion or lack of interest in others. They include:

Paranoid personality disorder

• Lacks trust and is suspicious of others and the reasons for their actions.
• Believes that others are trying to do harm with no reason to feel this way.
• Doubts the loyalty of others.
• Is not willing to trust others.
• Hesitates to confide in others for fear that others will use that information against them.
• Takes innocent remarks or situations that are not threatening as personal insults or attacks.
• Becomes angry or hostile to what are believed to be slights or insults.
• Has a habit of holding grudges.
• Often suspects that a spouse or sexual partner is unfaithful with no reason to feel this way.

Schizoid personality disorder

• Appears to be cold to or not interested in others.
• Almost always chooses to be alone.
• Is limited in how emotions are expressed.
• Cannot take pleasure in most activities.
• Cannot pick up typical social cues.
• Has little to no interest in having sex with another person.

Schizotypal personality disorder

• Has unusual thinking, beliefs, speech or behavior.
• Feels or thinks strange things, such as hearing a voice whisper their name.
• Has flat emotions or emotional responses that are socially unusual.
• Has social anxiety, including not being comfortable making close connections with others or not having close relationships.
• Responds to others in ways that are not proper or shows suspicion or lack of interest.
• Has "magical thinking"— the belief that their thoughts can affect other people and events.
• Believes that some casual incidents or events have hidden messages.

Group B personality disorders

Group B personality disorders have a consistently dysfunctional pattern of dramatic, overly emotional thinking or unpredictable behavior. They include:

Borderline personality disorder

• Has a strong fear of being alone or abandoned.
• Has ongoing feelings of emptiness.
• Sees self as being unstable or weak.
• Has deep relationships that are not stable.
• Has up and down moods, often due to stress when interacting with others.
• Threatens self-harm or behaves in ways that could lead to suicide.
• Is often very angry.
• Shows impulsive and risky behavior, such as having unsafe sex, gambling or binge eating.
• Has stress-related paranoia that comes and goes.

Histrionic personality disorder

• Always seeks attention.
• Is overly emotional or dramatic or stirs up sexual feelings to get attention.
• Speaks dramatically with strong opinions but has few facts or details to back them up.
• Is easily led by others.
• Has shallow emotions that change quickly.
• Is very concerned with physical appearance.
• Thinks relationships with others are closer than they are.

Narcissistic personality disorder

• Has beliefs about being special and more important than others.
• Has fantasies about power, success and being attractive to others.
• Does not understand the needs and feelings of others.
• Stretches the truth about achievements or talents.
• Expects constant praise and wants to be admired.
• Feels superior to others and brags about it.
• Expects favors and advantages without a good reason.
• Often takes advantage of others.
• Is jealous of others or believes that others are jealous of them.

Antisocial personality disorder

• Has little, if any, concern for the needs or feelings of others.
• Often lies, steals, uses false names and cons others.
• Has repeated run-ins with the law.
• Often violates the rights of others.
• Is aggressive and often violent.
• Has little, if any, concern for personal safety or the safety of others.
• Behaves impulsively.
• Is often reckless.
• Has little, if any, regret for how their behavior negatively affects others.

Group C personality disorders

Group C personality disorders have a consistently dysfunctional pattern of anxious thinking or behavior. They include:

Avoidant personality disorder

• Is very sensitive to criticism or rejection.
• Does not feel good enough, important or attractive.
• Does not take part in work activities that include contact with others.
• Is isolated.
• Does not try new activities and does not like meeting new people.
• Is extremely shy in social settings and in dealing with others.
• Fears disapproval, embarrassment or being made fun of.

Dependent personality disorder

• Relies on others too much and feels the need to be taken care of.
• Is submissive or clingy toward others.
• Fears having to take care of self if left alone.
• Lacks confidence in abilities.
• Needs a lot of advice and comforting from others to make even small decisions.
• Finds it hard to start or do projects due to lack of self-confidence.
• Finds it hard to disagree with others, fearing they will not approve.
• Endures poor treatment or abuse, even when other options are available.
• Has an urgent need to start a new relationship when a close one ends.

Obsessive-compulsive personality disorder

• Focuses too much on details, orderliness and rules.
• Thinks everything needs to be perfect and gets upset when perfection is not achieved.
• Cannot finish a project because reaching perfection is not possible.
• Needs to be in control of people, tasks and situations.
• Cannot assign tasks to others.
• Ignores friends and enjoyable activities because of too much focus on work or a project.
• Cannot throw away broken or worthless objects.
• Is rigid and stubborn.
• Is not flexible about morality, ethics or values.
• Holds very tight control over budgeting and spending money.

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, which is an anxiety disorder.

Many people with one type of personality disorder also have symptoms of at least one other type. The number of symptoms a person has may vary.

When to see a doctor

If you have any symptoms of a personality disorder, see your doctor or a mental health professional. When personality disorders are not treated, they can cause serious issues in relationships and mood. Also, the ability to function and pursue personal goals may get worse without treatment.

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It's believed that personality disorders are caused by a blend of how genetics and your environment affect you. Your genes may make it more likely that you develop a personality disorder, and what happens to you in life may set a personality disorder into motion.

Risk factors

Although the specific causes of personality disorders are not known, some factors seem to increase the risk of having one:

• Specific personality traits. This includes always trying to stay away from harm, or the opposite — a strong need to seek out new activities that get the adrenaline pumping. It also includes poor impulse control.
• Early life experiences. This includes a home environment that is not stable, predictable or supportive. It also includes a history of trauma — physical neglect or abuse, emotional neglect or abuse, or sexual abuse.

Complications

Personality disorders can seriously disrupt your life and the lives of those who care about you. They may cause issues in relationships, work or school. And they can lead to social isolation, other mental health issues with addictions, as well as occupational and legal issues.

• Personality disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022; https://dsm.psychiatryonline.org. Accessed Feb. 28, 2023.
• Overview of personality disorders. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders. Accessed March 2, 2023.
• What are personality disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders. Accessed March 2, 2023.
• Skodol A. Overview of personality disorders. https://www.uptodate.com/contents/search. Accessed March 2, 2023.
• Martin RJ, et al., eds. Support for the family. In: Fanaroff and Martin's Neonatal-Perinatal Medicine: Disease of the Fetus and Infant. 11th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed March 2, 2023.
• Nelson KJ. Pharmacotherapy for personality disorders. https://www.uptodate.com/search. Accessed March 3, 2023.
• Kavanagh BE, et al. Personality disorder increases risk of low quality of life among women with mental state disorders. Comprehensive Psychiatry. https://www.clinicalkey.com. Accessed March 3, 2023.
• Allen ND (expert opinion). Mayo Clinic. April 20, 2023.
• Sadock BJ, et al., eds. Personality disorders. In: Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th ed. Wolters Kluwer; 2017. https://ovidsp.ovid.com. Accessed June 9, 2023.
• Stern TA, et al. Personality and personality disorders. In: Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd edition. Elsevier; 2015.
• Solmi M, et al. Risk and protective factors for personality disorders: An umbrella review of published meta-analyses of case-control and cohort studies. Frontiers in Psychiatry. 2021; doi:10.3389/fpsyt.2021.679379.
• Bozzatello P, et al. Borderline personality disorder: Risk factors and early detection. Diagnostics. 2021; doi:10.3390/diagnostics11112142.
• Lebow JR (expert opinion). Mayo Clinic. June 12, 2023.
• Skodol A. Psychotherapy for borderline personality disorder. https://www.uptodate.com/contents/search. Accessed June 15, 2023.

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Personality Disorders: A Guide to the 10 Different Types

A personality disorder significantly impacts the way you see yourself and how you interact with others—in a way that's outside of societal norms. Emotional control is another issue. There are 10 different types. Here's what to know.

Your personality is influenced by many factors. Your experiences, surroundings, and genetics all have an impact. Generally speaking, your personality stays the same over time. But when someone thinks, feels, and behaves in a way that deviates drastically from society's expectations—and it interferes with daily functioning—they may have a personality disorder.¹

What Is a Personality Disorder?

Experts say personality disorders are considered mental illnesses. There are 10 different types that make up the group, but many symptoms overlap.

Someone with a personality disorder repetitively engages in behaviors that others find offensive or problematic. Yet the individual does not understand why others think this way about their behavior, says Steven Hollon, PhD, of Brentwood, Tennessee, a professor of psychology at Vanderbilt University. “They just don’t see anything wrong with how they are acting,” he explains.

“A personality disorder is a sort of disruption in your thinking style that usually leads to dysregulation in some aspect of your life,” explains Scott Krakower, DO, a psychiatrist at Zucker Hillside Hospital in Glen Oaks, New York. “It’s like a disruption in your overall being and the way you think and act, and it impairs your day-to-day functioning.”

A personality disorder can affect how people think about themselves and others, how they respond and relate to others, and how they control their behavior. Without treatment, a personality disorder can last for a long time and severely impact a person’s ability to enjoy stable relationships .²

The American Psychiatric Association lists 10 specific types of personality disorders, each one has a persistent pattern of behavior that generally starts by late adolescence or early adulthood.

Clusters A, B, and C: What's the Difference?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) organizes the 10 types of personality disorders into these three clusters—A, B, and C. Each personality disorder within a cluster shares certain characteristics with other personality disorders in that cluster.³

Cluster A: These personality disorders are characterized by eccentric behavior and include the following: paranoid, schizoid, schizotypal . “Cluster A personality disorders are the least common,” Hollon says.

Cluster B: These personality disorders are characterized by behavior that appears dramatic, erratic, or emotional. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders . “Someone one who has one of these really stands out,” Hollon explains. "A person with a cluster B personality disorder can appear unstable and behave aggressively to others."

Cluster C: Those with a cluster C personality disorder can appear anxious or fearful. This cluster includes avoidant, dependent, and obsessive-compulsive personality disorders .² These personality disorders are the most common,” Hollon says. “Up to 15% of people may have one of the cluster C disorders.” However, people suffering from cluster C disorders are less overtly disruptive in their relationships, and may go undiagnosed because of this.

What Is the Most Common Personality Disorder?

Antisocial personality disorder and borderline personality disorder (BPD) are the most frequently diagnosed personality disorders.³

But that does not necessarily mean they are the most common. Some other personality disorders may be more common, but often go undiagnosed, says Naftali Berrill, PhD, director of the New York Center for Neuropsychology and Forensic Behavioral Science in Glen Head, New York.

“For instance, someone with narcissistic personality disorder may not feel that they have any problem,” he says. "And since they don’t think they have any problem, they are not likely to seek out any treatment so their personality disorder would go undiagnosed."

By some estimates, obsessive-compulsive personality disorder (OCPD) is the most common personality disorder. Around 1 in 100 individuals have OCPD, and it is diagnosed in twice as many men as women.

OCPD is different from obsessive-compulsive disorder ( OCD ), Berrill explains. “If you grow up in a house where your parents are high-strung and everything has to be orderly—and you are rewarded for certain kinds of behavior—these could be the seeds necessary to cultivate certain characteristics of obsessive-compulsive personality disorder,” he says. “It is also possible to have more than one personality disorder. So, you could have narcissistic personality disorder as well.”

To be diagnosed with OCD, a person must be acting in a way that is readily observed by others and that may cause social problems and occupational problems as well as internal problems for the person, Berrill says.

The difference between OCD and OCPD is that people with OCD recognize that their unwanted thoughts aren’t reasonable, and they can feel tortured by them. People with OCPD, on the other hand, feel that their way is the right way. They are very comfortable with their self-imposed rigid perfectionism, excessive fixation with minor rules, and unwavering sense of righteousness about how things should be done. For those with OCPD it's more of a voluntary coping mechanism, whereas such impulses are uncontrollable in OCD.

Here, an overview of the 10 personality disorders listed in the DSM-5.

Borderline personality disorder  is defined in the DSM by “a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.” Borderline personality disorder causes a disturbance in the person’s emotional state and can lead to a dysregulation in how the person acts, Dr. Krakower says. “This personality disorder affects how you react to other people and how you perceive things,” he says. “Narcissism can be a part of BPD as well.” Self-harming behaviors like cutting and suicidal thinking are also common in BPD. Often, a person with BPD may be helped by dialectical behavior therapy (DBT), a cognitive-behavioral treatment that combines individual psychotherapy with group skills training classes to help individuals learn new skills and strategies for managing their emotions and reducing conflict in their lives. “DBT can help you find a better balance in your life,” says Dr. Krakower. “It encompasses mindfulness and healing.” DBT offers weekly individual and group sessions (yes, there is often homework), and the aim of therapy is to help people discover better ways to deal with stress and resist the urge to engage in self-destructive behavior.⁴

Paranoid personality disorder : According to Dr. Krakower, an individual with this disorder exhibits a distrust toward others that typically begins by early adulthood. “In addition to recurrent suspicions of others, the person reads hidden meanings into benign remarks,” he explains. “The person may suspect that others are deceiving them.” The DSM defines the disorder as “a pattern of distrust and suspiciousness such that the motives of others are interpreted as malevolent.” The individual suffering from paranoid personality disorder experiences “suspicion without an objective or sufficient basis,” says explains Shawna Newman, MD, an adult, child, and adolescent psychiatrist at Lenox Hill Hospital in New York City. “The individual can read negative meaning into very innocent remarks. They perceive a lot of unintentional insults and may be very unforgiving.”

Schizoid personality disorder :  This disorder is explained in the DSM as “a pattern of detachment from social relationships and a restricted range of emotional expression.” “The person may be more of a loner and choose solitary activities,” Dr. Krakower says. While a person with schizoid personality disorder can benefit from social skills groups, more often these individuals choose not to seek treatment, as they don't miss social interaction that much.

Schizotypal personality disorder  is marked by a pattern of difficulty with relationships that is accompanied by cognitive and perceptual distortions and eccentric behaviors, says Dr. Krakower. “The individual may be superstitious and have magical beliefs or strange and unusual ideas,” he explains. While a person with schizotypal personality disorder could benefit from social skills groups, they often choose not to seek out treatment. Individuals with this disorder are so highly superstitious they are basically dysfunctional, Dr. Newman says. “They may have odd beliefs that influence their behavior, such as ideas about clairvoyance or telepathy, and those with this personality disorder often have very bizarre thoughts,” she says. Individuals tend to have excessive social anxiety with everyone except first-degree relatives, she says.

Antisocial personality disorder:  This disorder entails a pattern of behavior that is marked by disregard for and violation of the rights of others. Antisocial personality disorder is sometimes called sociopathy or, in more severe cases, psychopathy. These individuals often fail to conform to social norms, which may result in repetitive arrests and criminal behavior, Dr. Krakower explains. “Males with antisocial behavior tend to break the law, disregard rules of conduct, and be manipulative and reckless,” says John M. Oldham, MD, interim chief of staff at the Menninger Clinic and distinguished emeritus professor at the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Texas. “They show no remorse for the things they do, and they don’t conform to social norms,” he says. “There is not a good treatment for antisocial personality disorder, and you should start early in life to try to prevent it because once it’s there, it’s hard to fix.”

A person with a  histrionic personality disorder exhibits a pattern of attention-seeking behaviors, which may entail a heightened sense of dramatization and inappropriate sexual or provocative behaviors, Dr. Krakower says. Sometimes, this individual has borderline personality disorder as well. People with histrionic personality disorder could benefit from DBT.

Narcissistic personality disorder  involves a pattern of grandiose behaviors with an exaggerated sense of self-esteem, Dr. Krakower says. “Someone with NPD has the feeling that they are always right about everything,” he says. “They have a very high sense of self-esteem.” A person with narcissistic personality disorder is likely to have extreme mood swings between self-admiration and insecurity and is oversensitive to failure.⁵ There are subtypes of NPD, however, so in addition to those who appear outwardly confident and callous, there are those who are "covert," self-absorbed and hypersensitive to criticism. To treat this disorder, psychotherapy (aka talk therapy) is effective—but often ignored as many with NPD don’t think there is a problem. During therapy the person with NPD would gain insight into the causes of their emotions (why are they so distrustful of others?) and would learn to better relate to other people so that their relationships are more enjoyable.⁶ Dr. Oldham says these people believe they are special and unique. “They feel entitled to excessive admiration from others as a result,” he says. “These individuals are not very good at having empathy. Nor are they interested in trying to understand how other people feel.” A person with a narcissistic personality disorder may also have borderline personality disorder and could benefit from individual therapy, he says, but unfortunately, it’s common for the person to refuse treatment. Transference-focused psychotherapy can be effective with this personality disorder,” Dr. Krakower says. “It is an old-school form of analytical therapy that works well,” he explains. In transference-focused psychotherapy, the therapist and patient work to integrate and bring together the patient’s split-off parts, and the primary goal is to change the patient’s behavior as well as their sense of self.

An  avoidant personality disorder  involves a pattern of behavior with heightened social inhibition, which is often accompanied by a fear of rejection of others. The person may have feelings of inadequacy and be hypersensitive to negative evaluation. “This disorder is easy to miss because people close to those with avoidant personality disorder don’t recognize it as a problem—it can be subtle,” says Dr. Oldham. Psychotherapy is the primary treatment, he says.

A person with a  dependent personality disorder  exhibits a pattern of behavior marked by excessive neediness or clinginess, accompanied by fears of separation, Dr. Krakower explains. They are more at risk of abusive relationships. Both CBT and psychotherapy (talk therapy) can help someone with dependent personality disorder. In therapy, the person can learn how to handle difficult situations and improve their self-confidence.⁷

Someone living with  anankastic (obsessive-compulsive) personality disorder  displays a pattern of behavior of excessive orderliness and perfection. Dr. Krakower explains that the person is also inflexible and rigid. “With OCD, the person can have unwanted images that they just cannot get out of their head,” he says. “They may be totally focused on neatness and orderliness, which can be exhausting. Everything has to be exact and perfect.” Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs) can be helpful. Cognitive-behavioral therapy and psychodynamic therapy may be effective at treating people with OCPD.⁸

Unfortunately, most personality disorders can’t be treated with medication. But if depression or anxiety exist along with a personality disorder, those symptoms may improve through the use of medication. One of the unique treatment challenges associated with personality disorders is that the person living with the problem isn’t motivated to change because they don’t see their behavior as problematic. But encouraging a loved one to establish a relationship with an experienced psychotherapist may give them the best chance at improvement.

