Source of information about DSM diagnoses: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

overview

Personality disorders are enduring patterns of inner experience and behavior that deviate significantly from cultural expectations, are inflexible and pervasive, begin in adolescence or early adulthood, remain stable over time, and cause distress or impairment in functioning. The DSM outlines ten specific personality disorders, grouped into three clusters based on descriptive similarities. The manual also includes alternative models to support evolving perspectives in research and clinical practice.

Personality Disorders:

• Paranoid: Distrust and suspicion of others, interpreting motives as harmful.

• Schizoid: Detachment from social relationships and limited emotional expression.

• Schizotypal: Discomfort in close relationships, with unusual thoughts, perceptions, or behavior.

• Antisocial: Disregard for others’ rights, impulsivity, and a pattern of rule-breaking or criminal behavior.

• Borderline: Instability in relationships, self-image, and emotions, with marked impulsivity.

• Histrionic: Excessive emotionality and attention-seeking behavior.

• Narcissistic: Grandiosity, need for admiration, and lack of empathy.

• Avoidant: Social inhibition, feelings of inadequacy, and hypersensitivity to criticism.

• Dependent: Excessive need to be cared for, leading to submissive and clingy behavior.

• Obsessive-Compulsive: Preoccupation with order, control, and perfectionism.

Clusters of Personality Disorders:

• Cluster A (Odd or Eccentric): Paranoid, Schizoid, Schizotypal

• Cluster B (Dramatic, Emotional, or Erratic): Antisocial, Borderline, Histrionic, Narcissistic

• Cluster C (Anxious or Fearful): Avoidant, Dependent, Obsessive-Compulsive

DSM Chapter Sections:

• Dimension Models for Personality Disorders
• General Personality Disorder
• Cluster A Personality Disorders
• Cluster B Personality Disorders
• Cluster C Personality Disorders
• Other Personality Disorders

general personality disorder

General personality disorder refers to long-standing patterns of thinking, feeling, and behaving that differ significantly from what is typically expected within the individual’s cultural context. These patterns impact how a person understands themselves and others, manages emotions, navigates relationships, and controls impulses. For a diagnosis, the traits must be inflexible, persist across various situations, cause noticeable distress or difficulty in functioning, and begin in adolescence or early adulthood.

Criteria:

A. There is a lasting pattern of inner experience and behavior that differs greatly from cultural expectations. This pattern affects at least two of the following areas:

1. Ways of perceiving and interpreting oneself, others, and events

2. Emotional expression and regulation

3. Ability to relate to others

4. Impulse control

B. This pattern is rigid and appears across a wide range of personal and social settings.
C. The pattern causes significant distress or problems in social, work, or other important areas of life.
D. The pattern is stable over time and can be traced back to adolescence or early adulthood.
E. The pattern is not better explained by another mental disorder.
F. The pattern is not the result of substance use or a medical condition.

Cluster A personality disorders

Paranoid Personality Disorder

Paranoid personality disorder is marked by a consistent pattern of mistrust and suspicion toward others. Individuals with this disorder tend to believe, without valid evidence, that others are trying to harm, deceive, or betray them. These beliefs begin in early adulthood and affect various aspects of daily life, including relationships, work, and social interactions. People with this condition often misinterpret neutral or friendly behaviors as threatening and may respond with hostility or withdrawal.

Associated Features:

• Frequently experience conflict in relationships due to suspiciousness or aloofness

• May appear argumentative, defensive, or cold

• Tend to misread others’ actions as hostile or critical

• Often rigid, critical of others, yet hypersensitive to criticism themselves

• May be drawn to strict ideologies or groups that confirm their suspicious beliefs

• Exhibit a need for control and struggle to trust others

• May become involved in legal conflicts or display litigious behavior

Criteria:

A. A long-standing pattern of distrust and suspicion of others, where their motives are seen as harmful or deceptive. This pattern starts by early adulthood and shows up in various situations, as reflected by four or more of the following:

1. Believes, without sufficient evidence, that others are trying to exploit, harm, or deceive them

2. Frequently doubts the loyalty or trustworthiness of friends or colleagues

3. Hesitates to share personal information due to unwarranted fear that it will be used against them

4. Interprets harmless comments or events as threatening or insulting

5. Holds grudges and is unwilling to forgive perceived slights

6. Perceives attacks on their character or reputation that are not obvious to others and responds with anger or counterattacks

7. Suspects, without justification, that their partner is being unfaithful

B. These traits are not limited to episodes of schizophrenia, bipolar disorder, depression with psychotic features, or another psychotic disorder, and are not caused by a medical condition or substance use.
Note: If these traits appear before the onset of schizophrenia, the diagnosis should be labeled “paranoid personality disorder (premorbid).”

