What is personality disorder?

Personality disorder is a mental health condition that can make it difficult to relate to other people, regulate emotions and impulses, and feel comfortable in themselves. It is not uncommon for people living with personality disorder to feel intense distress and anger, feel empty or act impulsively. 

Everyday settings can feel overwhelming or upsetting. Relationships can be particularly challenging for people living with personality disorder. Things that others say or do can feel hurtful and it may be difficult to feel secure in relationships. Sometimes the distress associated with painful feelings may cause the person to engage in self-harm or other risky and damaging activities, in an attempt to control or escape from the intensity of their experiences.

Personality disorder symptoms tend to arise due to unhelpful patterns of thinking, feeling and behaving. These patterns usually emerge during adolescence or young adulthood, but it is not uncommon for someone to receive a diagnosis later in life. People with personality disorder are commonly misdiagnosed with other disorders prior to receiving a diagnosis of personality disorder. For instance, it is estimated that approximately 40% of people diagnosed with bipolar affective disorder are actually suffering from borderline personality disorder. Personality disorder can be associated with serious and intense psychological pain, suffering, and instability.

Personality disorder is not the person’s fault; they did not cause the disorder. Symptoms tend to develop due to an interaction between genetic vulnerabilities and adverse, invalidating and sometimes traumatic experiences earlier in life. The relative contribution of each of these factors varies between individuals.

The way we understand personality disorder has changed dramatically over the last 20-30 years, accompanied by the development of effective evidence-based treatments. It is now well established that personality disorder is an eminently treatable condition. The symptoms of personality disorder usually improve over time. Treatment can accelerate remission. Most importantly, people with personality disorder often recover and live independent, fulfilling lives.

While the DSM-5-TR uses a categorical model, the ICD-11 (World Health Organisation) has moved to a dimensional model for understanding and diagnosing personality disorder. The ICD-11 model specifies the severity of personality disorder along with key personality traits:

• negative affectivity:

  • tendency to experience a broad range of negative emotions

• detachment

  • tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment)

• dissociality

  • disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy
    

• disinhibition

  • tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of potential negative consequences
    

• anankastia

  • narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behaviour and controlling situations to ensure conformity to these standards
    

• borderline pattern

  • Characterised by a pervasive pattern of instability of interpersonal relationships, self-image and affect, with marked impulsivity

The borderline pattern has the same criteria for borderline personality disorder (BPD) as per the DSM-5-TR. The borderline pattern (unlike the trait qualifiers) still requires at least 5 out of the 9 criteria for a diagnosis.

The decision to keep borderline personality disorder (BPD) in the new ICD-11 model was based on the robust and growing evidence for effective BPD-specific treatment.