• American Psychiatric Association. Personality disorders. Retrieved from https://psychiatry.org/Patients-Families/Personality-Disorders . Accessed October 18, 2022.
• Merck Manual. Overview of personality disorders. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/personality-disorders/overview-of-personality-disorders Accessed October 18, 2022
• Cleveland Clinic. Personality disorders. Available at https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview Accessed October 18, 2022
• Merck Manual. Borderline personality disorder. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/personality-disorders/borderline-personality-disorder-bpd Accessed October 19, 2022
• Mayo Clinic. Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/diagnosis-treatment/drc-20366690 Accessed October 17, 2022
• Mental Health America. Personality disorder. Retrieved from https://www.mhanational.org/conditions/personality-disorder Accessed October 18, 2022
• Cleveland Clinic. Dependent personality disorder. Retrieved from https://my.clevelandclinic.org/health/diseases/9783-dependent-personality-disorder . Accessed October 22, 2022.
• Merck Manual. Obsessive-Compulsive Personality Disorder. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/personality-disorders/obsessive-compulsive-personality-disorder#v36027302 Accessed August 20, 2022
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Retrieved from: https://doi.org/10.1176/appi.books.9780890425596
• International OCD Foundation. Obsessive Compulsive Personality Disorder. https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf
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Personality Disorders: Summary and Conclusion

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Personality Disorder Definition

Since everyone has a personality, but not everyone has a personality disorder, these disorders are considered a variant form of normal, healthy personality.

• However, the most significant and defining feature of personality disorders is the negative effect these disorders have on interpersonal relationships .
• People with personality disorders tend to respond to differing situations and demands with a characteristically rigid constellation of thoughts, feelings, and behavior .
• This inflexibility and difficulty in forming nuanced responses represents the primary difference between healthy and disordered personalities.

Personality Disorder Diagnosis

The diagnosis of personality disorders is often very complex as these disorders frequently co-occur with each other and with other psychiatric categories of disorders . The current diagnostic system of the DSM-5 (APA, 2013) relies upon a categorical approach that outlines the following criteria to meet a personality disorder diagnosis:

• Significant impairments in interpersonal functioning and self-identity that are relatively consistent across time and situations.
• The impairments have no discernable cause outside of the individual's personality trait domains, like psychological or head trauma, sociological/cultural environment and are not due to the effects of using a substance .

Personality Disorder Causes

The exact cause of personality disorders remains uncertain. However, it is clear there are both biological and psychosocial factors that influence the development of personality and personality disorders.

Several psychological theories of personality disorders attempt to explain the psychosocial origins of personality disorders. The following psychological theories of personality disorders were reviewed:

• Object relations theory.
• Attachment theory (including mentalization).
• Cognitive-behavioral theory (including dialectical behavior theory and schema theory).

Personality Disorder Treatment

Not too long ago, personality disorders were thought to be untreatable. There are now several highly effective treatments for personality disorders that derive from the same psychological theories previously reviewed, with pharmacological interventions serving as an important adjunct. These treatments include:

• Transference-focused therapy (TFP) .
• Mentalization-based therapy (MBT) .
• Cognitive-behavioral therapy (CBT) .
• Dialectical behavior therapy (DBT) .
• Schema therapy .

In conclusion , recent technological advancements and improvements to diagnostic methodologies have enabled researchers to study personality and personality disorders as never before.

• As a result, we now have a much greater understanding of these disorders.
• Furthermore, this research has facilitated the development of several highly effective treatments for personality disorders that are evidenced-based.
• As research continues, these treatment approaches will be further refined.

Additional Resources

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• Alternative Diagnostic Models for Personality Disorders Continued
• Alternative Diagnostic Models for Personality Disorders: The DSM-5 Dimensional Approach
• Attachment Theory Expanded: Mentalization
• Attachment Theory of Personality Disorder
• Biological Explanations of Personality Disorder
• Biological Factors Related to the Development of Personality Disorders (Nature)
• Borderline Personality Disorder – Raising Questions, Finding Answers
• Co-Occurence of Personality Disorders
• Co-occurrence of Personality Disorders with Other Disorders
• Cognitive-Behavioral Theory of Personality Disorders
• Cognitive-Behavioral Therapy for Personality Disorders (CBT)
• Defense Mechanisms
• Defining Features of Personality Disorders: Distorted Thinking Patterns
• Defining Features of Personality Disorders: Impulse Control Problems
• Defining Features of Personality Disorders: Problematic Emotional Response Patterns
• DSM-5 The Ten Personality Disorders: Cluster C
• DSM-5: The Ten Personality Disorders: Cluster A
• DSM-5: The Ten Personality Disorders: Cluster B
• Early life Experiences and the Development of Personality Disorders (Nurture):
• Everyone Has A Personality
• Examples of Personality Disorders With Distorted Thinking Patterns
• Flexibility: The Key to a Healthy Personality
• Kernberg’s Dimensional Approach: An Alternative Classification System
• Medications for Treating Personality Disorder
• Mentalization-Based Treatment (MBT) Continued
• Mentalization-Based Treatment (MBT) for Personality Disorders
• Object Relations Theory Continued
• Object Relations Theory of Personality Disorders
• Other Explanations of Personality Disorders: Structural Analysis of Social Behavior (SASB)
• Problems with the Current Diagnostic System Continued
• Problems with the Diagnostic System for Personality Disorders
• References and Resources – Part I
• Schema Therapy for Personality Disorders
• Summary of What is a Personality Disorder
• The Bio-Psycho-Social Model of Human Behavior
• The Definition of a Personality Disorder
• The Dimension of Personality Organization
• The History of the Psychiatric Diagnostic System
• The History of the Psychiatric Diagnostic System Continued
• The Most Significant, Defining Featured of Personality Disorders: Interpersonal Difficulties
• The Three Levels of Personality Organization
• The Treatment of Personality Disorders
• Transference Focused Psychotherapy (TFP) for Personality Disorders
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What Are Cluster C Personality Disorders?

Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics. 

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Verywell Mind / Getty Images

• Personality Disorder Clusters

Cluster C Types

• Avoidant Personality
• Dependent Personality
• Signs & Symptoms: Do I Have a Cluster C Personality Disorder?

Cluster C personality disorders are marked by symptoms of anxiety and fear. Cluster C personality disorders include avoidant personality disorder (AVPD), dependent personality disorder, and obsessive-compulsive personality disorder (OCPD).

Personality disorders are mental health conditions characterized by changes in a person’s mood, behavior, and thinking patterns.

Read on to learn about Cluster C personality disorder types, how to identify if you might have one, and how it can be treated.

Overview of Personality Disorder Clusters

According to the National Institutes of Mental Health (NIMH), approximately 9% of U.S. adults have been diagnosed with a personality disorder.

What Are the Three Personality Disorder Clusters?

The DSM-5-TR categorizes personality disorders into three clusters:

• Cluster A: People with Cluster A personality disorders exhibit behaviors others might find odd. They might have unusual levels of paranoia or severe disinterest in people and social relationships. 
• Cluster B : This set of disorders causes a person to be overly dramatic or emotional. One of the most commonly recognized disorders in this cluster is borderline personality disorder , characterized by impulsive behaviors, unstable relationships, and emotions.
• Cluster C: Cluster C personality disorders trigger intense feelings and behaviors of anxiety and fear.

Causes of Cluster C Personality Disorders 

Thoughts, behaviors, and emotions form your personality . Personality disorders can skew your personal and social relationships. A combination of genetics, environmental and developmental factors may contribute to developing personality disorders.

One theory suggests that family history has a significant role to play. For example, you are more likely to develop a personality disorder if a parent or sibling has a personality disorder.

Brain Changes

Scientists have observed differences in brain structure in some people with certain personality disorders. In one study, scientists observed a decrease in grey matter in the medial temporal cortex of women with borderline personality disorder.

Cultural Factors

There's a connection between culture and personality disorders. Culture plays a vital role in defining who you are. It dictates many parts of your personality and self-image. Cultures encouraging emotional sensitivity are less likely to shape people who exhibit impulsive and suicidal behaviors.

Trauma and Abuse

Environmental factors also have a role to play, especially when combined with family history. For instance, a history of abuse can make you more susceptible to developing personality disorders. Research shows a strong link between childhood sexual trauma and borderline personality disorder.

Types of Cluster C Personality Disorders 

There are three types of Cluster C personality disorders, each with a set of unique symptoms and characteristics.

• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder

Avoidant Personality Disorder 

People with avoidant personality disorder (AVPD) struggle with feelings of inadequacy . They are typically overly sensitive to negative remarks and tend to avoid interacting with other people as a result. They are also likely to have low self-esteem and struggle to interact with new people.

According to the DSM-5-TR, for a diagnosis of AVPD, a person must exhibit a consistent pattern of hypersensitivity to criticism, feelings of inadequacy, and avoiding social interactions.

Dependent Personality Disorder 

As the name implies, dependent personality disorder makes people with the condition over-reliant on other people. They are likely to constantly seek external validation from others and become despondent when they feel they are not receiving adequate support. 

A person with a dependent personality disorder will exhibit people-pleasing behaviors and have an unreasonable fear of separation. A person with this condition must show a persistent need to be taken care of, leading them to become clingy and submissive.

Obsessive-Compulsive Personality Disorder (OCPD) 

This personality disorder causes a person to develop an inflexible need for order and control. People with this condition are perfectionists and react negatively when people or situations threaten their sense of order. 

OCPD and OCD Are Not the Same Disorders

It’s crucial to understand that obsessive-compulsive personality disorder (OCPD) is distinct from obsessive-compulsive disorder (OCD),  a type of anxiety disorder.

People with OCD are typically aware of their condition, while people with OCPD tend to be oblivious to the behaviors they are exhibiting.

OCPD is a personality disorder

Believes their thoughts and behaviors are right

Driven by a need for perfection

Capable of functioning efficiently

OCD is an anxiety disorder

Feels distressed over their thoughts and behaviors

Driven by a need to prevent disasters

Struggle with daily functioning

Signs & Symptoms: Do I Have a Cluster C Personality Disorder?

Personality disorders are all characterized by changes to your personality. Symptoms of Cluster C personality disorders depend on your Cluster C condition.

You might be wondering if you're exhibiting any signs or symptoms of a Cluster C personality disorder or know someone who is.

Read ahead to learn more about the common signs and symptoms for each type of Cluster C personality disorder.

Avoidant Personality Disorder Symptoms 

People with avoidant personality disorder exhibit behaviors such as:

• Avoiding work and social activities 
• Having feelings of inferiority  
• Being overly sensitive to criticism or negative feedback
• Having difficulty accepting rejection
• Being extremely shy or socially awkward 
• Avoiding meeting new people or trying out new activities 

Dependent Personality Disorder Symptoms 

Dependent personality disorder causes a person to exhibit the following characteristics:

• Having a constant need to be in romantic relationships 
• Entering a new romantic relationship as soon as one ends 
• Having a fear of being alone  
• Being overly dependent on other people 
• Being unable to take care of one’s self adequately 
• Tolerating abusive relationships or situations because of a fear of being alone 
• Low self-esteem 
• A constant need for external validation 

Obsessive-Compulsive Personality Disorder Symptoms 

This personality disorder typically causes a person to fixate on minute details and systematization. Other symptoms include:

• Demanding perfection in all scenarios 
• Being unable to function at any sign of disorder or disorganization 
• Demanding perfectionism from themselves and others  
• Needing to be in control of people and tasks at all times 
• Being unable to delegate tasks 

Diagnosis of Cluster C Personality Disorders 

Cluster C personality disorders must be diagnosed by a medical or mental health professional. If you are exhibiting symptoms, make an appointment with your healthcare provider as soon as possible. 

The DSM-5-TR provides diagnostic criteria for each personality disorder. After performing a physical exam to evaluate the severity of your symptoms, your doctor will likely compare the symptoms you’ve been exhibiting to the diagnostic criteria provided by the DSM-5-TR. 

Your physical exam involves an in-depth analysis of your family and medical history. Your family history is crucial as Cluster C personality disorders can be passed down through families. 

Cluster C Personality Disorder Treatment 

Treatment for a personality disorder can be challenging. The severity of your symptoms and any comorbid conditions you may have will typically be considered.

Research shows that people with Cluster C personality disorders are at high risk of developing substance use disorder.  

A combination of medication and psychotherapy can be used to manage symptoms.

Medications 

Although the FDA approves no specific medications for treating personality disorders, your doctor may prescribe medication for particular symptoms. 

If you exhibit signs of depression, your healthcare provider may prescribe antidepressants. Mood stabilizers can also help to regulate your mood if you’ve been experiencing severe mood swings.  

Psychotherapy 

Psychotherapy  is a vital treatment tool for many mental health conditions, including personality disorders. You can consider different types of therapy, from group therapy to individual talk therapy. 

Therapy can equip you with the skills to handle social interactions and healthy coping mechanisms to handle challenging emotions. In many cases, psychotherapy is the first line of treatment used to manage personality disorders.

Coping With Cluster C Personality Disorders 

Lifestyle management for personality disorders is just as crucial as treatment is for this group of conditions.

Strategies that you can employ to cope better include:

• Exercise regularly : Staying physically active is vital when living with a mental health condition . Understandably, however, severe symptoms can make exercise challenging. To overcome this, find an activity you love and do it regularly. This could be swimming, dancing, or simply taking a daily walk in the park. 
• Join a support group : Knowing you are not alone in dealing with your condition can be empowering. Joining a support group of people with Cluster C personality disorders helps you learn more about your condition and how best to manage it outside your treatment plan. 
• Don’t stop treatment: It can be tempting to discontinue your treatment, especially when your symptoms are mild or dormant. However, sticking to your treatment plan is crucial until your doctor advises you to stop it. 

Frequently Asked Questions

No, ADHD is not a personality disorder, it is a neurodevelopmental disorder. However, ADHD is often associated with Cluster B personality disorders (like borderline personality disorder), but a study found that ADHD can also co-occur alongside Cluster C personality disorder traits.

There’s currently no cure for personality disorders; however, they are treatable. Symptoms of personality disorders can be managed with medication and therapy to encourage changed behavior.

Massaal-van der Ree LY, Eikelenboom M, Hoogendoorn AW, Thomaes K, van Marle HJF. Cluster B versus Cluster C Personality Disorders: A Comparison of Comorbidity, Suicidality, Traumatization and Global Functioning .  Behav Sci (Basel) . 2022;12(4):105. Published 2022 Apr 12. doi:10.3390/bs12040105

NIMH. Personality disorders .

Ward RK. A ssessment and management of personality disorders. AFP. 2004;70(8):1505-1512.

Fatimah H, Wiernik BM, Gorey C, McGue M, Iacono WG, Bornovalova MA. Familial factors and the risk of borderline personality pathology: genetic and environmental transmission. Psychol Med. 2020;50(8):1327-1337.

Soloff P, Nutche J, Goradia D, Diwadkar V. Structural brain abnormalities in borderline personality disorder: A voxel-based morphometry study. Psychiatry Research: Neuroimaging. 2008;164(3):223-236.

Ronningstam EF, Keng SL, Ridolfi ME, Arbabi M, Grenyer BFS. Cultural aspects in symptomatology, assessment, and treatment of personality disorders . Curr Psychiatry Rep. 2018;20(4):22.

American Psychological Association. What causes personality disorders?

Perry J. Cluster c personality disorders: avoidant, dependent, and obsessive-compulsive. In: Gabbard’s Treatments of Psychiatric Disorders. Fifth Edition. American Psychiatric Publishing; 2014.

MSD Manual Professional Edition. Avoidant personality disorder (Avpd) - psychiatric disorders.

MSD Manual Professional Edition. Dependent personality disorder (Dpd) - psychiatric disorders.

MedlinePlus Medical Encyclopedia. Obsessive-compulsive personality disorder:

Roncero C, de Miguel A, Fumero A, et al. Anxiety and depression in drug-dependent patients with cluster c personality disorders. Front Psychiatry. 2018;9:19.

Ripoll LH. P sychopharmacologic treatment of borderline personality disorder. Dialogues in Clinical Neuroscience. 2013;15(2):213-224.

Davison SE. Principles of managing patients with personality disorder. Adv psychiatr treat. 2002;8(1):1-9.

MSD Manual Professional Edition. Overview of personality disorders - psychiatric disorders.

Koomen LEM, van der Horst MZ, Deenik J, Cahn W. Lifestyle interventions for people with a severe mental illness living in supported housing: A systematic review and meta-analysis. Front Psychiatry. 2022;13:966029.

CDC. ADHD .

Arancibia M, Valdivia S, Morales A, et al. R asgos de personalidad del grupo C y trastorno por déficit de atención en estudiantes de medicina: estudio transversal analítico [Cluster C personality traits and attention deficit disorder in medical students. An analytical cross-sectional study] .  Rev Med Chil . 2020;148(8):1105-1112. doi:10.4067/S0034-98872020000801105

Personality Disorder Awareness Network. Are personality disorders treatable?

By Toketemu Ohwovoriole Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics.

Personality Disorders: Theory, Research, and Treatment

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Journal scope statement

Personality Disorders: Theory, Research, and Treatment ® ( PD:TRT ) publishes a wide range of cutting-edge research on personality disorders and related psychopathology from a categorical and/or dimensional perspective including laboratory and treatment outcome studies, as well as integrative conceptual manuscripts and practice reviews that bridge science and practice.