Schizoid Personality Disorder

Schizoid personality disorder involves a long-term pattern of emotional detachment and limited interest in forming close relationships. Individuals with this disorder often prefer solitude, show little interest in social interaction, and express a narrow range of emotions in social settings. This pattern typically begins by early adulthood and is observed across various areas of life, including friendships, work, and family connections.

Associated Features:

• Often appear emotionally flat or unresponsive, even when provoked.

• May seem directionless or disengaged from long-term goals.

• Tend to respond passively to life challenges.

• Rarely express anger, even when appropriate.

• Typically have very few, if any, romantic or social relationships.

• May perform well in jobs that involve little interpersonal interaction.

Criteria:

A. A persistent pattern of emotional detachment and limited expression in social interactions, beginning in early adulthood and seen in various contexts, with at least four of the following traits:

1. Lacks interest in forming or maintaining close relationships, including with family

2. Regularly chooses activities that can be done alone

3. Shows little or no interest in sexual relationships with others

4. Takes limited pleasure in most, if any, activities

5. Has no close friends or confidants outside of immediate family

6. Appears unaffected by praise or criticism from others

7. Displays emotional coldness, detachment, or reduced emotional expression

B. These characteristics are not exclusively part of schizophrenia, bipolar or depressive disorders with psychotic features, another psychotic disorder, or autism spectrum disorder, and are not the result of a medical condition.
Note: If these traits are present before the onset of schizophrenia, the diagnosis may be noted as “schizoid personality disorder (premorbid).”

Schizotypal Personality Disorder

Schizotypal personality disorder is defined by a long-standing pattern of social and interpersonal challenges, including deep discomfort in close relationships, along with unusual thoughts, perceptions, and behaviors. These individuals often appear eccentric and may believe in things like telepathy or other paranormal phenomena. The disorder typically begins by early adulthood and is noticeable in a variety of life situations.

Associated Features:

• May seek help for symptoms of anxiety or depression rather than personality traits.

• Often appear awkward, socially anxious, or suspicious in interactions.

• Dress or behave in ways that seem strange or mismatched with social norms.

• Struggle to form or maintain close relationships, though they may feel distressed by their isolation.

Criteria:

A. A consistent pattern of discomfort with close relationships, along with unusual perceptions, beliefs, and behaviors. This pattern begins by early adulthood and shows up in many situations. At least five of the following must be present:

1. Interprets casual events or remarks as personally meaningful (but not delusional)

2. Holds odd beliefs or engages in magical thinking that affects behavior and is not culturally typical

3. Experiences unusual perceptions, such as bodily illusions

4. Speaks in an odd or overly elaborate way that may seem vague or overly abstract

5. Frequently suspicious or believes others have harmful intentions

6. Shows limited or inappropriate emotional expression

7. Behaves or dresses in a way that appears eccentric or out of the ordinary

8. Has few or no close relationships outside of immediate family

9. Experiences intense social anxiety that persists over time and is tied to suspiciousness, not self-judgment

B. These traits do not occur solely as part of schizophrenia, bipolar disorder, depression with psychotic features, another psychotic disorder, or autism spectrum disorder.
Note: If these traits appear before the onset of schizophrenia, the diagnosis may be noted as “schizotypal personality disorder (premorbid).”

Comparison of Schizoid vs. Schizotypal Personality Disorders

Cluster B personality disorder

Antisocial Personality Disorder

Antisocial personality disorder is defined by a long-standing pattern of violating the rights of others, often through deceit, impulsivity, aggression, or illegal behavior. This pattern typically begins with conduct problems in childhood or early adolescence and continues into adulthood. Individuals with this disorder often show little remorse for their actions, disregard the safety or needs of others, and struggle with responsibility and long-term planning.

