Personality Disorders

Personality disorders are a group of severe mental health conditions. They are characterized by long-standing patterns of thoughts, feelings, behaviors (e.g., impulse control), and ways of relating that cause distress or challenges in multiple areas of a person’s life. The Diagnostic and Statistical Manual of Mental Disorders categorizes personality disorders into three ‘clusters’ based on shared features: Cluster A (odd or eccentric behavior), Cluster B (dramatic, emotional, or erratic behavior), and Cluster C (anxious or fearful behavior). Understanding and treating personality disorders often requires an integrative approach, combining psychological, social, and biological perspectives.

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Pessimism

Pessimism

Information handouts

Links to external resources

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Assessment

  • Borderline Symptom List 23 (BSL-23) | Bohus, Kleindienst, Limberger, Stieglitz, Domsalla, Chapman, Steil, Philipsen, Wolf | 2009
    • Scale
    • Reference Bohus, M., Limberger, M. F., Frank, U., Chapman, A. L., Kühler, T., & Stieglitz, R.-D. (2007). Psychometric properties of the Borderline Symptom List (BSL). Psychopathology, 40(2), 126–132. https://doi.org/10.1159/000098493

Exercises

  • Mindfulness exercise: Five things | Project Air
  • Mindfulness exercise: Bubbles | Project Air
  • Mindfulness exercise: Sushi train | Project Air
  • Mindfulness exercise: Leaves on a stream | Project Air
  • Mindfulness exercise: Rhythms & sounds | Project Air
  • Mindfulness exercise: Dropping anchor | Project Air
  • Making and using a sensory box | Project Air
  • Identifying Relationship Patterns | Project Air
  • Mindfulness of walking | Project Air | 2018
  • How did I get here? | Project Air | 2018

Guides and workbooks

  • Personality And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Trimingham | 2011

Information Handouts

  • Understanding self-harm and suicidal thinking: For families, partners, and carers | Project Air
  • Managing distress | Project Air
  • Managing emotions | Project Air
  • The importance of self care | Project Air
  • Effective communication: For families, partners, and carers | Project Air | 2018
  • Managing anger: For families, partners, and carers | Project Air
  • Helpful tips for challenging relationships: For families, partners, and carers | Project Air
  • Myths And Facts About Borderline Personality Disorder | Project Air
  • You've been diagnosed with BPD, what now? | Project Air
  • What are personality disorders? | Project Air
  • What is Borderline Personality Disorder? | Project Air
  • What is Narcissistic Personality Disorder? | Project Air
  • What is Antisocial Personality Disorder? | Project Air
  • What is Avoidant Personality Disorder? | Project Air
  • What is Obsessive Compulsive Personality Disorder? | Project Air
  • What is Schizotypal Personality Disorder? | Project Air
  • What treatment is available to me? | Project Air
  • Intellectual Disability & Personality Disorder | Project Air
  • Guide to Borderline Personality Disorder | Your Health In Mind / The Royal Australian & New Zealand College Of Psychiatrists
  • How to talk respectfully about Personality Disorder | Project Air
  • Understanding Borderline Personality Disorder through the lens of the brain | Project Air
  • Giving a diagnosis of personality disorder: A guide for mental health professionals | Project Air
  • Providing compassionate, recovery-oriented care: A guide for mental health professionals | Project Air

Self-Help Programmes

Treatment Guide

  • Treatment guidelines for personality disorders | Project Air: Grenyer, Jenner, Jarman, Carter, Bailey, Lewis | 2015
  • Brief intervention manual for personality disorders | Project Air: Grenyer, Jenner, Jarman, Carter, Bailey, Helyer, Bargenquast | 2015
  • Adolescent brief intervention manual for complex mental health issues | Project Air: Grenyer, Jenner, Jarman, Carter, Bailey, Helyer, Bargenquast, Matthews, Marceau, Huxley, Townsend | 2019
  • A modified DBT group therapy manual: For clinicians working with adolescents and young adults experiencing substance misuse (Clinician manual) | Misson Australia, Foundation For Alcohol Research And Education | 2015
  • A modified DBT group therapy manual (Client workbook) | Mission Australia, Foundation For Alcohol Research And Education
  • A quality manual for MBT | Anthony Bateman, Dawn Bales, Joost Hutsebaut | 2014

Worksheets

What Are Personality Disorders?

Personality disorders are defined by the presence of maladaptive personality traits that are rigid, pervasive, and lead to significant problems in everyday functioning. According to the DSM-5 and ICD-11, individuals with personality disorders often struggle with self-image, interpersonal relationships, and emotional regulation. Unlike other mental health conditions, personality disorders represent deeply ingrained and enduring patterns of functioning, rather than episodic symptoms.

DSM-5 Classification of Personality Disorders:

  1. Cluster A (Odd/Eccentric):

    • Paranoid Personality Disorder: Pervasive distrust and suspicion of others’ motives.

    • Schizoid Personality Disorder: Detachment from social relationships and restricted emotional expression.

    • Schizotypal Personality Disorder: Discomfort with close relationships, eccentric behaviors, and cognitive distortions.

  2. Cluster B (Dramatic/Emotional):

    • Antisocial Personality Disorder: Disregard for others’ rights, impulsivity, and deceit.

    • Borderline Personality Disorder (BPD): Instability in relationships, self-image, and emotions, with a heightened fear of abandonment.

    • Histrionic Personality Disorder: Excessive emotionality and attention-seeking behavior.

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

  3. Cluster C (Anxious/Fearful):

    • Avoidant Personality Disorder: Pervasive feelings of inadequacy and hypersensitivity to criticism.