Equity, diversity, and inclusion

Personality Disorders: Theory, Research, and Treatment supports equity, diversity, and inclusion (EDI) in its practices. More information on these initiatives is available under EDI Efforts .

Call for papers

• General call for papers

Open science

The APA Journals Program is committed to publishing transparent, rigorous research; improving reproducibility in science; and aiding research discovery. Open science practices vary per editor discretion. View the initiatives implemented by this journal .

Editor’s Choice

In each issue of Personality Disorders: Theory, Research, and Treatment one accepted manuscript will be selected to serve as an “ Editor’s Choice ” paper. Selection will follow discussion by the editor and associate editor and consider issues such as overall contribution, clinical implications, or the highlighting of important theoretical, methodological, or quantitative issues or advances in the study of personality pathology.

Author and editor spotlights

Explore journal highlights : free article summaries, editor interviews and editorials, journal awards, mentorship opportunities, and more.

Prior to submission, please carefully read and follow the submission guidelines detailed below. Manuscripts that do not conform to the submission guidelines may be returned without review.

Personality Disorders: Theory, Research, and Treatment ® ( PD:TRT ) is now using a software system to screen submitted content for similarity with other published content. The system compares each submitted manuscript against a database of 25+ million scholarly publications, as well as content appearing on the open web.

This allows APA to check submissions for potential overlap with material previously published in scholarly journals (e.g., lifted or republished material). A similarity report will be generated by the system and provided to the PD:TRT Editorial office for review immediately upon submission.

To submit to the editorial office of Joshua D. Miller, PhD, please submit manuscripts electronically through the Manuscript Submission Portal (.rtf, .doc, or .pdf files).

Prepare manuscripts according to the Publication Manual of the American Psychological Association using the 7 th edition. Manuscripts may be copyedited for bias-free language (see Chapter 5 of the Publication Manual ). APA Style and Grammar Guidelines for the 7 th edition are available.

New to 2021 and beyond submissions

An emphasis of PDTRT moving forward is to publish studies with larger sample sizes given the problems associated with smaller samples including lack of statistical power, lower precision and poorer stability of effect sizes (e.g., Schönbrodt & Perugini, 2013), and the increased odds that statistically significant effect sizes from small samples may be substantial overestimates. Studies submitted with very small samples are likely to be rejected without review (even when reporting patient data). Given the importance of power, all submissions must discuss how they decided upon the current sample size, report power analyses that influenced such decisions (if conducted), and if power was not part of the original plan, must report sensitivity analyses as to the smallest effects of interest the study was powered to find. Post-hoc power analyses based on the current effect sizes should not be reported. For case control designs (e.g., borderline PD vs. healthy groups), our strong preference will be that a third group be included (e.g., major depressive disorder) so as to speak to the specificity of the findings. Submissions must also note whether attempts were made to screen for data validity (e.g., with self-report data, reporting on tests of inconsistent or invariant responding, use of validity scales, attention checks, or cut-offs for timing deemed implausible). If data were not screened for validity, this must be noted explicitly. If participants were removed for invalid responding, the details (i.e., how many and for what reasons) must be provided.

Another goal of PDTRT is to increase transparency. In that vein, it is our hope that authors will submit work that was pre-registered . As such, authors must report in the first footnote of the study whether the study was pre-registered and, if so, provide an anonymized link to the pre-registration so that it can be examined by reviewers. Similarly, please note whether the data and code for the study are publicly available and, if so, where these can be found. Although pre-registration itself is not required for submission to PDTRT, it is our goal that an increasing percentage of PDTRT submissions will have been pre-registered across our 6 year term. We also welcome Registered Report submissions . If interested authors have questions about Registered Reports, please contact Josh Miller .

Submit Manuscript

Joshua D. Miller Department of Psychology 153 Psychology Building University of Georgia Athens, GA 30602 Email

In addition to addresses and phone numbers, please supply email addresses and fax numbers for use by the editorial office and later by the production office. Most correspondence between the editorial office and authors is handled by email, so a valid email address is important for the timely flow of communication during the editorial process.

Keep a copy of the manuscript to guard against loss.

Masked review policy

PD:TRT uses a masked reviewing system for all submissions. Omit the authors' names and affiliations on the first page of the manuscript, but include the title of the manuscript and the submission date. Authors are to make every effort to see that the manuscript itself contains no clues to their identities, including grant numbers, names of institutions providing IRB approval, self-citations, and links to online repositories for data, materials, code, or preregistrations (e.g., Create a View-only Link for a Project ).

Please ensure that the final version for production includes a byline and full author note for typesetting.

List five keywords on the title page to facilitate the selection of peer reviewers. Additionally, provide a cover letter indicating the proposed category under which the manuscript was submitted (e.g., Brief Report) and up to four suggestions for potential reviewers. Suggested reviewers should generally not include those with possible conflicts of interest (COI). In most cases, this would include frequent collaborators, mentors, departmental colleagues, current or previous lab mates, or close personal friends. In some rarer cases in which the research is done in a very small, niche area it may be impossible to avoid suggestions with some COI. In these cases, please include information pertaining to this issue in the cover letter.

Transparency and openness

APA endorses the Transparency and Openness Promotion (TOP) Guidelines by a community working group in conjunction with the Center for Open Science ( Nosek et al. 2015 ).

Empirical research, including meta-analyses, submitted to the PD:TRT must at least meet the “requirement” level (Level 2) for citation; data, code, and materials transparency; design and analysis transparency; and study and analysis plan preregistration. Authors should include a subsection in the method section titled “Transparency and Openness.” This subsection should detail the efforts the authors have made to comply with the TOP guidelines.

For example:

• We report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study, and we follow JARS (Appelbaum et al., 2018). All data, analysis code, and research materials are available at [stable link to repository]. Data were analyzed using R, version 4.0.0 (R Core Team, 2020) and the package ggplot , version 3.2.1 (Wickham, 2016). This study’s design and its analysis were not pre-registered.

Data, materials, and code

Authors must state whether data and study materials are posted to a trusted repository and, if so, how to access them, including their location and any limitations on use. If they cannot be made available, authors must state the legal or ethical reasons why they are not available. Trusted repositories adhere to policies that make data discoverable, accessible, usable, and preserved for the long term. Trusted repositories also assign unique and persistent identifiers. Recommended repositories include APA’s repository on the Open Science Framework (OSF), or authors can access a full list of other recommended repositories .

In a subsection titled “Transparency and Openness” at the end of the method section, specify whether and where the data and materials are available or note the legal or ethical reasons for not doing so. For submissions with quantitative or simulation analytic methods, state whether the study analysis code is posted to a trusted repository, and, if so, how to access it (or the legal or ethical reason why it is not available).

• All data have been made publicly available at the [trusted repository name] and can be accessed at [persistent URL or DOI].
• Materials and analysis code for this study are not available [for ethical or legal reason].
• The code behind this analysis/simulation has been made publicly available at the [trusted repository name] and can be accessed at [persistent URL or DOI].

If you cannot make your data available on a public site, authors are required to follow current APA policy to make the materials and data used in a published study available in a timely manner to other researchers upon request.

If an author has multiple studies, the repository landing page should clearly identify how to access the specific type of information for each study and the links.

Disclosure of prior uses of data

Upon submission of a manuscript, the authors must disclose any prior uses in published, accepted, or under review papers of data reported in the manuscript. The cover letter should include a complete reference list of these articles as well as a description of the extent and nature of any overlap between the present submission and the previous work.

Citation standards

Upon submission, all data sets, materials, and program code created by others must be appropriately cited in the text and listed in the reference section. Such materials should be recognized as original intellectual contributions and afforded recognition through citation.

Where possible, references for data sets and program code should include a persistent identifier assigned by digital archives, such as a Digital Object Identifier (DOI).

Data set citation example:

Campbell, Angus, & Kahn, Robert L. (1948). American National Election Study [Data set]. ICPSR07218v3. Interuniversity Consortium for Political and Social Research (Ann Arbor, MI) [distributor] (1999). [Data set]. http://doi.org/10.3886/ICPSR07218.v3

Design and analysis transparency

Authors must adhere to the Journal Article Reporting Standards (JARS) (PDF, 220KB) . See also the specific section editorials and instructions on information to include in method and results sections. It is particularly important to provide justifiable power considerations and specific details related to sample characteristics.

Preregistration of studies and analysis plans

Preregistration of studies and specific hypotheses can be a useful tool for making strong theoretical claims. Likewise, preregistration of analysis plans can be useful for distinguishing confirmatory and exploratory analyses. Investigators may reregister prior to conducting the research via a publicly accessible registry system (e.g., OSF , ClinicalTrials.gov, or other trial registries in the WHO Registry Network). There are many available templates; for example, APA, the British Psychological Society, and the German Psychological Society partnered with the Leibniz Institute for Psychology and Center for Open Science to create Preregistration Standards for Quantitative Research in Psychology (Bosnjak et al., 2022).

At the same time, we recognize that there may be good reasons to change a study or analysis plan after it has been preregistered, and thus encourage authors to do so when appropriate so long as all changes are clearly and transparently disclosed in the manuscript. Articles must state whether or not any work was preregistered and, if so, where to access the preregistration. Preregistrations must be available to reviewers; authors may submit a masked copy via stable link or supplemental material. Links in the method section should be replaced with an identifiable copy on acceptance.

• This study’s design was preregistered; see [STABLE LINK OR DOI].
• This study’s design and hypotheses were preregistered; see [STABLE LINK OR DOI].
• This study’s analysis plan was preregistered; see [STABLE LINK OR DOI].
• This study was not preregistered.

Whether or not a study is preregistered, PD:TRT stresses the importance of transparency in reporting and expects researchers to fully disclose in their manuscript all decisions that were data-dependent (e.g., deciding when to stop data collection, what observations to exclude, what covariates to include, and what analyses to conduct after rather than before seeing the data).

Replication and Registered Reports

Personality Disorders: Theory, Research, and Treatment acknowledges the significance of replication in building a cumulative knowledge base in our field. We therefore encourage submissions that attempt to replicate important findings. Major criteria for publication of replication papers include (i) theoretical significance of the finding being replicated, (ii) statistical power of the study that is carried out, and (iii) the number and power of previous replications of the same finding.

Other factors that would weigh in favor of a replication submission include: pre-registration of hypotheses, design, and analysis; submissions by researchers other than the authors of the original findings; and attempts to replicate more than one study of a multi-study original publication. Personality Disorders: Theory, Research, and Treatment publishes Registered Reports, which are particularly well-suited for planned replications (but not limited to such content). Such submissions will consist of a detailed research proposal, including an abstract, introduction, hypotheses, method, planned analyses, and implications of the expected results. We recommend that authors initially contact the editor before submitting a Registered Report. For Registered Reports, the proposed research will be reviewed and, if approved, should then be carried out in accordance with the proposed plan. To the extent that the study is judged to have been competently performed, the paper will be accepted (pending any necessary revisions) regardless of the outcome of the study.

Types of manuscripts

Four types of manuscripts will be accepted:

• full-length articles
• brief reports
• target conceptual articles
• practice reviews (jointly written by a researcher and primary clinician)

Further, the journal will operate an open-access message board to foster continuing dialogue on the target conceptual article.

Full-length articles

Manuscripts presenting empirical findings may be submitted as full-length articles. Full-length articles should not exceed 36 pages total (including cover page, abstract, text, references, tables, and figures), with margins of at least 1 inch on all sides and a standard font (e.g., Times New Roman) of 12 points (no smaller). The entire paper (text, references, tables, etc.) must be double-spaced.

PD:TRT requires that reports of randomized clinical trials conform to CONSORT reporting standards , including the submission of a flow diagram and checklist. Nonrandomized clinical trials must conform to TREND criteria .

Brief reports

In addition to full-length manuscripts, PD:TRT will consider brief reports of empirical findings. Brief reports are to be prepared in line with the guidelines for full-length articles, yet they may not exceed 18 pages.

Target conceptual articles

Manuscripts that evaluate and synthesize the research literature and/or make important theoretical contributions are sought for target conceptual articles. Four commentaries invited by the journal will be published on the PD:TRT homepage, along with the author's response to the commentaries.

Target conceptual articles are to be prepared in line with the guidelines for full-length articles, yet they may not exceed 40 pages. Please note that these are typically invited submissions. If you have an idea for a manuscript or a prepared manuscript that may be relevant for this mechanism, please email the editor-in-chief prior to submission for initial consideration.

Meta-analytic and narrative reviews are appropriate for submission to PD:TRT with a preference for quantitative reviews when possible. These reviews can be a maximum of 40 pages; for meta-analyses, references to studies summarized can be included in supplemental materials, if necessary. Narrative reviews in particular must provide a systematic, integrative synthesis of the empirical literature in a given area and/or should be a springboard to the development of a new theory or model. Mere reviews of the literature without integrative synthesis or model/theory development will not be considered.

Practice reviews

In line with the journal's commitment to bridging science and practice, practice reviews will present an issue from clinical practice, review relevant research, and provide a practical recommendation informed by the reviewed research.

Practice reviews must be coauthored by at least one individual with a primary focus in clinical practice and at least one individual with a primary focus in research. This partnering of individuals with a different professional emphasis is crucial for practice reviews to provide a credible bridge between research and practice.

When submitting a practice review, provide a description of each individual's primary professional focus in the cover letter. Manuscripts not meeting this partnering requirement will be returned without review. New collaborations are especially encouraged.

Practice reviews are to be prepared in line with the guidelines for full-length articles, yet they may not exceed 30 pages.

Manuscript preparation

Prepare manuscripts according to the Publication Manual of the American Psychological Association using the 7th edition. Manuscripts may be copyedited for bias-free language (see Chapter 5 of the Publication Manual ).

Review APA's Journal Manuscript Preparation Guidelines before submitting your article.

Double-space all copy. Other formatting instructions, as well as instructions on preparing tables, figures, references, metrics, and abstracts, appear in the Manual . Additional guidance on APA Style is available on the APA Style website .

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Display equations

We strongly encourage you to use MathType (third-party software) or Equation Editor 3.0 (built into pre-2007 versions of Word) to construct your equations, rather than the equation support that is built into Word 2007 and Word 2010. Equations composed with the built-in Word 2007/Word 2010 equation support are converted to low-resolution graphics when they enter the production process and must be rekeyed by the typesetter, which may introduce errors.

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Use Equation Editor 3.0 or MathType only for equations or for formulas that cannot be produced as Word text using the Times or Symbol font.

Computer code

Because altering computer code in any way (e.g., indents, line spacing, line breaks, page breaks) during the typesetting process could alter its meaning, we treat computer code differently from the rest of your article in our production process. To that end, we request separate files for computer code.

In online supplemental material

We request that runnable source code be included as supplemental material to the article. For more information, visit Supplementing Your Article With Online Material .

In the text of the article

If you would like to include code in the text of your published manuscript, please submit a separate file with your code exactly as you want it to appear, using Courier New font with a type size of 8 points. We will make an image of each segment of code in your article that exceeds 40 characters in length. (Shorter snippets of code that appear in text will be typeset in Courier New and run in with the rest of the text.) If an appendix contains a mix of code and explanatory text, please submit a file that contains the entire appendix, with the code keyed in 8-point Courier New.

Use Word's insert table function when you create tables. Using spaces or tabs in your table will create problems when the table is typeset and may result in errors.

Author contribution statements using CRediT

The APA Publication Manual (7th ed.) stipulates that "authorship encompasses…not only persons who do the writing but also those who have made substantial scientific contributions to a study." In the spirit of transparency and openness, PD:TRT has adopted the Contributor Roles Taxonomy (CRediT) to describe each author's individual contributions to the work. CRediT offers authors the opportunity to share an accurate and detailed description of their diverse contributions to the manuscript. During submission, the corresponding author will be asked to identify the contribution(s) of each author so each may be tagged with metadata that is both visible and trackable. Authors can claim credit for more than one contributor role, and the same role can be attributed to more than one author. If the manuscript is accepted for publication, the CRediT designations will be published as an author contributions statement in the author note. All authors should have reviewed and agreed to their individual contribution(s) before submission.

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Authors who feel that their manuscript may benefit from additional academic writing or language editing support prior to submission are encouraged to seek out such services at their host institutions, engage with colleagues and subject matter experts, and/or consider several vendors that offer discounts to APA authors .

Please note that APA does not endorse or take responsibility for the service providers listed. It is strictly a referral service.

Use of such service is not mandatory for publication in an APA journal. Use of one or more of these services does not guarantee selection for peer review, manuscript acceptance, or preference for publication in any APA journal.

Submitting supplemental materials

APA can place supplemental materials online, available via the published article in the APA PsycArticles ® database. Please see Supplementing Your Article With Online Material for more details.

Abstract and keywords

All manuscripts must include an abstract containing a maximum of 250 words typed on a separate page. After the abstract, please supply up to five keywords or brief phrases.

List references in alphabetical order. Each listed reference should be cited in text, and each text citation should be listed in the References section.

Examples of basic reference formats:

Journal article

McCauley, S. M., & Christiansen, M. H. (2019). Language learning as language use: A cross-linguistic model of child language development. Psychological Review , 126 (1), 1–51. https://doi.org/10.1037/rev0000126

Authored book

Brown, L. S. (2018). Feminist therapy (2nd ed.). American Psychological Association. https://doi.org/10.1037/0000092-000

Chapter in an edited book

Balsam, K. F., Martell, C. R., Jones. K. P., & Safren, S. A. (2019). Affirmative cognitive behavior therapy with sexual and gender minority people. In G. Y. Iwamasa & P. A. Hays (Eds.), Culturally responsive cognitive behavior therapy: Practice and supervision (2nd ed., pp. 287–314). American Psychological Association. https://doi.org/10.1037/0000119-012

Data, code, and methods

All data, program code and other methods must be cited in the text and listed in the References section.