Associated Features:

• Often show a lack of empathy, appearing cold or indifferent to others’ pain.

• May have an inflated sense of self-worth or feel entitled.

• Can be superficially charming, using manipulation to gain personal advantage.

• Frequently irresponsible in work, parenting, and financial matters.

• May have unstable or exploitative sexual relationships.

• Commonly have a history of legal problems, unstable housing, or dishonorable military discharges.

• Increased risk for early death due to risky behaviors or suicide.

Criteria:

A. A persistent pattern of ignoring or violating the rights of others, beginning by age 15, shown by at least three of the following:

1. Repeatedly breaks laws and engages in behaviors that can lead to arrest

2. Frequently lies, uses false identities, or manipulates others for personal benefit

3. Acts impulsively or fails to plan ahead

4. Is often irritable and aggressive, leading to physical fights or assaults

5. Disregards the safety of self or others

6. Fails to fulfill responsibilities in work or finances consistently

7. Lacks remorse, often rationalizing or minimizing harm caused to others

B. The person is at least 18 years old.
C. There is clear evidence of conduct disorder before age 15.
D. These behaviors do not occur exclusively during the course of schizophrenia or bipolar disorder.

Borderline Personality Disorder

Borderline personality disorder is defined by a persistent pattern of emotional instability, impulsive behavior, and chaotic relationships. Individuals with this disorder often struggle with a shifting sense of self, intense mood swings, and a deep fear of abandonment. These difficulties typically begin in early adulthood and affect many aspects of daily life, including relationships, self-image, and decision-making.

Associated Features:

• May sabotage progress in relationships, education, or work just as success is near.

• Sometimes experience brief psychotic-like symptoms under stress.

• May rely more on pets or possessions than people for comfort.

• High risk of premature death from suicide or related health complications.

• Frequent history of childhood trauma, including neglect, abuse, or loss.

• May have unstable employment, academic history, or romantic relationships.

Criteria:

A pervasive pattern of instability in relationships, self-image, emotions, and behavior that begins by early adulthood and appears in various contexts. At least five of the following must be present:

1. Intense efforts to avoid actual or imagined abandonment (excluding suicidal or self-injuring behavior).

2. Unstable and intense relationships that alternate between idealizing and devaluing others.

3. Ongoing confusion or instability in self-image or sense of identity.

4. Impulsivity in at least two areas that are potentially harmful (e.g., spending, sex, substance use, reckless driving, overeating).

5. Recurrent suicidal behavior, threats, gestures, or self-injuring acts.

6. Sudden mood changes and emotional instability in response to stress.

7. Persistent feelings of emptiness.

8. Intense or poorly controlled anger, such as frequent outbursts or physical fights.

9. Temporary stress-related paranoid thoughts or dissociative symptoms.

Histrionic personality disorder

Histrionic personality disorder is marked by ongoing patterns of excessive emotional expression and a strong need for attention. Individuals with this disorder often seek to be the center of attention and may engage in flirtatious, dramatic, or provocative behavior to maintain that focus. These behaviors emerge in early adulthood and can affect social, occupational, and relational functioning.

Associated Features:

• Often display a dominant interpersonal style that may come across as intrusive or controlling.

• Struggle with maintaining close same-sex friendships due to flirtatious behavior or attention-seeking.

• Romantic relationships are frequently unstable or superficial.

• Can become easily bored and seek constant stimulation or novelty.

• May quickly lose interest in projects or people when attention or excitement fades.

• Experience distress when they are not the center of attention or are required to delay gratification.

Criteria: 

A consistent pattern of excessive emotionality and attention-seeking, beginning in early adulthood and evident in different settings. At least five of the following behaviors are present:

1. Feels uneasy when not the focus of attention.

2. Engages in socially inappropriate flirtatious or seductive behavior.

3. Emotions shift quickly and tend to be shallow.

4. Uses physical appearance to attract attention.

5. Speech tends to be vague and overly dramatic, with little detail.

6. Behaves in an exaggerated, theatrical manner.

7. Easily influenced by others or by the situation.

8. Often perceives relationships as more intimate than they actually are.

Narcissistic personality disorder

Narcissistic personality disorder is marked by a consistent pattern of grandiosity, a strong need for admiration, and a lack of empathy for others. These individuals often believe they are special or superior, expect to be recognized as such, and may exploit others to maintain their inflated self-image. This behavior begins by early adulthood and appears across different areas of life, including work, relationships, and social settings.