    • Dependent Personality Disorder: Excessive reliance on others for emotional and decision-making support.

    • Obsessive-Compulsive Personality Disorder (OCPD): Preoccupation with orderliness, perfectionism, and control.

ICD-11 Classification

The ICD-11 uses a dimensional approach, categorizing personality disorders as mild, moderate, or severe, based on the degree of functional impairment. It also includes descriptions of specific traits (e.g., anankastic, borderline) rather than distinct categories.

Incidence and Risk Factors

Personality disorders affect approximately 10–15% of the general population, with prevalence varying by specific disorder (Tyrer et al., 2015). Risk factors include a combination of genetic predispositions, neurobiological vulnerabilities, and adverse early life experiences, such as trauma or neglect (Paris, 2018). Parenting styles characterized by overcontrol, invalidation, or inconsistency have also been linked to personality pathology (Fonagy et al., 2002).

Psychological Models and Theories

Psychodynamic Perspectives:

Psychodynamic theories, particularly object relations theory, suggest that personality disorders arise from disruptions in early attachment relationships and difficulties in developing a cohesive sense of self (Kernberg, 1984). This approach emphasizes unconscious conflicts and defense mechanisms as core features of personality pathology.

Cognitive Behavioral Models:

Cognitive behavioral approaches highlight the role of maladaptive schemas and patterns of thinking that develop early in life in personality disorders (Beck et al., 2004). Schema Therapy, for instance, suggests that early maladaptive schemas (EMS) such as ‘social isolation’ (“I am different to others”) and ‘defectiveness (“I am worthless and inadequate,”) perpetuate dysfunctional behaviors (Thimm & Chang, 2022; Young et al., 2003).

Biopsychosocial Model:

This integrative framework emphasizes the interaction between genetic predispositions, environmental stressors, and social factors. For example, borderline personality disorder (also known as emotionally unstable personality disorder) has been linked to heightened emotional sensitivity, invalidating environments, and disrupted interpersonal relationships (Linehan, 1993).

Evidence-Based Psychological Approaches

Cognitive behavior therapy (CBT) targets the factors that maintain personality disorders, such as maladaptive beliefs about the self and/or others and skills deficits. It includes techniques like cognitive restructuring, behavior modification, exposure, psychoeducation, and skills training (Beck et al., 2004). Research indicates that CBT is an effective approach for reducing symptoms and improving functional outcomes in individuals with these difficulties (Matusiewicz et al., 2011).

Dialectical Behavior Therapy (DBT) is an effective treatment for borderline personality disorder. It combines mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance to address emotional dysregulation and self-destructive behaviors. Randomized controlled trials (RCTs) consistently demonstrate its efficacy in reducing suicidal behaviors and improving functioning (e.g., Linehan et al., 2006).

Schema Therapy targets deeply ingrained maladaptive beliefs and coping strategies associated with personality disorders (Young et al., 2003). Research indicates that it can be effective for these difficulties (Zhang et al., 2023).

Mentalization-Based Therapy (MBT) focuses on improving individuals’ ability to understand and interpret their own and others’ mental states (Bateman & Fonagy, 2008). This approach is effective for borderline personality disorder, helping reduce symptoms and improve individuals’ quality of life (Vogt & Norman, 2019)

Transference-Focused Psychotherapy (TFP) addresses distorted interpersonal patterns by exploring the therapeutic relationship, with a focus on interpretation, transference analysis, and countertransference utilization (Kernberg et al., 2008). It is particularly useful for addressing severe personality pathology, including antisocial and borderline traits (Clarkin et al., 2007; Doering et al., 2010).

Resources for Working with Personality Disorders

Psychology Tools offers a range of resources for understanding and working with personality disorders, including:

  • Cognitive-behavioral formulations and schemas for personality pathology.

  • Worksheets for challenging maladaptive beliefs and behaviors.

  • Psychoeducation materials on emotional regulation and interpersonal skills.

  • Mindfulness practices to enhance self-awareness and reduce impulsivity.

References And Further Reading

  • Bateman, A. W., & Fonagy, P. (2008). 8-Year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165(5), 631–638.

  • Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (2007). Psychotherapy for borderline personality: Focusing on object relations. Guilford Press.

  • Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., ... & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British Journal of Psychiatry, 196, 389-395.

  • Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. Other Press.

  • Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: Overview and update. The International Journal of Psychoanalysis, 89, 601-620.

  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

  • Linehan, M. M., et al. (2006). Dialectical behavior therapy for suicidal behavior: A meta-analysis of RCTs. Journal of Clinical Psychology, 62, 241–254.

  • Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatric Clinics, 33, 657-685.

  • Paris, J. (2018). Personality disorders: A biopsychosocial perspective. Wiley-Blackwell.

  • Thimm, J. C., & Chang, M. (2022). Early maladaptive schemas and mental disorders in adulthood: A systematic review and meta-analysis. International Journal of Cognitive Therapy, 15, 371-413.

  • Tyrer, P., Reed, G. M., & Crawford, M. J. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet, 385(9969), 717–726.

  • Vogt, K. S., & Norman, P. (2019). Is mentalization‐based therapy effective in treating the symptoms of borderline personality disorder? A systematic review. Psychology and Psychotherapy: Theory, Research and Practice, 92, 441-464.

  • Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

  • Zhang, K., Hu, X., Ma, L., Xie, Q., Wang, Z., Fan, C., & Li, X. (2023). The efficacy of schema therapy for personality disorders: a systematic review and meta-analysis. Nordic Journal of Psychiatry, 77, 641-650.

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