Data Set Citation:

Alegria, M., Jackson, J. S., Kessler, R. C., & Takeuchi, D. (2016). Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003 [Data set]. Inter-university Consortium for Political and Social Research. http://doi.org/10.3886/ICPSR20240.v8

Preferred formats for graphics files are TIFF and JPG, and preferred format for vector-based files is EPS. Graphics downloaded or saved from web pages are not acceptable for publication. Multipanel figures (i.e., figures with parts labeled a, b, c, d, etc.) should be assembled into one file. When possible, please place symbol legends below the figure instead of to the side.

• All color line art and halftones: 300 DPI
• Black and white line tone and gray halftone images: 600 DPI

Line weights

• Color (RGB, CMYK) images: 2 pixels
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• Stroke weight: 0.5 points

APA offers authors the option to publish their figures online in color without the costs associated with print publication of color figures.

The same caption will appear on both the online (color) and print (black and white) versions. To ensure that the figure can be understood in both formats, authors should add alternative wording (e.g., “the red (dark gray) bars represent”) as needed.

For authors who prefer their figures to be published in color both in print and online, original color figures can be printed in color at the editor's and publisher's discretion provided the author agrees to pay:

• $900 for one figure
• An additional $600 for the second figure
• An additional $450 for each subsequent figure

Permissions

Authors of accepted papers must obtain and provide to the editor on final acceptance all necessary permissions to reproduce in print and electronic form any copyrighted work, including test materials (or portions thereof), photographs, and other graphic images (including those used as stimuli in experiments).

On advice of counsel, APA may decline to publish any image whose copyright status is unknown.

• Download Permissions Alert Form (PDF, 13KB)

Open science badges

Articles are eligible for open science badges recognizing publicly available data, materials, and/or preregistered plans and analyses. These badges are awarded on a self-disclosure basis.

At submission, authors must confirm that criteria have been fulfilled in a signed badge disclosure form (PDF, 42KB) that must be submitted as supplemental material. If all criteria are met as confirmed by the editor, the form will then be published with the article as supplemental material.

Authors should also note their eligibility for the badge(s) in the cover letter.

For all badges, items must be made available on an open-access repository with a persistent identifier in a format that is time-stamped, immutable, and permanent. For the preregistered badge, this is an institutional registration system.

Data and materials must be made available under an open license allowing others to copy, share, and use the data, with attribution and copyright as applicable.

Available badges are:

Note that it may not be possible to preregister a study or to share data and materials. Applying for open science badges is optional.

Publication policies

For full details on publication policies, including use of Artificial Intelligence tools, please see APA Publishing Policies .

APA policy prohibits an author from submitting the same manuscript for concurrent consideration by two or more publications.

See also APA Journals ® Internet Posting Guidelines .

APA requires authors to reveal any possible conflict of interest in the conduct and reporting of research (e.g., financial interests in a test or procedure, funding by pharmaceutical companies for drug research).

• Download Full Disclosure of Interests Form (PDF, 41KB)

In light of changing patterns of scientific knowledge dissemination, APA requires authors to provide information on prior dissemination of the data and narrative interpretations of the data/research appearing in the manuscript (e.g., if some or all were presented at a conference or meeting, posted on a listserv, shared on a website, including academic social networks like ResearchGate, etc.). This information (2–4 sentences) must be provided as part of the Author Note.

Ethical Principles

It is a violation of APA Ethical Principles to publish "as original data, data that have been previously published" (Standard 8.13).

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Special issue of the APA journal Personality Disorders: Theory, Research, and Treatment, Vol. 14, No. 1, January 2023. This special issue presents a compilation of manuscripts by leading scholars in the study of personality disorders that address a wide range of important methodological and quantitative issues.

Special issue of APA journal Personality Disorders, Vol. 13, No. 2, July 2022. In this special issue, the authors begin by summarizing the main findings and recommendations from each target review and its commentaries, as well as the shorter review articles, after which they offer additional remarks in the hopes of contributing to the setting of an agenda for the next iteration of the DSM.

Special issue of the APA journal Personality Disorders, Vol. 2, No. 1, January 2011. Articles discuss proposed changes to personality and personality disorders in the DSM-5.

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Borderline Personality Disorder Overview Essay

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Personality disorders are a group of mental health illnesses defined by specific behavior patterns and distinctive cognitive and affective characteristics. Such disorders are characterized by significant deviations in the way of thinking about oneself and others, emotional responses, regulating behavior, and the ability to relate to other people (Robitz, 2018). This essay will consider borderline personality disorder (BPD), its manifestations, personal characteristics and cognitive features associated with the disease, and potential genetic causes and neurochemical features.

BPD is a severe disorder that can significantly affect one’s health, well-being, and ability to develop meaningful relationships. Patients with BPD often experience sudden mood swings and regularly change their interests and personal values due to the present uncertainty of their place in the world (National Institute of Mental Health, 2017). People diagnosed with the disorder are not capable of building stable relationships as their views and opinions, including those of other people, change suddenly and radically.

BPD is traditionally assessed by completing an in-depth interview with the patient and a medical examination employed to rule out other causes for behavioral manifestations (National Institute of Mental Health, 2017). In addition, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) can be employed for the initial assessment of BPD (Dabaghi et al., 2020). Family history and the patient’s medical history can also be included in the evaluation.

Several risk factors are distinguished when discussing BPD and its development. According to the National Institute of Mental Health (2017), environmental, cultural, social, and family factors are substantial risk factors for developing the disorder. Some studies show a possibility of a genetic predisposition to BPD and state that specific genes can modulate the effect of stressful events on one’s impulsivity and aggression (Bassir Nia et al., 2018).

In particular, catechol o-methyltransferase (COMT) val158met polymorphism and 5-HTTPLR ss/sl polymorphism were found to have a determining effect on one’s aggression and impulsivity. Furthermore, persons diagnosed with BPD often present with structural and functional changes in the brain, specifically, in the prefrontal cortex, responsible for regulating impulses (Bassir Nia et al., 2018; National Institute of Mental Health, 2017). Thus, it can be argued that BPD is the result of the intercorrelation of multiple factors, including genetics, brain structure, and social and environmental aspects.

BPD is generally associated with several typical personality characteristics and cognitive features. The National Institute of Mental Health (2017) distinguishes several BPD personality traits, including feelings of emptiness, distorted self-image, inability to trust other people and build relationships with them, and self-harming behaviors. The disorder is also associated with such cognitive impairments as “deficits in executive functions, response inhibition, attention, and cognitive control and abnormal social cognition” (Bassir Nia et al., 2018, p. 63). Thus, persons with BPD often display intense anger, severe mood swings, impulsive behavior, and suicidal ideation (National Institute of Mental Health, 2017).

Considering the complex nature of the disorder and the genetic, social, family, and environmental factors that determine it, the development of BPD cannot be prevented. However, it can be diagnosed early and managed with effective therapies.

In summary, BPD is a severe, complex mental health disorder characterized by a pattern of unstable moods, impulsive behavior, and destructive self-image. Individuals diagnosed with BPD experience difficulties in building relationships and tend to change their opinions and values regularly. Furthermore, BPD is presented with issues with controlling aggression, focus, and communication. Research into the disorder shows that the risk factors for BPD include genetic predisposition, structural and functional changes in the brain, and environmental, social, and familial factors.

Bassir Nia, A., Eveleth, M. C., Gabbay, J. M., Hassan, Y. J., Zhang, B., & Perez-Rodriguez, M. M. (2018). Past, present, and future of genetic research in borderline personality disorder. Current Opinion in Psychology , 21 , 60–68. Web.

Dabaghi, P., Asl, E., & Taghva, A. (2020). Screening borderline personality disorder: The psychometric properties of the Persian version of the McLean screening instrument for borderline personality disorder . Journal of Research in Medical Sciences , 25 (1), 97–104. Web.

National Institute of Mental Health. (2017). Borderline personality disorder . Web.

Robitz, R. (2018). What are personality disorders? American Psychiatric Association. Web.

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Personality and Depression: Explanatory Models and Review of the Evidence

Understanding the association between personality and depression has implications for elucidating etiology and comorbidity, identifying at-risk individuals, and tailoring treatment. We discuss seven major models that have been proposed to explain the relation between personality and depression, and we review key methodological issues, including study design, the heterogeneity of mood disorders, and the assessment of personality. We then selectively review the extensive empirical literature on the role of personality traits in depression in adults and children. Current evidence suggests that depression is linked to traits such as neuroticism/negative emotionality, extraversion/positive emotionality, and conscientiousness. Moreover, personality characteristics appear to contribute to the onset and course of depression through a variety of pathways. Implications for prevention and prediction of treatment response are discussed, as well as specific considerations to guide future research on the relation between personality and depression.

INTRODUCTION

The hypothesis that depression is linked to personality can be traced to antiquity, when Hippocrates, and later Galen, argued that particular “humors” were responsible for specific personality types and forms of psychopathology. In this article, we discuss the major conceptual models that have been proposed to explain the association between personality and depression, comment on some important methodological issues, and selectively review the empirical literature. Due to space limitations, we limit our review to nonbipolar forms of depression.

This literature has developed along several distinct lines: ( a ) early clinical psychiatrists’ descriptions of affective temperaments; ( b ) research on the structure and neurobiology of personality; ( c ) psychoanalytic and cognitive-behavioral theory and observations; and ( d ) developmental psychologists’ work on temperament. In recent years, there has been substantial convergence between these lines of work, and it is increasingly possible to view them within a single integrative framework. Understanding the associations between personality and depression has a number of potentially important implications for research and practice. First, personality traits associated with emotional experience, expression, and regulation may be intermediate phenotypes that provide more tractable targets for genetic and neurobiological research than depressive diagnoses ( Canli 2008 ). Second, personality may be useful in identifying more homogeneous subgroups of depressive disorders that differ in developmental trajectories and etiological influences (e.g., Beck 1983 ). Third, tracing the pathways between personality and depressive disorders can help elucidate more proximal processes involved in the development of mood disorders ( Compas et al. 2004 , Klein et al. 2008a , Lahey 2009 ). Fourth, personality may be useful in tailoring treatment ( Zinbarg et al. 2008 ) and predicting treatment response ( Quilty et al. 2008a ). Fifth, temperament/personality may provide a means to identify at-risk individuals who could benefit from prevention and early intervention efforts ( Kovacs & Lopez-Duran 2010 ). Finally, there is substantial comorbidity between depressive disorders and other forms of psychopathology. Some personality traits, such as neuroticism, are associated with multiple psychiatric conditions. Thus, personality could help explain patterns of comorbidity and point toward more etiologically relevant classification systems ( Brown & Barlow 2009 , Kotov et al. 2007 , Watson 2009 ).

THE CONSTRUCT OF PERSONALITY

Before addressing the relation between personality and depression, several conceptual issues regarding the construct of personality should be considered. First, personality has traditionally been conceptualized as having two components: temperament, which refers to biologically based, early-emerging, stable individual differences in emotion and its regulation, and character, which refers to individual differences due to socialization. However, the distinctions between these constructs are questionable, as a large body of evidence has accumulated indicating that personality traits have all the characteristics of temperament, including strong genetic and biological bases and substantial stability over the lifespan ( Krueger & Johnson 2008 , Watson et al. 2006 ). Hence, the terms “personality” and “temperament” are now often used interchangeably ( Caspi & Shiner 2006 , Clark & Watson 1999 ). As most research on personality in childhood has been conducted under the temperament rubric, in this review we refer to this work using the term “temperament” and reserve the term “personality” for discussing the literature on adolescents and adults. However, this is intended to reflect traditional usage rather than a conceptually meaningful distinction.

Second, a variety of personality classifications have been proposed over the past century, but in the 1980s they were integrated in a consensus taxonomy, the Five-Factor Model (FFM). The FFM recognized that personality is ordered hierarchically from a large number of specific traits to five general characteristics ( Digman 1994 , Goldberg 1993 , Markon et al. 2005 ). These “Big Five” traits are neuroticism, extraversion, conscientiousness, agreeableness, and openness to experience. Importantly, the FFM can be further reduced to three dimensions of negative emotionality, positive emotionality, and disinhibition versus constraint that form the next level of the personality hierarchy ( Clark & Watson 1999 , Markon et al. 2005 ). This “Big Three” model is used in studies of temperament as well as personality, although disinhibition is often labeled as effortful control in the child literature ( Caspi & Shiner 2006 , Rothbart & Bates 2006 ). The Big Five and Big Three schemes are closely related, with neuroticism being essentially identical to negative emotionality and extraversion corresponding to positive emotionality ( Clark & Watson 1999 , Markon et al. 2005 ); we refer to these two dimensions as neuroticism/negative emotionality (N/NE) and extraversion/positive emotionality (E/PE), respectively. Disinhibition does not have an exact counterpart in the FFM but instead reflects a combination of low conscientiousness and low agreeableness. Finally, openness to experience is outside the territory covered by the Big Three.

Third, there is increasing recognition that temperament and personality are not a fixed, static set of characteristics, but rather are dynamic constructs that develop over the lifespan and change in response to maturation and life circumstances ( Fraley & Roberts 2005 , Rothbart & Bates 2006 ). For example, although the rank-order stability of most personality traits is in the moderate range, it increases over the course of development ( Roberts & DelVecchio 2000 ). In addition, mean levels of conscientiousness and some facets of E/PE increase, and levels of N/NE decrease, over time, particularly in young adulthood ( Roberts et al. 2006 ). A number of processes contribute to stability and change of personality. For example, genes are a major influence on stability ( Krueger & Johnson 2008 , Kandler et al. 2010 ). In addition, people often select, create, and construe environments in ways that reinforce and maintain their initial trait dispositions ( Caspi & Shiner 2006 ). However, life stressors and major shifts in social roles and relationships can contribute to personality change ( Fraley & Roberts 2005 , Kandler et al. 2010 ). We consider the implications of these processes for the relation between personality and depression below.

MODELS OF PERSONALITY AND DEPRESSION

Classical models of personality-depression relations.

A variety of models of the relation between personality and mood disorders have been proposed (e.g., Akiskal et al. 1983 , M.H. Klein et al. 1993 , Krueger & Tackett 2003 ). These proposed relations include: ( a ) personality and depressive disorders have common causes; ( b ) personality and depressive disorders form a continuous spectrum; ( c ) personality is a precursor of depressive disorders; ( d ) personality predisposes to developing depressive disorders; ( e ) personality has pathoplastic effects on depression; ( f ) personality features are state-dependent concomitants of depressive episodes; and ( g ) personality features are consequences (or scars) of depressive episodes. The distinctions between some of these accounts are subtle (cf. Kendler & Neale 2010 ), and other models, as well as combinations of these scenarios, are plausible. However, these seven models provide a useful conceptual framework for approaching the issue.

These models can be divided into three groups. The first three models (common cause, continuum/spectrum, and precursor) view personality and depression as having similar causal influences but do not see one as having a causal influence on the other. The fourth and fifth models (predisposition and pathoplasticity) hold that personality has causal effects on the onset or maintenance of depression. Finally, the sixth and seventh models (concomitants and consequences) view depression as having a causal influence on personality. These models, and their unique predictions, are summarized in Table 1 .

Summary of key predictions of the classic models

The common cause model views personality and depressive disorders as distinct entities that arise from the same, or at least an overlapping, set of etiological processes. From this perspective, personality and depression are not directly related; rather, the association is due to a shared third variable. The common cause model would be supported by evidence that personality traits and depression have shared etiological influences.

The continuum/spectrum model emphasizes the conceptual overlap between depressive disorders and certain personality traits and argues for a fundamental continuity between them. A depressive diagnosis is thought to simply identify individuals who have the most extreme scores on a relevant trait. Like the common cause model, the continuum/spectrum model assumes that personality and depression arise from a similar, if not identical, set of causal factors. However, the continuum/spectrum model goes further in positing that the association between the trait and disorder should be fairly specific because they are on the same continuum. 1 Moreover, this association is expected to be nonlinear, so that almost nobody below the definitional threshold on the trait has the diagnosis but nearly everyone above the threshold meets the criteria. Thus, the continuum/spectrum model would be supported by evidence that the trait and depression are associated with the same etiological influences and that the trait-disorder relationship is fairly specific and nonlinear.

The precursor model views personality as an early manifestation or “forme fruste” of depressive disorder. Like the common cause and continuum/spectrum accounts, the precursor model posits that personality and depressive disorders are caused by similar etiologic factors. Also like the continuum/spectrum account, it implies considerable phenomenologic similarity between the relevant trait and depression. However, the precursor model differs from both of these other models in that it assumes a particular developmental sequence, with the personality traits being evident prior to the onset of depressive disorder. In other words, both the common cause and continuum/spectrum models assume a fixed clinical expression as traits or disorder, whereas the precursor model implies escalation from traits to disorder within individuals over time. Support for the precursor model would come from evidence that the trait and depression are associated with the same etiological influences and that individuals with high levels of the trait are at increased risk for developing the disorder over time. 2

The common cause, continuum/spectrum, and precursor models do not posit causal relations between personality and depression. In contrast, the predisposition model holds that personality plays a causal role in the onset of depression. However, the predisposition model overlaps with the precursor model in that both propose that the relevant traits are evident prior to the onset of depressive disorder. The major difference between these two accounts is that the precursor model assumes that personality and depression derive from the same set of etiological processes, but the predisposition model posits that the processes that underlie personality differ from those that lead to depression. Thus, the predisposition account implies a complex interplay among risk factors involving moderation and/or mediation, and this is what distinguishes it from the precursor model. 3 The most common example—the diathesis-stress model—conceptualizes personality as the diathesis and stress as a moderator that precipitates the onset of depressive disorder. Alternatively, stress may be a mediator, so that personality vulnerability leads to negative experiences (e.g., interpersonal rejection, job loss), which in turn increase the probability of a depressive episode. A second difference between these models is that the predisposition model does not assume any phenomenological links between personality traits and depressive symptoms. Consequently, the predisposing trait may not have any phenotypic similarity to depression. Thus, the two most critical sources of support for the predisposition model would involve demonstrating that individuals with the trait are at increased risk for subsequently developing depression, and that other variables play a role in mediating or moderating this transition.

