Personality refers to all the ways in which an individual shapes and adapts uniquely to internal and external environments. No psychiatric assessment is adequate without a description of the person’s personality and its development across the lifespan. Personality disorders are characterized by inflexible, deeply ingrained, maladaptive patterns of adjustment to life. These patterns can cause distress or significant impairment of adaptive functioning. Personality disorders are common and chronic disorders. They occur in 10 to 20 percent of the general population and in about half of psychiatric patients. Personality disorders are divided into three categories. Cluster A includes disorders with odd, aloof features (paranoid, schizoid, and schizotypal). Cluster B includes disorders with dramatic, impulsive, and erratic features (borderline, antisocial, narcissistic, and histrionic). Cluster C includes disorders with anxious and fearful features (avoidant, dependent, and obsessive-compulsive).

Patients with personality disorders typically blame other people for unfavorable circumstances for their own problems. Most of these patients perceive their own deviant behaviors as appropriate and adequate. In light of this, patients with personality disorders try to change others, not themselves, and most people with these disorders seldom seek or accept treatment. Typically, they seek help when their maladaptive behaviors culminate in severe marital, family, and career problems or for comorbid anxiety, depression, substance abuse, or eating disorders.

It is hard to find a psychotherapeutic method that has not been tried to treat personality disorders. Each school of psychotherapy provides a specific understanding of behavior and a particular method of intervention. In practice, many of these schools overlap or complement each other.

A growing body of evidence demonstrates that pharmacotherapy is at least equally important to psychotherapy in the overall treatment of patients with these disorders. Pharmacotherapy is aimed at correcting neurobiological dispositions to underlying deviant traits or at correcting target symptoms of these disorders.

The terms personality, temperament, motivation, character, and psyche are often used interchangeably. This is misleading, and students are encouraged to review and distinguish these terms with more clarity. Students should also familiarize themselves with the complicated questions surrounding these disorders, including (1) Are they clinical or social diagnoses? (2) What is the categorical versus dimensional approach to these disorders? And (3) How are they measured?

Students should study the questions and answers below for a useful review of all these disorders.