Associated Features:

• May be hypersensitive to criticism, often reacting with anger or withdrawal.

• Struggle with feelings of shame, emptiness, or low self-worth despite outward confidence.

• Relationships may be shallow or exploitative, focused on boosting self-image.

• Tend to devalue others’ accomplishments and exaggerate their own.

• May show perfectionism or avoid challenges due to fear of failure.

• Some may appear socially successful, while others withdraw due to vulnerability or fear of imperfection.

Criteria:

A long-standing pattern of grandiosity, craving admiration, and lacking empathy, beginning in early adulthood and seen in various contexts. At least five of the following must be present:

1. Exaggerates talents or achievements and expects to be seen as superior.

2. Frequently daydreams about success, power, beauty, or ideal love.

3. Believes they are unique and should only associate with other high-status people.

4. Needs constant admiration from others.

5. Has a strong sense of entitlement and expects special treatment.

6. Uses others to meet personal goals.

7. Shows little interest in others’ feelings or experiences.

8. Feels envious of others or believes others are envious of them.

9. Behaves in an arrogant or condescending manner.

Cluster C personality disorders

Avoidant Personality Disorder

Avoidant personality disorder is characterized by extreme social discomfort, feelings of inadequacy, and an intense fear of being judged or rejected. Individuals with this disorder often want close relationships but struggle to form them due to deep-rooted self-doubt and fear of criticism. These patterns typically begin in early adulthood and affect many areas of life, including friendships, work, and self-image.

Associated Features:

• May closely monitor others for signs of criticism or rejection.

• Often seen as shy, quiet, or socially isolated.

• Tend to misread neutral or positive feedback as negative.

• Desire connection but withdraw due to fear of disapproval.

• Low self-esteem and high sensitivity limit both social and professional opportunities.

• May idealize relationships from a distance while avoiding real connection.

• Attachment style is often insecure, marked by fear of being devalued or hurt.

Criteria:

A long-standing pattern of avoiding social situations, feeling inadequate, and being hypersensitive to negative judgment. These patterns begin in early adulthood and appear across many settings. At least four of the following must be present:

1. Avoids jobs or roles that require a lot of social interaction due to fear of rejection or criticism.

2. Hesitant to engage with others unless sure of being accepted.

3. Holds back in close relationships out of fear of embarrassment or ridicule.

4. Is overly concerned with being criticized or rejected in social settings.

5. Feels shy or awkward in new situations due to self-doubt.

6. Views self as socially unskilled, unlikable, or inferior.

7. Avoids trying new things or taking risks due to fear of embarrassment.

Dependent Personality Disorder

Dependent personality disorder involves a chronic and excessive need to be cared for, leading to submissive, clingy behavior and intense fears of separation. These individuals rely heavily on others for guidance and reassurance, often doubting their own abilities. The pattern begins in early adulthood and affects many aspects of life, including relationships, decision-making, and self-confidence.

Associated Features:

• Often doubt their own skills and expect others to lead.

• Tend to avoid responsibility or independent roles.

• Easily hurt by criticism or disapproval.

• May tolerate mistreatment to maintain a relationship.

• Frequently seek new attachments quickly after a relationship ends.

• May appear passive, anxious, or overly compliant.

• Can experience difficulty with occupational roles that require independence.

Criteria:

A persistent and excessive need to be cared for, leading to submissive behavior and separation fears, beginning in early adulthood and present in multiple contexts. At least five of the following must be present:

1. Struggles to make everyday decisions without constant advice and reassurance.

2. Depends on others to take responsibility for major areas of life.

3. Avoids disagreement out of fear of losing support or approval.

4. Lacks confidence to start projects independently.

5. Goes to great lengths to gain support, even doing unpleasant tasks.

6. Feels helpless or anxious when alone due to fear of being unable to care for oneself.

7. Seeks another relationship urgently when a close one ends.

8. Constantly worries about being left to manage life alone.

Comparison of Avoidant vs. Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder is defined by a consistent pattern of rigid thinking, perfectionism, and a strong need for control. These individuals often become so focused on rules, schedules, or details that they lose sight of the main purpose of tasks. Their behavior may interfere with relationships, decision-making, and work-life balance. This pattern typically starts in early adulthood and appears across many settings.