The pathoplasticity model is similar to the predisposition model in that it also views personality as having a causal influence on depressive disorder. However, rather than contributing to the onset of depression, the pathoplasticity model posits that personality influences the expression of the disorder after onset. This influence can include the severity or pattern of symptomatology, course, and response to treatment. The pathoplasticity model would be supported by evidence that personality explains variation among depressed individuals in their clinical presentation or outcome.

The final two models also assume that there is a causal relation between personality and depression. However, these models reverse the direction of causality. In the concomitants (or state-dependent) model, assessments of personality are colored, or distorted, by the individual’s mood state. This model implies that personality returns to its baseline form after recovery from the episode. In contrast, the consequences (or scar) model holds that depressive episodes have an enduring effect on personality, such that changes in personality persist after recovery. These models would be supported by evidence that depression alters levels of personality traits, either concurrently (concomitants model) or over the longer-term (consequences model).

Dynamic Models of Personality-Depression Relations

The models above consider traits to be perfectly stable. As noted earlier, there is now extensive evidence indicating that personality shows plasticity in childhood, with long-term test-retest correlations of r ≈ 0.35, and continues to change across the lifespan, although personality consistency gradually increases up to r ≈ 0.75 after the age of 50 ( Roberts & DelVecchio 2000 ). Models of personality-psychopathology relations can be expanded to recognize the malleability of traits (e.g., Ormel et al. 2001 ). For example, one can posit a dynamic precursor model 4 in which early temperament defines the baseline level of risk but subsequent experiences modify personality liability to depression. This model explains variability in disorder onset as a function of the initial level of risk and steepness of the trait trajectory over time. Given the evidence on patterns of personality continuity and change ( Roberts & DelVecchio 2000 ), it appears likely that trait vulnerability is more malleable early in life, but significant life events can alter its trajectory even in old age. A depressive disorder is thought to emerge when personality liability crosses the threshold. Thus, individuals who are born with an elevated personality liability or those with a rapidly increasing trait trajectory would have a childhood onset of the disorder, whereas those with a more slowly increasing trait trajectory would not cross the threshold until much later, if ever. Moreover, a pathological trait trajectory may be checked or reversed by positive experiences ( Ormel & de Jong 1999 ). In fact, personality generally tends to change in a more adaptive direction with age ( Roberts et al. 2006 ), although this pattern is not universal ( Johnson et al. 2007 ). This may help to explain why the probability of first-episode depression peaks in adolescence, as trait deviance is more common at that age.

Similarly, the predisposition model can be expanded to recognize personality change. This dynamic predisposition model ( Ormel & de Jong, 1999 , Ormel et al. 2001 ) acknowledges transactions between personality and the environment and integrates them with the environmental moderation and mediation mechanisms of the classic predisposition model. In the environmental moderation version of this account, negative life experiences influence not only depression onset but also levels of trait vulnerability ( Middledorp et al. 2008 ). This increase in personality liability may then lead to additional life stress. If this vicious cycle is perpetuated unchecked, personality liability would continue to increase, and at some point, a negative life event could overwhelm coping capabilities and elicit a depressive disorder. Importantly, and in contrast to the dynamic precursor model, in this account maladaptive traits alone are not sufficient to cause depression, and an environmental trigger is necessary.

The vicious cycle of increasing trait vulnerability and stress exposure does not necessarily indicate that personality per se influences depression onset. Indeed, certain traits may increase stress exposure but have no effect on depression otherwise (e.g., it is possible that low conscientiousness does not cause depression directly but leads to depressogenic experiences, such as academic difficulties, job loss, and relationship problems; Roberts et al. 2007 ), consistent with the environmental-mediation pathway.

Dynamic models offer richer and more complete accounts of the role of personality in the onset of depression. Moreover, it is important to recognize that depressive disorders have been linked to multiple traits (as reviewed below), and it is likely that different personality characteristics contribute through different pathways.

METHODOLOGICAL ISSUES

A number of methodological issues must be considered in evaluating the relation between personality and mood disorders, including ( a ) study design, ( b ) heterogeneity of depressive disorders, and ( c ) assessment of personality.

Study Design

A number of research designs can be useful in studying the relation between personality and depressive disorders. The common cause, continuum/spectrum, precursor, and predisposition models would all be supported by family studies demonstrating personality differences between nonaffected relatives of probands with and without a history of depression. The common cause, continuum/spectrum, and precursor models would be supported by twin and genetic association studies demonstrating that the same genes predispose to both personality and depressive disorders. The precursor and predisposition models posit that personality abnormalities are trait markers and hence should be present prior to the onset, and after recovery from, depressive episodes. Hence, these models can be tested by comparing individuals with a history of depression that is currently in remission to persons with no history of depression on relevant personality traits. An even stronger approach to testing the precursor and predisposition models is to use prospective longitudinal studies of persons with no prior history of mood disorder to determine whether particular personality traits predict the later onset of depressive disorder. Although no single design can distinguish among these four models, the combination of designs can bolster the case for particular accounts. For example, finding substantial common genetic variance in twin studies, but no evidence of developmental sequencing in longitudinal studies, would support the common cause and continuum/spectrum models. In turn, these two models could be compared by examining the specificity of the association between trait and disorder and whether there is a nonlinear relation between trait level and probability of disorder. On the other hand, if there were evidence of developmental sequencing in longitudinal studies as well as substantial common genetic variance in twin studies (or overlap of other etiological factors in other designs), it would support the precursor model (particularly if the trait was also phenomenologically similar to depression). In contrast, developmental sequencing but less shared genetic (or other etiological) variance would support the predisposition model. Also crucial for the predisposition model is evidence from longitudinal studies demonstrating that other variables (e.g., life stress) moderate or mediate the association between personality and subsequent depression.

The pathoplasticity model can be evaluated in longitudinal studies of persons with depressive disorders by examining the associations among personality traits and clinical features, course, and treatment response. Specifically, the pathoplasticity model posits that the trait would predict these outcomes even after controlling for initial illness severity and other prognostic factors. Of note, an alternative explanation of such results is that the personality trait is a marker for a more severe, chronic, or etiologically distinct subgroup, rather than having a causal influence on the expression of the disorder. A multiwave follow-up of individuals with a depressive disorder could be helpful in ruling out this possibility. If the trait influences the disorder course directly, rather than because it is an indicator of a latent disorder class, changes in personality scores should predict subsequent changes in outcomes.

The concomitants model can be tested through cross-sectional studies comparing persons who are currently depressed, persons who have recovered from depressive episodes, and healthy controls. An even better approach is to conduct longitudinal studies assessing individuals when they are in a depressive episode and again after they have recovered. If personality measures are abnormal during depressive episodes but not after recovery, it would suggest that they are concomitants of the depressed state. Multilevel analyses can also be used to separate personality variance into trait and state components and to test whether state variance is associated with concurrent measures of depression (e.g., Duncan-Jones et al. 1990 ).

The consequences (or scar) hypothesis can be evaluated by assessing persons before and after a first depressive episode. If personality deviance is much greater after the episode has remitted, it would suggest that scarring has occurred.

Testing dynamic theories requires longitudinal data with at least three assessment points. These assessments should measure relevant contextual factors (e.g., life stress) in addition to depression and personality to allow the examination of dynamic and transactional effects. Multilevel modeling and structural equation modeling offer powerful approaches to evaluating such effects with longitudinal data.

Heterogeneity of Depressive Disorders

The depressive disorders are almost certainly etiologically heterogeneous, reflecting the convergence of multiple developmental pathways. Hence, it is likely that the role of personality factors and, as suggested above, the applicability of different models of the relation between personality and depression differ for different forms of depression. The current classification system for depressive disorders is based on clinical features and is a poor approximation of etiological distinctions. Nonetheless, it is important to consider whether the role of personality varies as a function of the specific depressive diagnosis (e.g., major depressive disorder, dysthymic disorder), subtype (e.g., psychotic, melancholic, atypical), and clinical characteristics such as age of onset, recurrence, and chronicity. Failure to take heterogeneity into account may obscure important personality-depression associations. Conversely, personality may provide a basis for identifying more homogeneous subgroups within the depressive disorders. Unfortunately, few studies of personality and depressive disorders have attempted to take this heterogeneity into account.

It is important to note, however, that associations between personality and specific subtypes and clinical characteristics do not necessarily indicate etiological heterogeneity. Instead, they could reflect pathoplasticity, in which personality influences symptom presentation and/or course, but the primary etiological process is the same, or they could reflect differential severity of subtypes that results in quantitative differences in their trait profiles.

Finally, a significant source of heterogeneity in depression is comorbidity with other forms of psychopathology. Given the high rates of comorbidity, particularly with the anxiety disorders, associations between personality and depressive disorders may actually reflect the relation of personality with a co-occurring nonmood disorder. Indeed, personality may be a third variable that explains broad patterns of comorbidity among many disorders. For example, recent hierarchical models of classification posit that trait dispositions such as N/NE account for much of the comorbidity between depression and other disorders ( Griffith et al. 2010 , Kotov et al. 2007 ). Thus, it is important for researchers to consider whether traits have specific relations with depression over and above more general associations with the broader group of internalizing disorders.

Temperament/personality can be assessed using a variety of methods, including self-report inventories, semistructured interviews, informants’ reports, and observations in naturalistic settings and the laboratory. Unfortunately, most of the literature examining the association between personality and depressive disorders has assessed personality via self-report. This is potentially problematic because self-reports of personality can be complicated by current mood state, limited insight, response styles, and the difficulty of distinguishing traits from the effects of stable environmental contexts ( Chmielewski & Watson 2009 ). In addition, when the same individual provides information on both personality and depression, as has been the case in almost all studies in this area, common method variance can inflate associations. Hence, there is a need for greater use of informant report and observational measures.

A second issue concerns the overlap between some personality constructs and psychopathology ( Lahey 2004 ). For example, many items on N/NE scales are similar to depressive symptoms ( Ormel et al. 2004b ). This can inflate associations between measures of personality and depression. On the other hand, personality and symptom assessments usually have different time frames, with trait scales reflecting long-standing patterns and depression measures tapping more recent experiences (e.g., past week, past month). This trait versus state distinction parallels that between personality and other related constructs. For example, measures of N/NE and negative affect have nearly identical content but are distinguished by their time frames ( Watson 2000 ). Thus, the degree to which this content overlap threatens the validity of personality-psychopathology research depends, at least in part, on the duration/chronicity of the disorders of interest. The extent to which this is a concern also depends on one’s model of personality-depression relations. From the continuum/spectrum perspective, personality and depression are variants of the same phenomenon, so the two constructs should overlap. In contrast, the predisposition model views personality and depression as distinct domains, so from this perspective it is important to define and assess these sets of constructs as independently as possible and to judiciously delineate their time frames.

AFFECTIVE TEMPERAMENTS

The classical European descriptive psychopathologists in the late-nineteenth and early-twentieth centuries observed that many patients with mood disorders, as well as their relatives, exhibited particular patterns of premorbid personalities that appeared to be attenuated versions of their illnesses. For example, Kraepelin (1921) described four patterns of personality that he considered the “fundamental states” underlying manic-depressive illness: depressive, manic, irritable, and cyclothymic temperament. He believed that these were precursors or “rudimentary forms” of the major mood disorders. Schneider (1958) described similar types; however, he viewed them as personality disorders that were not necessarily related to the mood disorders. Two variants of these types, cyclothymic disorder and dysthymic disorder, are included as mood disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; Am. Psychiatr. Assoc. 1994 ). However, these disorders are defined as fairly severe conditions, with the criteria emphasizing symptomatology rather than personality traits. As a result, these categories appear to be limited to the more severe, symptomatic manifestations of the affective temperaments described by Kraepelin and Schneider ( Akiskal 1989 ).

On the basis of Kraepelin’s and Schneider’s descriptions, Akiskal (1989) proposed formal criteria for the affective temperament types, and he and his colleagues developed interview and self-report measures of these constructs that have been applied in a number of settings and cultures (e.g., Akiskal et al. 2005 ). Akiskal’s work also provided the basis for including depressive temperament as a personality disorder in the DSM-IV appendix. Of the four affective temperament types, depressive temperament has been the most systematically studied in relation to nonbipolar depressive disorders. The terms “depressive temperament,” “depressive personality,” and “depressive personality disorder” have been used interchangeably in the literature to refer to the following constellation of traits: introversion, passivity, and nonassertiveness; gloominess, cheerlessness, and joylessness; self-reproach and self-criticism; pessimism, guilt, and remorse; being critical and judgmental of others; conscientiousness and self-discipline; brooding and given to worry; and feelings of inadequacy and low self-esteem.

Data on the nature of the relation between depressive personality and depressive disorders are consistent with most of the causal models described above, illustrating the complexity of the associations between personality and depression. The strongest support for the common cause and continuum/spectrum models derives from twin and family studies. In a large twin study, Ørstavik et al. (2007) found that depressive personality and major depressive disorder (MDD) shared substantial genetic variance, although there was evidence for unique genetic factors as well. Family studies indicate that individuals with depressive personality have an increased rate of mood disorders in their first-degree relatives (e.g., Klein & Miller 1993 ). In addition, patients with MDD, particularly those with chronic forms of depression, have elevated levels of depressive personality traits in their first-degree relatives ( Klein 1999 ).

Consistent with Kraepelin’s (1921) retrospective observations, prospective longitudinal data indicate that depressive personality traits precede the onset of depressive disorders. Kwon et al. (2000) found that young women with depressive personality and no comorbid Axis I and II disorders had a significantly increased risk of developing dysthymic disorder (but not MDD) over the course of a three-year follow-up. Taken together with the twin and family studies, these findings provide compelling support for the precursor model. In addition, in light of the conceptual issue regarding traits and states raised above for the continuum/spectrum and precursor models, it is noteworthy that depressive personality is most closely associated with chronic forms of depression at both the family and individual levels.

Evidence also supports the predisposition, pathoplasticity, and consequences models. Rudolph & Klein (2009) reported that youth with elevated levels of depressive personality traits experienced a significant increase in depressive symptoms 12 months later. While consistent with the precursor model, it is noteworthy that this association was moderated by pubertal status and timing. Thus, youth with elevated levels of depressive personality traits and more advanced pubertal status and earlier pubertal timing experienced the greatest increase in depressive symptoms. This supports the predisposition model, suggesting that depressive personality traits confer vulnerability to depression in the presence of other maturational and psychosocial processes.

Depressive personality also appears to have a pathoplastic effect on the course of depressive disorders, predicting poorer outcomes and response to treatment ( Laptook et al. 2006 , Ryder et al. 2010 ). Moreover, Rudolph & Klein (2009) recently reported preliminary support for the consequences model, at least in youth. They found that in a sample of early adolescents, higher levels of depressive symptoms predicted an increase in depressive personality traits 12 months later. Finally, the limited evidence available suggests that semi-structured interview assessments of depressive personality traits are not influenced by a depressive episode ( Klein 1990 ), arguing against the concomitants model.

Although the work on affective temperaments is important in understanding the development of depressive disorders, it is unlikely that these types actually reflect basic temperamental processes that originate in early childhood, as their defining features include a number of developmentally complex cognitive and interpersonal characteristics. Instead, these temperament types are more likely to be intermediate outcomes that reflect the interaction of more basic temperament traits that are elaborated over development in conjunction with early socialization and other environment influences.

In recent years, considerable evidence has accumulated indicating that depressive personality is associated with several of the basic personality trait dimensions discussed below, particularly high N/NE and low E/PE and a number of their facets (e.g., Huprich 2003 , Vachon et al. 2009 ).

PERSONALITY TRAIT DIMENSIONS

The affective temperaments are conceptualized within a categorical framework. In contrast, most of the other work on personality and depression views personality in dimensional terms. In this section, we focus on the FFM, but we also briefly consider Gray’s (1994) and Cloninger and colleagues’ (1993) psychobiological models and several additional traits from the clinical literature (e.g., self-criticism, dependency, and rumination). This section focuses primarily on studies of adults and adolescents using self-report measures of personality. Studies of younger children using observational measures of temperament are reviewed in a later section.

The Five-Factor Model

Cross-sectional associations.

In their influential theory of personality and depression, Clark & Watson (1999 , Clark et al. 1994 ) posited that depressive disorders are characterized by high levels of N/NE and low levels of E/PE. A large number of cross-sectional studies have evaluated these relations as well as the links between depression and the other FFM dimensions. Kotov et al. (2010) recently conducted a meta-analysis of this literature, which revealed that MDD is associated with very high N/NE (Cohen’s d =1.33) and low conscientiousness ( d =−0.90). The link to low E/PE was more modest ( d =−0.62) and inconsistent, with some studies finding positive effects. The associations with the other two traits were weak and unremarkable. The N/NE finding is consistent with expectations, but the effect for E/PE was smaller and that for conscientiousness was larger than anticipated. Dysthymic disorder exhibited a more extreme profile with remarkably strong and consistent links to E/PE ( d =−1.47), N/NE ( d =1.93), and conscientiousness ( d =−1.24). This is not surprising as dysthymic disorder is thought to be more trait-like than MDD, and a greater contribution from personality might be expected.

To determine whether the observed personality links are specific to depression, Kotov et al. (2010) also examined personality profiles of anxiety disorders. They found that with the exception of specific phobia, which had relatively weak associations with all five traits, all anxiety disorders showed stronger effects on N/NE, E/PE, and conscientiousness (average d =1.91, −1.05, −1.02, respectively) than did MDD. Several also scored above dysthymic disorder on N/NE. Dysthymia had stronger associations than anxiety disorders on the other two traits, but the differences were slight.

It is conceivable that more specific associations were not evident because these analyses focused on broad personality dimensions. Narrow traits that comprise the general dimensions may have stronger associations with depressive disorders. Indeed, self-harm—a component of N/NE that reflects propensity to self-deprecation and self-injury—was found to contribute to depression even after controlling for the broad traits, and this effect was specific relative to other common mental disorders ( Watson et al. 2006 ). With regard to E/PE, evidence is emerging that the positive affectivity facet, but not the sociability/extraversion facet, is related to depression ( Durbin et al. 2005 , Naragon-Gainey et al. 2009 ). This may explain the surprisingly modest association between MDD and E/PE, if this general trait includes much variance not relevant to depression. Thus, facet-level research promises to yield stronger and more specific evidence of personality-depression links.

Evidence bearing on causal models

Because most attempts to tease apart explanatory models of the association between depression and personality have focused on N/NE and E/PE, we consider only these two traits in this section. The section is organized by the type of research design used to address the models.

Personality during and after a depressive episode

Studies of personality and psychopathology may be complicated by the influence of participants’ mood states on reports of their personalities (the concomitants model). For example, many studies have found that individuals with MDD report higher levels of N/NE when they are depressed than when they are not depressed ( Hirschfeld et al. 1983b , Kendler et al. 1993 , Ormel et al. 2004a ). In contrast, the evidence for mood state effects on E/PE is weaker and less consistent ( de Fruyt et al. 2006 , Kendler et al. 1993 , Morey et al. 2010 ). However, the influence of mood state on personality should not be overstated. Even though levels of N/NE decline significantly after remission from a depressive episode (i.e., absolute stability), individuals’ relative positions with respect to levels of N/NE (i.e., rank-order stability) tend to be moderately well preserved ( de Fruyt et al. 2006 , Morey et al. 2010 ). Moreover, clinical trials suggest that changes in depressive symptoms are not necessarily accompanied by changes in personality ( Quilty et al. 2008b , Tang et al. 2009 ).

Cross-sectional comparisons of remitted patients and controls

A number of early studies used remission designs, comparing patients who had recovered from a depressive episode to never-depressed controls or population norms on self-rated personality traits. These studies found that E/PE is significantly lower in formerly depressed patients than in healthy controls ( Hirschfeld et al. 1983a , Reich et al. 1987 ), arguing against the concomitants model and in favor of the precursor, predisposition, and/or consequences models. However, the results for N/NE were less consistent ( Hirschfeld et al. 1983a , Reich et al. 1987 ). This inconsistency may be due to a number of factors, including insufficiently stringent criteria for recovery, thereby possibly confounding personality and residual symptoms; using normative data collected by other investigators, which may introduce demographic and sociocultural differences between the formerly depressed and comparison samples; and selection effects, as N/NE is associated with a poorer course (discussed below) and thus samples of remitted depressives may include a disproportionate number with low levels of this trait.

Personality before and after a depressive episode

Several studies have tested the consequences (or scar) hypothesis by comparing personality measures in depressed individuals before and after a MDD episode. The results of these studies have been inconsistent. Kendler and colleagues reported increases in N/NE (but not E/PE) after a depressive episode in two separate samples ( Fanous et al. 2007 , Kendler et al. 1993 ); however, other studies have found that N/NE and E/PE do not change from before to after a MDD episode (e.g., Ormel et al. 2004a , Shea et al. 1996 ). Importantly, the studies reporting scarring used less stringent criteria for recovery and shorter follow-ups, suggesting that the findings may be due to residual symptoms and/or that the scars dissipate over time.

Personality in relatives of depressed individuals

A number of studies have tested the common cause, continuum/spectrum, precursor, and predisposition models by comparing personality traits in the never-depressed relatives of patients with mood disorders and never-depressed controls (e.g., Farmer et al. 2002 , Hecht et al. 1998 , Ouimette et al. 1996 ). The results have been mixed, with some studies reporting higher N/NE and/or lower E/PE in the never-depressed relatives of probands with mood disorders, and other studies reporting no differences. However, interpretation of these studies is complicated by two factors. First, personality traits may not play the same role in risk for depression among familial as nonfamilial forms of depression. Second, there may be selection biases in samples using well relatives who are already partly through the risk period for mood disorder. Thus, those relatives with the strongest personality vulnerabilities may have already developed the disorder and be excluded from the study.

Twin studies

As discussed above, a valuable approach to testing the common cause, continuum/spectrum, and precursor models is through twin studies. These studies indicate that there are substantial associations between the liabilities for N/NE and MDD, but only weak associations between the genetic liabilities for E/PE and MDD ( Fanous et al. 2007 ; Kendler et al. 1993 , 2006 ).

Prospective longitudinal studies

The most direct approach to testing the precursor and predisposition models is to conduct prospective studies of personality in never-depressed participants to determine whether personality characteristics predict the subsequent onset of depressive disorders. Several studies using large community samples have reported that higher levels of N/NE predict the onset of first lifetime MDD episodes ( de Graaf et al. 2002 ; Fanous et al. 2007 ; Kendler et al. 1993 , 2006 ; Ormel et al. 2004a ). In addition, several studies using measures of other traits that overlap with N/NE or its facets have reported similar findings ( Hirschfeld et al. 1989 , Rorsman et al. 1993 ). Although there is some evidence that E/PE predicts the first onset of MDD ( Kendler et al. 2006 , Rorsman et al. 1993 ), it is much weaker, and several studies have failed to find an association ( Fanous et al. 2007 , Hirschfeld et al. 1989 , Kendler et al. 1993 ).

Personality and the subsequent course of depression

Finally, there is evidence that both N/NE and E/PE have pathoplastic influences on the course of depression after the onset of the disorder. For example, many studies have reported that higher N/NE and lower E/PE predict a poorer course and response to treatment, although the findings regarding E/PE are slightly less consistent ( de Fruyt et al. 2006 , Duggan et al. 1990 , Morris et al. 2009 , Quilty et al. 2008a , Tang et al. 2009 ). As noted above, however, these findings are also consistent with diagnostic heterogeneity, such that personality dysfunction is a marker for a more severe or etiologically distinct group. Indeed, there is evidence that the nonmelancholic subtype is characterized by more vulnerable personality styles than is melancholia and that chronic depressions are associated with higher N/NE and lower E/PE than is nonchronic MDD ( Klein 2008 , Kotov et al. 2010 ).

Evidence relevant to dynamic models

Transactions between N/NE and environmental contexts have received the most attention in the literature ( Ormel & de Jong 1999 , van Os & Jones 1999 ). N/NE shows reciprocal relations with a range of significant life experiences, such as initiation and break-up of a committed relationship, relationship quality, occupational attainment, and financial security ( Neyer & Lehnart 2007 , Roberts et al. 2003 , Scollon & Diener 2006 ). Furthermore, N/NE has been repeatedly implicated in the generation of stressful life events ( Kercher et al. 2009 , Lahey 2009 , Middeldorp et al. 2008), which suggests an environmentally mediated relationship between this trait and depression. The environmentally moderated mechanism has also received support, as several studies found that N/NE interacts with stressful life events to predict first onset of major depression ( Kendler et al. 2004 , Ormel et al. 2001 , van Os & Jones 1999 ).

E/PE has demonstrated bidirectional effects with many significant social and occupational experiences ( Neyer & Lehnart 2007 , Roberts et al. 2003 , Scollon & Diener 2006 ). In addition, a decrease in E/PE over time was found to predict future internalizing problems ( Van den Akker et al. 2010 ). However, little attention has been given to mechanisms underlying the association between this trait and depression. Support for an environmentally mediated effect is limited and mixed (Middeldorp et al. 2008, Wetter & Hankin 2009 ), and the environmental moderation model is largely untested, although there is some evidence that positive affect moderates the effects of daily stressors on depressive symptoms ( Wichers et al. 2007 ).

Finally, conscientiousness may play an important role in dynamic models of personality-depression relations. It has reciprocal associations with family support, divorce, occupational attainment, and job involvement ( Roberts et al. 2003 , Roberts & Bogg 2004 ). Conscientiousness is hypothesized to influence depression by increasing exposure to negative life events ( Anderson & McLean 1997 , Compas et al. 2004 ), but mediation and moderation effects have not been tested.

Interactions between temperament dimensions

Finally, personality-depression relations may be multivariate, rather than bivariate, with multiple traits interacting to influence depression. Indeed, in their influential model of personality and depression, Clark & Watson (1999 , Clark et al. 1994 ) hypothesized that depression is characterized by high N/NE and low E/PE, raising the possibility that it is the combination of the two traits that is particularly important in depressive disorders. A growing number of studies have reported that the interaction of high N/NE and low E/PE predicts subsequent depressive symptoms or disorders in adults and youth ( Gershuny & Sher 1998 , Joiner & Lonigan 2000 , Wetter & Hankin 2009 ), although several studies have not found such an interaction ( Jorm et al. 2000 , Kendler et al. 2006 , Verstraeten et al. 2009 ). The interaction between N/NE and conscientiousness is also of interest, as the latter construct includes aspects of self-regulation and effortful control ( Rothbart & Bates 2006 ) and may therefore reflect the ability to modulate one’s affective reactivity. Indeed, there is cross-sectional evidence that effortful control moderates the association between N/NE and depressive symptoms in adolescents ( Verstraeten et al. 2009 ).

Summary and discussion

Cross-sectional studies have documented strong links of depressive disorders to N/NE, conscientiousness, and E/PE, although the latter effect is substantial in dysthymic disorder but only moderate in MDD. In fact, personality generally appears to play a greater role in dysthymia. None of these relations are specific, however, as anxiety disorders have very similar trait profiles. This observation argues against the continuum/spectrum model at least with regard to these broad dimensions. It may be possible to find traits that are specific to depression by targeting lower-order personality dimensions. Narrower traits may also explain the surprisingly modest link between E/PE and MDD, as some, but not other, facets of this general dimension are relevant to depression.

The nature of relations between these personality traits and depression is complex, and our understanding is still limited. N/NE, the most widely studied personality trait in depression, raises challenging conceptual and methodological issues due to the overlap between some of its features and depressive symptoms ( Ormel et al. 2004b ). Nonetheless, this cannot completely explain the association between these constructs ( Tang et al. 2009 ). N/NE is moderately influenced by clinical state (the concomitants model), shares common etiological influences with MDD (common cause, continuum/spectrum, and precursor models), predicts the subsequent onset of MDD (precursor and predisposition models), and influences the course of depression (pathoplasticity model). In addition, N/NE appears to contribute to subsequent stress and adversity and increases the risk of depression in the face of negative life events (predisposition model). Finally, it may also be changed by experience of MDD episodes (consequences model), but the evidence for this is weaker and less consistent.

The role played by E/PE in depression is less clear. Its cross-sectional association with dysthymia is substantial, but its relation to MDD is more modest. E/PE is not influenced by clinical state or changed by the experience of depressive episodes. It appears to be abnormally low even during remission, which is consistent with the continuation of trait deviance from the pre-morbid stage (precursor or predisposition accounts). Moreover, low E/PE tends to predict a poorer course of depression. However, the degree of shared etiological influences between E/PE and MDD is low, and the evidence that E/PE predicts the onset of MDD in prospective longitudinal studies is weak. As noted above, three possible reasons for the weaker and less consistent findings regarding E/PE are ( a )it plays a greater role in some forms of depression than others (e.g., chronic depressions); ( b ) only some facets of the broader trait (e.g., low positive affective and approach motivation) are related to depression; and ( c ) E/PE may make a greater contribution to depression by moderating N/NE than as a main effect ( Olino et al. 2010 ).

Finally, there appears to be a strong negative association between conscientiousness and depression, at least in cross-sectional studies. This may appear surprising in light of the positive associations discussed below between depression and a number of other constructs that are thought to be related to conscientiousness, such as behavioral inhibition system sensitivity, harm avoidance, perfectionism, and temperamental behavioral inhibition. It is important to note, however, that these latter constructs are more strongly associated with high N/NE, and in some cases, low E/PE, than with conscientiousness ( de Fruyt et al. 2000 , Muris et al. 2009a , Smits & Boeck 2006 ). Hence, it is likely that their positive correlations with depression are driven by their shared variance with high N/NE. Unfortunately, few studies testing causal models of personality and depression have considered conscientiousness. However, evidence indicating that this trait may moderate the effects of N/NE on depression and that it increases the likelihood of subsequent adversity that could then, in turn, produce depression suggests that further research on the role of conscientiousness is warranted.

Psychobiological Models

Gray’s model.

Gray’s (e.g., Gray 1994 ) influential theory proposes that there are two major neurobehavioral systems that underlie behavior: the behavioral activation system (BAS), which responds to signals of reward, and the behavioral inhibition system (BIS), which is sensitive to cues for punishment. Although BAS and BIS differ conceptually and empirically from E/PE and N/NE, their relations with depression are thought to be similar. Thus, it has been hypothesized that depression is associated with reduced BAS and/or heightened BIS sensitivity ( Depue & Iacono 1989 , Gray 1994 ). Although much of this work has focused on bipolar disorder (e.g., Alloy et al. 2008 , Johnson et al. 2008 ), several recent studies have examined self-report measures of BAS and BIS sensitivity in MDD. Consistent with Gray’s model, compared with healthy controls, currently depressed patients report lower levels of BAS and higher levels of BIS, and patients with a past history of MDD report lower levels of BAS ( Pinto-Meza et al. 2006 ). In addition, lower BAS sensitivity, but not higher BIS sensitivity, is associated with a poorer course of MDD (e.g., Kasch et al. 2002 , McFarland et al. 2006 ), suggesting that BAS may have a pathoplastic effect on depression.

Cloninger’s model

Cloninger (e.g., Cloninger et al. 1993 ) has proposed a model of personality that includes four temperament and three character dimensions. The temperament dimensions include novelty seeking (an appetitive/approach system), harm avoidance (an inhibition/avoidance system), reward dependency (a system that is responsive to signals of social approval and attachment), and persistence. The character dimensions are self-directedness (responsible, goal-directed), cooperativeness (helpful, empathic versus hostile and alienated), and self-transcendence (imaginative, unconventional). Harm avoidance is conceptually and empirically associated with BIS, and novelty seeking and persistence are associated with BAS. Similarly, harm avoidance is positively correlated with N/NE and negatively associated with E/PE, self-directedness is negatively correlated with N/NE, and novelty seeking and persistence are associated with E/PE (e.g., de Fruyt et al. 2000 ).

A number of studies have reported that patients with MDD report higher levels of harm avoidance and lower levels of self-directedness than do healthy controls (e.g., Celikel et al. 2009 ). Most of the traits in Cloninger’s system are influenced by the respondent’s mood state (e.g., Farmer et al. 2003 ); however, abnormal levels of harm avoidance and self-directedness are present even after remission (e.g., Smith et al. 2005 ). Increased harm avoidance and lower self-directedness are also characteristic of most anxiety disorders, indicating that these effects are not specific to MDD ( Öngür et al. 2005 ).

Few studies have explicitly tested the common cause, precursor, predisposition, and consequences hypotheses for Cloninger’s model. Farmer et al. (2003) found that the never-depressed siblings of patients with MDD reported significantly greater harm avoidance and less self-directedness than did the never-depressed siblings of healthy controls. In addition, Cloninger et al. (2006) reported that in a large community sample, high harm avoidance and persistence and low self-directedness predicted an increase in self-reported depressive symptoms 12 months later. A larger number of studies have addressed the pathoplasticity hypothesis, albeit with mixed results. Low harm avoidance, self-directedness, and reward dependency have predicted a poorer response to treatment in some, but not all, studies; the other dimensions have generally not been associated with course and treatment outcome ( Joyce et al. 2007 , Kennedy et al. 2005 , Morris et al. 2009 ).

Clinical Traits

Independent of the traditional personality field, clinical researchers have developed a number of trait-like constructs to describe dispositions to depression. These clinical traits are similar in scope to personality facets, and their stability is comparable to that of a typical personality dimension (e.g., Kasch et al. 2001 , Zuroff et al. 2004 ). Also, factor analytic studies have shown that most of these clinical traits can be successfully incorporated in the personality taxonomy as components of neuroticism ( Watson et al. 2006 ). Next, we briefly discuss three of the most studied constructs: ruminative response style, self-criticism, and dependency.

Ruminative response style, a tendency to dwell on sad mood and thoughts ( Nolen-Hoeksema 1991 ), is correlated with concurrent depressive symptoms and predicts future symptoms as well as increases in symptoms over time ( Rood et al. 2009 ). Also, one study reported that ruminative response style prospectively predicts onset of MDD ( Nolen-Hoeksema 2000 ). The trait has also been linked to anxiety disorders, but the association with depression is appreciably stronger ( Cox et al. 2001 , Nolen-Hoeksema et al. 2008 ).