Associated Features:

• Struggle with decision-making when clear rules are not present.

• May express anger indirectly or ruminate rather than confront problems.

• Rigid, formal, or emotionally restrained in relationships.

• Uncomfortable with spontaneity or displays of strong emotions.

• May prioritize structure and control over connection or pleasure.

• Often defer to authority they respect but challenge authority they do not.

• Difficulty relaxing or enjoying leisure without feeling unproductive.

Criteria:

A persistent pattern of perfectionism, preoccupation with order, and need for control, often at the expense of flexibility and effectiveness. This pattern begins by early adulthood and appears in multiple settings. At least four of the following must be present:

1. Becomes overly focused on rules, details, or routines, missing the main purpose of the activity.

2. Holds unrealistically high standards that interfere with completing tasks.

3. Prioritizes work and productivity over friendships or recreation.

4. Rigid and inflexible about moral, ethical, or value-based issues (not explained by culture or religion).

5. Struggles to throw away worn-out or useless items with no sentimental value.

6. Hesitates to delegate unless others follow exact methods.

7. Has a frugal approach to spending for self and others, saving excessively for imagined future crises.

8. Displays rigidity and stubbornness in thoughts and behavior.

Comparison of Obsessive-Compulsive Personality Disorder (OCPD) vs. Obsessive-Compulsive Disorder (OCD)

other personality disorders

In addition to the ten specific personality disorders grouped into Clusters A, B, and C, the DSM includes several additional categories for personality-related conditions. These include personality changes that are the direct result of medical conditions, as well as diagnoses used when symptoms cause significant impairment but do not match the full criteria for a specific personality disorder. These categories provide clinicians with the flexibility to capture complex or atypical presentations that still require clinical attention.

Personality Change Due to Another Medical Condition

This diagnosis is used when a noticeable and lasting change in a person’s typical personality arises as a direct result of a medical condition. The change must differ significantly from the person’s usual behavior or emotional functioning and cannot be better explained by another mental health disorder. In children, the condition may show up as a significant and persistent deviation from normal development. This change often results in disruptions to daily life, relationships, or work.

Associated Features:

• Often described by others as “not acting like themselves.”

• May involve mood swings, impulsivity, aggression, apathy, or paranoia.

• Can include poor judgment, disinhibition, or emotional dullness, depending on the area of the brain affected.

• Neurological conditions linked to this disorder include brain injury, stroke, epilepsy, tumors, and degenerative diseases.

• Other medical causes may include HIV, thyroid or adrenal disorders, or autoimmune diseases affecting the brain.

• Symptoms and severity often reflect the underlying medical condition.

Criteria:

A lasting personality change that stems directly from another medical condition. All of the following must be true:

A. There is a consistent change from the person’s previous personality pattern.

In children, this means a significant and long-lasting shift in development or behavior for at least one year.

B. Medical evidence (from history, physical exam, or lab tests) confirms that the personality change is caused by a medical condition.
C. The symptoms are not better explained by a mental health disorder.
D. The change does not occur only during delirium.
E. The change causes significant distress or problems in daily functioning.

Specify Type:

• Labile type – Mood instability

• Disinhibited type – Poor impulse control

• Aggressive type – Outbursts of anger or aggression

• Apathetic type – Emotional flatness or lack of motivation

• Paranoid type – Suspicion or mistrust of others

• Other type – Personality changes that do not fit the above

• Combined type – Multiple features present

• Unspecified type

Other Specified Personality Disorder

This diagnosis is used when a person shows clear signs of a personality disorder that significantly impacts their daily life, but the symptoms do not fully align with the criteria for any one specific personality disorder. The other specified personality disorder category allows clinicians to document the reason the presentation does not meet full diagnostic criteria by specifying it in the record (e.g., “other specified personality disorder, mixed personality features”).

Unspecified Personality Disorder

This diagnosis is used when a person displays significant traits of a personality disorder that interfere with daily functioning, but the symptoms do not meet the full criteria for any specific personality disorder. Unspecified personality disorder is applied when the clinician either does not specify why the criteria are unmet or lacks enough information to make a more detailed diagnosis.

self-check

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