Blatt’s (1974 , 1991 ) theory of depression focuses on two trait vulnerabilities: self-criticism (an inclination to feelings of guilt and failure stemming from unrealistically high expectations for oneself) and dependency (a disposition to feelings of helplessness and fears of abandonment resulting from a preoccupation with relationships). These constructs are similar, although not identical, to Beck’s (1983) constructs of autonomy and sociotropy. Studies indicate that the link between dependency and depressive disorders is relatively weak and nonspecific, whereas self-criticism has been established as an important and specific factor in these conditions ( Zuroff et al. 2004 ). Both traits have been conceptualized as dynamic predispositions to depressive disorders, and there is some support for this view, including evidence of transactions with life stress as well as environmental mediation and moderation of personality effects ( Zuroff et al. 2004 ). Self-criticism, and to a lesser extent dependency, have also been found to predict future increases in depressive symptoms. In addition, there is evidence that dependency predicts the subsequent onset of major depression in older, but not younger, individuals ( Hirschfeld et al. 1989 , Rohde et al. 1990 ). The concomitants and pathoplasty models have also received empirical support ( Zuroff et al. 2004 ). Finally, there is some research indicating that dependency may increase as a function of depressive episodes (consequences model) in youth but not adults ( Rohde et al. 1990 , 1994 ; Shea et al. 1996 ).

As noted above, all of these constructs are strongly linked to N/NE ( Cox et al. 2001 , Kasch et al. 2001 ), and some (particularly rumination and self-criticism) can be considered facets of this broader trait ( Watson et al. 2006 ). Lower-order facets can account for variance over and above that of higher-order traits ( Paunonen & Ashton 2001 ), and several cross-sectional studies have supported the incremental validity of ruminative response style and self-criticism ( Cox et al. 2004 , Muris et al. 2009b ) in associations with depressive symptoms. However, this issue requires more research, particularly using longitudinal designs.

CHILD TEMPERAMENT

Most of the literature on personality and depression has focused on adolescents and adults. Research that is grounded in the child temperament literature in developmental psychology has the potential to extend existing work on personality in depression by ( a ) providing the strongest test of the precursor and predisposition models; ( b ) more precisely delineating the behavioral manifestations of temperamental vulnerabilities to mood disorders in young children; ( c ) tracing the development and continuity of trait vulnerabilities across the lifespan; and ( d ) examining the neurobiological, cognitive, and interpersonal processes that may mediate the association between early temperament traits and the subsequent development of depressive disorder ( Compas et al. 2004 , Klein et al. 2008a , Kovacs & Lopez-Duran 2010 ).

The early childhood temperament dimensions that have received the greatest attention with respect to depression are N/NE, E/PE, and behavioral inhibition (BI). BI refers to wariness, fear, and low exploration in novel situations ( Kagan et al. 1987 ). It combines aspects of N/NE (fear and anxiety), E/PE (low approach), and conscientiousness (constraint/ effortful control) that do not have a direct analog in most models of adult personality.

Cross-sectional and longitudinal studies of older children and adolescents using self-report measures have generally reported associations of low E/PE and high N/NE with depression similar to those in the adult literature (e.g., Lonigan et al. 2003 ). 5 Observational studies of younger children of depressed mothers also indicate that these traits may be associated with risk for depression ( Kovacs & Lopez-Duran 2010 ). For example, in a community sample of 100 three-year-olds, Durbin et al. (2005) reported that children of mothers with a history of mood disorder exhibited low PE in emotion-eliciting laboratory tasks. Importantly, this effect was limited to the affective (positive affect) and motivational (approach/engagement), rather than the interpersonal (sociability), components of PE. Furthermore, low PE at age 3 predicted depressotypic cognition and memory biases at age 7 ( Hayden et al. 2006 ) and parent-reported depressive symptoms at age 10 ( Dougherty et al. 2010 ).

Subsequently, using a larger community sample (N = 543), Olino et al. (2010) found that preschool-aged children of parents with a history of depression had higher levels of NE and BI. However, both main effects were qualified by interactions with child PE. At high and moderate (but not low) levels of child PE, higher levels of NE and BI were each associated with higher rates of parental depression. Conversely, at low (but not high and moderate) levels of child NE, low PE was associated with higher rates of parental depression. Taken together, these results suggest that children of depressed parents may exhibit diminished PE or elevated NE and BI. In this latter sample, low PE was also associated with elevated levels of cortisol shortly after awakening, an index of hypothalamic-pituitary-adrenal axis dysregulation that has been shown to predict MDD in adolescents and adults ( Dougherty et al. 2009 ).

In both the Durbin et al. (2005) and Olino et al. (2010) studies, the child temperament–parental psychopathology associations were specific to depression. However, other work suggests that children of parents with anxiety disorders may also exhibit elevated BI. For example, Rosenbaum et al. (2000) assessed BI using laboratory measures in 2-to 6-year-old children of parents with a history of MDD and/or panic disorder and parents with no history of mood or anxiety disorders. Children of patients with both MDD and panic disorder exhibited significantly greater BI than did children of parents with no history of mood or anxiety disorder. Children of parents with panic disorder alone and children of parents with MDD alone had intermediate levels of BI that did not differ significantly from children of parents in the comorbid and no-psychopathology groups.

Finally, there is some direct evidence that personality traits assessed in childhood predict the development of depressive disorders in adults. Caspi et al. (1996) reported that children who were rated as socially reticent, inhibited, and easily upset at age 3 had elevated rates of depressive (but not anxiety or substance use) disorders at age 21. Moreover, van Os et al. (1997) found that physicians’ ratings of behavioral apathy at ages 6, 7, and 11 were predictive of both adolescent mood disorder and chronic depression in middle adulthood. However, BI appears to predict the development of anxiety disorders at least as strongly as depression ( Hirshfeld-Becker et al. 2008 ).

CLINICAL IMPLICATIONS

Personality research has important implications for the prevention of depression. Meta-analytic evidence indicates that existing preventive interventions can reduce the incidence of depressive disorders by 25% ( Cuijpers et al. 2008 ). However, the available strategies are a mix of universal (intervention is administered to the entire population), selective (to a well-defined at-risk group), and indicated (to those with subthreshold disorder) approaches. Universal interventions are costly, lack a personalized focus, and require very large samples to yield detectable effects, whereas indicated interventions may be better described as treatment than prevention ( Muñoz et al. 2010 ). In contrast, selective interventions are true preventive measures that are cost effective and can be tailored to a specific mechanism of risk. However, implementation of selective strategies requires knowledge of risk factors and causal processes that lead from the vulnerability to the disorder.

The majority of established risk factors for depressive disorders are either immutable (e.g., demographic characteristics, family history) or predict onset only in the short term (e.g., stressful life events). In contrast, personality is at least somewhat malleable, especially in youth, but may forecast the onset of depression years in advance, which makes traits a potentially attractive means of identifying individuals at risk and informing selection of interventions. Different trait-disorder pathways would point to different preventive strategies; hence, further research on the nature of personality-depression relations can significantly facilitate development of preventive interventions. Another advantage of traits is that they can be assessed relatively easily and efficiently and thus are ideal for screening.

Treatment Response

Personality also can inform treatment of depressive disorders post onset. In particular, traits can predict response to treatment. Substantial evidence has accumulated that individuals with lower N/NE have better treatment outcomes across modalities ( Kennedy et al. 2005 , Mulder 2002 , Tang et al. 2009 ). Other Big Five traits have been studied less and their role is not yet certain. However, a recent large investigation of a combination intervention (medication plus psychotherapy) found that low N/NE and high conscientiousness predicted who would respond to treatment, and although high E/PE did not contribute directly, it amplified the effect of high conscientiousness ( Quilty et al. 2008a ). As discussed above, investigations of Cloninger’s traits have produced inconsistent results ( Joyce et al. 2007 , Kennedy et al. 2005 , Mulder 2002 ). Few studies have examined personality facets, but preliminary evidence suggests that lower-order traits can add substantially to the prediction of treatment response ( Bagby et al. 2008 ). Among clinical traits, self-criticism, but not dependency, was found to forecast poor treatment outcomes ( Blatt et al. 1995 ). Furthermore, personality may be useful in matching patients to interventions. For instance, Bagby et al. (2008) reported that patients high on N/NE or low on some agreeableness facets respond better to antidepressant medication than to psychotherapy.

The processes underlying these predictive associations are not entirely clear. One hypothesis is that personality change mediates the effect of treatment on depression. Indeed, there is a fair amount of evidence that depression treatment reduces N/NE and increases E/PE ( Zinbarg et al. 2008 ) and that this effect is not due to confounding by the depressive state ( Tang et al. 2009 ). Quilty et al. (2008b) tested a mediation model and found direct support for this hypothesis. Other possibilities need to be ruled out, however, particularly the hypotheses that traits predict poorer response because they indicate a more severe form of depression or that they interfere with treatment compliance and the therapeutic relationship, thus reducing the efficacy of the intervention.

CONCLUSIONS AND FUTURE DIRECTIONS

The literature on the relation between personality and depression is large, but it has many gaps and inconsistent findings. Nonetheless, it is possible to draw a number of conclusions. First, there are moderate-to-large cross-sectional associations between depression and three general personality traits—N/NE, E/PE, and conscientiousness—as well as with a variety of related traits (e.g., harm avoidance, rumination, and self-criticism) and personality types (depressive personality). Second, most of the personality traits associated with depression also are related to other forms of psychopathology, particularly anxiety disorders. This may reflect the phenomenon of multifinality, in which variables early in the causal chain lead to multiple outcomes depending on subsequent events in the causal pathway. On the other hand, many of the disorders that are currently classified as distinct conditions are closely related; hence, research on personality-psychopathology associations can provide important information for revising our nosological system. Third, reports of some traits (e.g., N/NE and harm avoidance) are influenced by clinical state, whereas other traits (e.g., E/PE) appear to be independent of mood state. However, state effects cannot fully account for the associations between personality and depression. Fourth, shared etiological factors (e.g., genes) account for a portion of the association between N/NE and depression. Fifth, depressive personality and some traits, particularly N/NE, predict the subsequent onset of depressive disorders. However, it is unclear at this point whether they are best conceptualized as precursors or predispositions, as it is difficult to tease these models apart, and there is evidence supporting both accounts. In either case, there is growing evidence that temperamental risk factors are evident at an early age, suggesting a promising approach to identifying young children at risk for depression. Sixth, there is evidence suggesting that other traits, such as low E/PE and low conscientiousness/effortful control, may moderate the relationship between N/NE and depression. Seventh, it appears unlikely that depressive episodes produce enduring changes in most personality traits. Finally, personality traits predict, and may in fact influence, the course and treatment response of depression.

To make further progress in elucidating the relation between personality and mood disorders, future studies should be guided by six broad considerations. First, most of the literature on personality and depression has focused on the broad traits of N/NE and E/PE. There is a need for further work on conscientiousness and on lower levels in the trait hierarchy (i.e., facets). It is important to determine whether a more specific level of analysis will yield more powerful effects and increase the specificity of associations between personality constructs and particular forms of psychopathology. Clinical traits, such as ruminative response style and self-criticism, need to be included in these studies and evaluated jointly with traditional personality dimensions. Finally, it is important to continue to explore interactions between traits.

Second, there is a critical need for prospective, longitudinal studies. Most existing longitudinal studies have begun in late adolescence or adulthood. However, a substantial proportion of mood disorders have already developed by mid-adolescence. Therefore, in order to further test the precursor and predisposition models, and to trace the developmental pathways between personality and depression, it is necessary to conduct longitudinal studies that start as early as possible in order to obtain a sufficient number of first-onset cases and avoid selection biases caused by excluding participants who already have a history of mood disorder at initial assessment.

Third, depression researchers have treated personality as static. However, personality changes over the course of development. Future work must begin to consider the complex personality-environment transactions that can strengthen or attenuate personality trajectories and predispositions for depressive disorder. In addition, as understanding of epigenetics increases, it will be important to explore epigenetic influences on personality change and their relation to depression.

Fourth, if personality is a precursor of, or predisposes to, the development of depressive disorders, it is critical to identify the moderating factors and mediating processes involved in these pathways. There is some evidence suggesting that moderators may include gender, early adversity, and life stress, and mediators may include interpersonal deficits, depressotypic cognitions, maladaptive coping, and behavioral and neurobiological stress reactivity ( Klein et al. 2008a ). There is a need for more systematic research examining these moderators and mediators in a longitudinal framework.

Fifth, self-reports have borne the brunt of most research in this area and have made important contributions. However, like all methods, they have limitations and cannot be applied in all contexts (e.g., young children). Thus, there is a need for further work using complementary methods such as informant reports and observations in naturalistic and laboratory settings.

Finally, the role of personality/temperament may differ for different forms of depressive disorder. Personality appears to play an especially important role in early-onset, chronic, and recurrent depressive conditions (e.g., Klein 2008 , Kotov et al. 2010 , van Os et al. 1997 ). Focusing on broad diagnostic categories such as MDD may obscure important associations with particular forms of depression; hence, future studies need to give greater consideration to the heterogeneity of depressive disorders.

SUMMARY POINTS

• There are moderate-to-large cross-sectional associations between depression and three general personality traits—N/NE, E/PE, and conscientiousness—as well as with a variety of related traits (e.g., harm avoidance, rumination, and self-criticism) and personality types (e.g., depressive personality).
• Most of the personality traits associated with depression also are related to other forms of psychopathology, particularly anxiety disorders. This may reflect the phenomenon of multifinality, in which variables early in the causal chain lead to multiple outcomes depending on subsequent events in the causal pathway. On the other hand, many of the disorders that are currently classified as distinct conditions are closely related; hence, research on personality-psychopathology associations can also provide important information for revising our nosological system.
• Reports of some traits (e.g., N/NE and harm avoidance) are influenced by clinical state, whereas other traits (e.g., E/PE) appear to be independent of mood state. However, state effects cannot fully account for the associations between personality and depression.
• Shared etiological factors (e.g., genes) account for a portion of the association between N/NE and depression.
• Depressive personality and some traits, particularly N/NE, predict the subsequent onset of depressive disorders. However, it is unclear at this point whether they are best conceptualized as precursors or predispositions, as it is difficult to tease these models apart, and there is evidence supporting both accounts. In either case, there is growing evidence that temperamental risk factors are evident at an early age, suggesting a promising approach to identifying young children at risk for depression.
• There is evidence suggesting that other traits, such as low E/PE and low conscientiousness/effortful control, may moderate the relationship between N/NE and depression.
• It appears unlikely that depressive episodes produce enduring changes in most personality traits.
• Personality traits predict, and may in fact influence, the course and treatment response of depression.

1 There may not be complete specificity owing to diagnostic heterogeneity. As discussed below, depression is a heterogeneous disorder with multiple etiological pathways (equifinality). A personality trait may be part of only one of the pathways. In contrast, multifinality, in which the trait is associated with multiple disorders, is less consistent with the continuum/spectrum view.

2 Application of the continuum/spectrum and precursor models to depressive disorders is not straightforward. Personality traits are relatively stable, whereas depression is often episodic. Existing formulations of the continuum/spectrum model have not explained how stable trait characteristics manifest as an episodic illness. Similarly, the precursor model does not account for why a stable trait would subsequently develop into a nonstable depressive state. Thus, the continuum/spectrum and precursor models may provide a better explanation for chronic than episodic forms of depression.

3 Although moderating and mediating variables play an explicit and central role in the predisposition model, it should be acknowledged that they are not incompatible with the precursor account. That is, the escalation from personality traits to depressive disorders in the precursor model implies that additional variables (e.g., maturational or environmental factors) must be involved to precipitate the change.

4 This could also be called the dynamic continuum model because once the dynamic element is introduced, it becomes virtually impossible to distinguish the continuum/spectrum and precursor models.

5 Few studies have examined the association of conscientiousness/effortful control with depression in youth, but analogous to the adult literature, there is cross-sectional evidence that effortful control is negatively correlated with depression ( Verstraeten et al. 2009 ).

DISCLOSURE STATEMENT

The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review.

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Home — Essay Samples — Nursing & Health — Mental Health — Personality disorders and their treatment

Personality Disorders and Their Treatment

• Categories: Mental Health

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Published: Oct 22, 2018

Words: 1196 | Pages: 3 | 6 min read

Table of contents

What is a personality disorder, psychotherapy, works cited:, what are the different types of personality disorders.

• Paranoid personality disorder: People with paranoid personality disorder are very distrustful of others and suspicious of their motives. They also tend to hold grudges.
• Schizoid personality disorder: People with this type of disorder display little interest in forming personal relationships or partaking in social interactions. They usually don’t pick up on normal social cues, so they can seem emotionally cold.
• Schizotypal personality disorder: In schizotypal personality disorder, people believe they can influence other people or events with their thoughts. They often misinterpret behaviors. This causes them to have inappropriate emotional responses. They may consistently avoid having intimate relationships.
• Antisocial personality disorder: People with antisocial personality disorder tend to manipulate or treat others harshly without expressing remorse for their actions. They may lie, steal, or abuse alcohol or drugs.
• Borderline personality disorder: People with this type of disorder often feel empty and abandoned, regardless of family or community support. They may have difficulty dealing with stressful events. They may have episodes of paranoia. They also tend to engage in the risky and impulsive behavior, such as unsafe sex, binge drinking, and gambling.
• Histrionic personality disorder: In histrionic personality disorder, people frequently try to gain more attention by being overly dramatic or sexually provocative. They are easily influenced by other people and are extremely sensitive to criticism or disapproval.
• Narcissistic personality disorder: People with narcissistic personality disorder believe that they are more important than others. They tend to exaggerate their achievements and may brag about their attractiveness or success. They have a deep need for admiration but lack empathy for other people.
• Avoidant personality disorder: People with this type of disorder often experience feelings of inadequacy, inferiority or unattractiveness. They usually dwell on criticism from others and avoid participating in new activities or making new friends.
• Dependent personality disorder: Independent personality disorder, people heavily depend on other people to meet their emotional and physical needs. They usually avoid being alone. They regularly need reassurance when making decisions. They may also be likely to tolerate physical and verbal abuse.
• Obsessive-compulsive personality disorder: People with obsessive-compulsive personality disorder have an overwhelming need for order. They strongly adhere to rules and regulations. They feel extremely uncomfortable when perfection isn’t achieved. They may even neglect personal relationships to focus on making a project perfect.

How Is a Personality Disorder Diagnosed?

• the way you perceive or interpret yourself and other people
• the way you act when dealing with other people
• the appropriateness of your emotional responses
• how well you can control your impulses in some cases, your primary care or mental health provider may perform blood tests to determine whether a medical problem is causing your symptoms.

How Is a Personality Disorder Treated?

• antidepressants, which can help improve a depressed mood, anger, or impulsivity
• mood stabilizers, which prevent mood swings and reduce irritability and aggression
• antipsychotic medications, also known as neuroleptics, which may be beneficial for people who often lose touch with reality
• anti-anxiety medications, which help relieve anxiety, agitation, and insomnia
• Becker-Phelps, L. (2017). Procrastination: Why you do it, what to do about it now. Retrieved from https://www.psychologytoday.com/us/blog/making-change/201712/procrastination-why-you-do-it-what-do-about-it-now
• Ferrari, J. R. (2018). Procrastination as self-regulation failure of performance: Effects of cognitive load, self-awareness, and time limits on "working best under pressure". European Journal of Personality, 32(6), 647-657.
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• Pychyl, T. A., & Flett, G. L. (2012). Procrastination and self-regulatory failure: An introduction to the special issue. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 30(4), 203-212.
• Steel, P. (2007). The nature of procrastination: A meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological Bulletin, 133(1), 65-94.
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• Tice, D. M., & Baumeister, R. F. (1997). Longitudinal study of procrastination, performance, stress, and health: The costs and benefits of dawdling. Psychological Science, 8(6), 454-458.
• van Eerde, W. (2003). A meta-analytically derived nomological network of procrastination. Personality and Individual Differences, 35(6), 1401-1418.
• Wohl, M. J. A., Pychyl, T. A., & Bennett, S. H. (2010). I forgive myself, now I can study: How self-forgiveness for procrastinating can reduce future procrastination. Personality and Individual Differences, 48(7), 803-808.

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The impact of low self-esteem and negative body image is adversely affecting adolescents as they try to fit in in a never-ending society of expectations. The definition of body image according to Merriam-Webster's dictionary is "a subjective picture of one's own physical appearance established both by self-observation and by noting the reactions of others. Body image is not just decided by ourselves, it is also decided by others. This occurs when people have physical reactions and facial expressions. The definition […]

Violence Caused by Media or not

Many people argue that media violence is the gateway to violent behavior in individuals. But upon closer examination, this argument falls apart. In fact, several studies definitively demonstrate how violence is caused by other factors, with media violence playing just a small part in the outcome. So, while it is commonly believed that consumption of violent media leads to more aggressive behavior in the population, personality, psychological disorders, upbringing, economics, and substance abuse are shown to contribute more towards the […]

Navigating the Intricacies of Sociopathic Tendencies

In the realm of popular culture, the term "sociopath" has become almost colloquial, often evoking images of cold, calculated villains or charming manipulators. However, the academic understanding of sociopathic tendencies delves far deeper, beyond mere Hollywood portrayals, offering insights into a complex psychological profile that is both fascinating and, at times, unsettling. Sociopathy, more formally recognized in psychiatric circles as Antisocial Personality Disorder (ASPD), is marked by persistent patterns of disregard for the rights of others, often manifesting in violation […]

Post-traumatic Stress Disorder and Fear Responses

The authors' research on post-traumatic stress disorder builds upon previous psychophysiological studies and their effects on human behavior. Post-traumatic stress disorder (PTSD) is a psychiatric disorder caused by traumatic life events. Approximately 8% of Americans have experienced some form of PTSD in their lives. PTSD heightens fear responses, hinders restrictions on conditioned fear, and inhibits the body's ability to distinguish between safety and fear signaling cues. Since this disorder varies case by case, not all individuals can be successfully treated […]

Will’s Aggressive Personality in ‘Good Will Hunting’ Movie

In Good Will Hunting , the main character Will is math genius with a high IQ that can solve any math problems in impressive time. Even though he is a math genius, he has had difficulties in his childhood and adulthood. Will worked as a janitor during his probation time at a MIT which gave him the opportunity to learn and solve math problems outside of the classroom. Will was continuously rebellious and was given a last strike of being […]

The Differences between Psychopaths and Sociopaths

In cinematic narratives, literary works, and colloquial discourse, the terms "psychopath" and "sociopath" are often bandied about, typically to denote individuals who engage in egregious acts without apparent concern for the repercussions. However, within the realm of psychology, these lexemes possess nuanced connotations, delineating discrete conditions within the spectrum of antisocial personality disorders. While both psychopaths and sociopaths evince akin behavioral tendencies, discerning the subtle disparities between them can illuminate the mechanisms underlying the genesis of such perilous behavioral patterns […]

Decoding the Differences: Psychopathy and Sociopathy in Personality Disorders

Let's tackle a topic that often gets tossed around in TV crime dramas but is a lot more intricate in real life: the difference between psychopaths and sociopaths. Though they're lumped together under the umbrella of antisocial personality disorders, they're not the same. This deep dive into the world of psychopathy and sociopathy is like unraveling a psychological mystery, layer by layer. First off, think of psychopathy and sociopathy as distant cousins in the family of antisocial behaviors. Psychopaths are […]

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Personality traits, types, and disorders: an examination of the relationship between three self-report measures

2005, European Journal of Personality

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Personality characteristics shape human behaviour and influence a wide range of life events and outcomes. They do so not only through their direct effects on life outcomes, but also through their indirect effects on other important personal factors and intermediate life events, such as the development of cognitive capacities, the attainment of educational qualifications and the formation of a family. As such, personality characteristics have a demonstrable relevance for a wide range of policy issues and represent an important, although often neglected, subject of policy interest. This paper reviews the scientific literature covering a wide range of personality characteristics, discussing their conceptualizations and main features, their relevance for important outcomes in life and work, and the chief ways they are measured. It aims to provide a comprehensive overview of various attributes of personality from the perspective of their potential importance for the Survey of Adult Skills (PIAAC), taking into account their analytical potential and policy relevance. The paper also outlines and evaluates the most important measurement instruments for each personality characteristic, with a focus on short self-report scales as the most appropriate form for inclusion in large-scale international surveys. Finally, it presents some considerations related to the evaluation and promotion of personality characteristics and introduces the substantive and measurement criteria that could be used to select the personality attributes, and related measurement scales, to include in large-scale surveys.

tatenda zviuya

TPQ® TECHNICAL MANUAL - 2023 EDITION

Gary C Townsend , Rujeko Nazare

The Townsend Personality Questionnaire (TPQ®) is based on the Five Factor Model of personality and was developed and validated using Rasch measurement. The Five Factor Model, often referred to as the ‘Big Five’ (Ewen, 1998, p.140), represents the most widely acknowledged general model of personality (Betram and Brown, 2005). It incorporates five different variables into a conceptual model for describing personality (Popkins, 1998). The five-factor theory is among the newest models developed for describing personality and has demonstrated that it is among the most practical and applicable models available in the field of personality psychology (Digman, 1990). The Big Five are collectively a taxonomy of personality traits. In essence, a framework for understanding which traits go together. They are an empirically based phenomenon, not a theory of personality (Srivastava, 2006). It is based on language since language itself is the structure with which we frame and understand the world around us (Lucius, 2008). There are various, well structured, psychological assessments in circulation using the big-five as the basis for their construction notably, Dr Tom Buchanan’s IPIP Five Factor Personality Inventory, the Hogan Personality Inventory, and the NEO assessments. However, despite traditional methods demonstrating both reliability and validity when measuring personality (Surgency or Extraversion (.91); Agreeableness (.88); Conscientiousness (.88); Constancy (.91), and Intellect or Imagination (.90)), there is a fundamental gap in the way all these measures are constructed as well as a lack of appropriate terminology for application in the real-world context (clinical and organisational). The TPQ® is designed to address these gaps. It does so by developing a personality measure, based on the big five model, that complies with the assumptions of linearity and conjoint additivity and reframes the constructs in more accessible language for use in personal development, clinical practice, as well as the South African workplace. While being based on a global, well-established model of personality, it has specific application for the South African context. It has been validated in the South African context and is currently being translated into all the other South African official languages.

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Five hundred and fifty-four undergraduate students attending a university-sector college in South Wales, United Kingdom, completed the Myers-Briggs Type Indicator (MBTI) (Form G) and the short-form Revised Eysenck Personality Questionnaire. The results showed a number of statistically significant relationships between the two models of personality and drew attention to two substantively significant relationships. In Eysenckian terms, the Myers-Briggs Type Indicator

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To obtain the opinions and preferences of practising clinicians about the clinical utility of personality scales included within 8 alternative dimensional models of personality disorder for inclusion within an official diagnostic nomenclature. Psychiatrists (n = 226) and psychologists (n = 164) from 2 continents provided clinical utility ratings on personality scales organized from 8 alternative dimensional models of personality disorder. The psychiatrists and the psychologists supported the inclusion of most of the scales from all 8 of the models that were compared. Normal personality traits were endorsed, although abnormal personality traits generally received higher levels of endorsement. The list of endorsed traits was reduced further by organizing the scales into groups based on redundancy within each of 5 broad domains and then selecting within each group the scale that received the highest rating. This list appears to represent each domain in a manner that is comprehensive bo...

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Dissociation Isn't Always About Trauma

Moods, panic, personality disorders, and daily events can instigate dissociation..

Posted June 29, 2024 | Reviewed by Devon Frye

• What Is Trauma?
• Find a therapist to heal from trauma
• Dissociation is thought of as a response to severe mental stress, but some dissociation is not pathological.
• The role of dissociation is different in trauma, depression, and personality disorders.
• While a surreal experience, dissociation does not have to be complicated to work with.

The term “dissociation” has received a lot of public and professional attention in recent years. This is likely due to the increased interest in psychological trauma, and, unfortunately, movies like "Split," ostensibly about someone with dissociative identity disorder (DID), but portrayed more as a psychopath .

Despite the rise of the awareness of dissociation, I can’t help but notice that the general understanding remains relatively narrow; it's usually presented as splitting into another identity or PTSD flashbacks. In reality, dissociation is part of everyday life—but it indeed can be pathological.

The definition of dissociation, from a clinical standpoint, is twofold:

• An alteration in consciousness or identity. Basically, there is a literal disconnect from their experience of self, encounters, and/or the environment .
• A separation of an idea or experience from it's emotional significance.

Everyday Dissociations

Considering the first definition, if you’ve ever been on a long car ride and all of a sudden it seems you arrived at the destination in no time, you’ve experienced dissociation. Now, if you’re sitting down, notice the feeling of the floor under your feet and your body against the chair. You probably weren’t aware of those contacts until I drew your attention to them because, you guessed it, you were not conscious of them.

Dissociations like these are just part of everyday life. They are often adaptable, like when there’s a lot of background noise and you’re able to “tune it out” to concentrate better.

As for the second definition, psychologist Nancy McWilliams (2011) explained that dissociative experiences are "a common first-line adaptation to deal with destabilizing situations like emotional intensity" and are considered normal experiences. If you have ever encountered what you consider an emotionally charged situation, like an EMT rescuing someone from an accident, but felt oddly calm, you have encountered the second definition. It is like a momentary emotional callous to help get through a situation where panic would be detrimental.

3 Types of Problematic Dissociation

While dissociations like the above are innocuous, everyday experiences, the other end of the dissociation continuum includes more pernicious encounters, often associated with trauma, depression , and personality disturbances, including the following:

1. Dissociative amnesia

In this form of dissociation, there are missing recollections of specific times/incidents. The amnesia can be for specific parts of the traumatic event, like the most frightening or painful, for example, or an entire timeframe leading up to, and following the event(s). Some, like children who have endured chronic abuse, neglect, and loss, or people living in war-torn regions, may literally not recall more than vague details of their childhood or the war period.

This psychological trick seems to be meant to protect the person from constantly enduring the replaying of the trauma, as if they weren’t there. Unfortunately, it’s a double-edged sword, because, as one can imagine, not recalling one’s childhood or another period of their life can wreak existential havoc.

It can also be a problem if there’s a crime witness issue. A viewer of a heinous crime might tell investigators they can’t remember what happened, for instance, only to be viewed as refusing to cooperate or somehow being an accomplice of the offender.

The Cleveland Clinic (2023) noted that the dissociated memories often resurface, but might be very painful, leading to depression or anxiety that requires its own intervention. Of course, it is possible that the intensity of the memories might lend themselves to being repressed to an amnesic state once again. Interestingly, dissociated memories can be retrieved, according to trauma expert Steven Gold, Ph.D. (2016), or, if not, the existential complications with sense of self or matters of life meaning can be worked through in therapy .

2. Dissociative identity disorder

Historically called “multiple personality disorder ,” people who suffer from DID invariably have very early histories of intense abuse and neglect. Thus, as their personality/identity is developing, they evolve compartmentalized alter identities. In effect, the core person's identity is fragmented or dissociated to deal with particular situations.

Mitra and Jain (2023) summarize four components that seem necessary for DID to evolve:

Several prominent psychologists, such as Kluft, have broken down the theory behind DID-in-sum. The theory describes predisposing factors for dissociation, which include an ability to dissociate, overwhelming traumatic experiences that distort reality, creation of alters with specific names and identities, and lack of external stability, which leads to the child's self-soothing to tolerate these stressors.

To put it into some perspective, many of us, if physically threatened, for example, will change to an aggressive demeanor and seem like a different person. And we remember the incident. Chances are, we’re not always conscious of our ability to become so defensive unless it is required. Now, imagine having dissociative amnesia for parts of childhood, but having evolved hypertrophied versions of normal survival/defensive reactions within.

Regardless of whether one can recall their problematic childhood, defenses are naturally programmed into them. Thus, when faced with a situation resonating with the subconscious (our “operating system,” always running in the background to keep things going, but we’re not really aware of it) as threatening, these overly developed defenses may show themselves, rendering a “different identity.”

Provided these reactions are really part of the person’s traumatic past, which is “forgotten,” it makes sense they tend not to recall being in an altered identity. Thus, those with DID often end up presenting for treatment not because they realize they are dissociating , but because they keep losing track of time or ending up in situations or places they don’t recall arranging/going to.

Therapy for DID is best summed up by the International Society for the Study of Trauma and Dissociation (2011) as, "Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process."

As one might imagine, this can be a complex process, as therapists must first gain the trust of the individual and the other identities. This creates a safe environment for them to be vulnerable, explore their roles and learn how to more effectively protect the core than splitting off at each vulnerability and creating upheaval in the core's life. (For an inside-out look at DID, and what successful treatment can look like, readers are directed to All of Me by Kim Noble.)

3. Depersonalization/derealization

Here, people may have out-of-body experiences or feel as though everything around them is surreal. Examples include seeing or hearing things as drastically larger or smaller/quieter or louder, or even feeling as if moving through water.

One patient told me it is like floating in and out of Salvador Dali paintings. While correlated to trauma, this condition can occur without “traditional” traumas like severe violence or neglect.

For instance, it is not unusual that people who panic might feel depersonalized, likely a defense to remove one from the unpleasant sensations going on during the panic attack. In addition, I’ve worked with depressed people who develop feelings of periodically living outside of the body or in “dreamlike” states with strange changes in sensory abilities which seem to be a protective effort from the misery of the mood. They then may self-injure to pull themselves out of such numbed or depersonalized sensations.

Some personality disturbances like borderline, schizoid, and schizotypal also experience this state, likely to escape the volatility of the inner world of the borderline person, and perhaps to cope with the stresses of feeling so unable to relate to other/the world in the latter two. This is also commonly induced by cannabis use, as explained in this article by psychologist Elena Buzzobova. People with schizophrenia also sometimes report dissociative experiences (e.g. Buetinger et al., 2020; Farrelly et al., 2024).

Treatment depends on the overall experience. For example, people presenting with depersonalization/derealization in the context of depression or panic will likely have a decrease in symptoms as the depression or panic improves. For others, learning to manage stress can reduce the intensity, and learning to attend to ground oneself in bodily sensations or other stimuli.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual's provider or formal supervision if you're a practitioner or student.

Buetiger, J.R., Hubl, D., Kupferschmid, S., Schultze-Lutter, F., Schimmelmann, B.G., Federspiel, A., Hauf, M., Walther, S., Kaess, M., Michel, C., & Kindler, J. (2020). Trapped in a glass bell jar: Neural correlates of depersonalization and derealization in subjects at clinical high-risk of psychosis and depersonalization–derealization disorder. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.535652

Cleveland Clinic (2023). Dissociative amnesia. Diseases and Conditions. https://my.clevelandclinic.org/health/diseases/9789-dissociative-amnesia

Farrelly, S., Peters, E., Azis, M., David, A.S., & Hunter, E.C.M. (2024). A brief CBT intervention for depersonalisation-derealisation disorder in psychosis: Results from a feasibility randomised controlled trial. J ournal of Behavior Therapy and Experimental Psychiatry , 82. https://doi.org/10.1016/j.jbtep.2023.101911 .

International Society for the Study of Trauma and Dissociation (2011): Guidelines for treating dissociative identity disorder in adults, (3rd rev). Journal of Trauma & Dissociation, 1 2 (2). 115-187.

Mcwilliams, N. (2013). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford.

Mitra, P & Jain, A. Dissociative Identity Disorder [Updated 2023 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. https://www.ncbi.nlm.nih.gov/books/NBK568768/

Anthony Smith, LMHC, has 23 years of experience that includes the roles of therapist, juvenile court evaluator, professor, and counseling supervisor.

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At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that could derail our entire day. Here’s how we can face triggers with less reactivity and get on with our lives.

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