Personality Disorders

• Expects others to use, trick, or hurt them without solid evidence.
• Keeps doubting whether friends or coworkers are truly loyal.
• Hesitates to share personal information out of fear it will be used against them.
• Reads insults or threats into ordinary comments or events.
• Holds long grudges and has trouble forgiving small slights.
• Feels attacked quickly and reacts with anger or counterattack.
• Suspects a partner of cheating without real reason.

At least 4 of 7 listed features, starting by early adulthood and present across many situations. Not diagnosed if the suspicion happens only during schizophrenia, a mood disorder with psychotic features, or another psychotic disorder, or if it is due to a medical condition.

About 0.5% to 4.4% of the general population; 2% to 10% of psychiatric outpatients (Jain & Torrico, 2024, StatPearls). Cleveland Clinic cites about 0.5% to 4.5% in the U.S.

Usually becomes clear in early adulthood. The course tends to be chronic and fairly stable across life.

Genetic factors and a family history of schizophrenia-spectrum conditions, childhood abuse or neglect, ongoing social stress, and an anxious, cautious temperament (high harm avoidance, low novelty seeking) (Jain & Torrico, 2024).

• Delusional disorder and schizophrenia: these involve fixed false beliefs held with full conviction, or hallucinations. Paranoid personality involves suspicion without true psychosis.
• Schizotypal personality disorder: also includes odd beliefs, magical thinking, and unusual perceptions.
• Schizoid personality disorder: shows detachment and little interest in people, but not the constant suspicion.
• Borderline and narcissistic personality disorders: can include brief suspicion under stress, but the core themes are unstable relationships or grandiosity.
• Paranoid thinking caused by substance use or by a medical condition.

Often co-occurs with depression, anxiety disorders, substance use disorders, and other personality disorders, especially schizotypal, schizoid, and avoidant (Jain & Torrico, 2024).

No FDA-approved medication. Supportive psychotherapy or cognitive behavioral therapy (CBT) that focuses on building trust and testing suspicious beliefs may help, but people rarely seek treatment and drop out often. Antipsychotic or other medicines are sometimes used for severe paranoid thinking or co-occurring conditions. Goals usually focus on reducing conflict and keeping life stable.

Fictional example: Jordan, a sophomore, refuses to join a group project because he is sure his teammates will steal his ideas, and he takes a friend's joke in the group chat as a hidden insult.

• Does not want or enjoy close relationships, including with family.
• Prefers doing things alone nearly all the time.
• Shows little interest in sexual experiences with another person.
• Gets little enjoyment out of most things.
• Usually has no one to confide in except, at most, a parent or sibling.
• Praise and criticism seem to make little difference to them.
• Appears emotionally cold, detached, or flat.

At least 4 of 7 listed features, starting by early adulthood and present across many situations. Not diagnosed if it occurs only during schizophrenia, another psychotic disorder, or autism spectrum disorder, or if it is due to a medical condition.

Estimates range from about 0% to 4.9% of the general population; it is one of the least common personality disorders (Torrico & Madhanagopal, 2024, StatPearls).

May first show as a loner child or teen with few friends. It is usually clear by early adulthood and is among the most stable personality disorders over time.

Moderate heritability (about 30%), a family history of schizophrenia-spectrum conditions, early attachment problems, trauma or neglect, and a reserved temperament (Torrico & Madhanagopal, 2024).

• Avoidant personality disorder: people want connection but fear rejection. People with schizoid traits truly are not very interested.
• Schizotypal personality disorder: adds odd beliefs, unusual perceptions, and eccentric behavior.
• Schizophrenia: involves hallucinations, delusions, or disorganized thinking.
• Autism spectrum disorder: involves more severe social communication differences and restricted, repetitive behaviors from early childhood.
• Depression: withdrawal and low pleasure appear as a change from how the person used to be, not as a lifelong style.

Often co-occurs with paranoid, schizotypal, and avoidant personality disorders, and with substance use disorders (Torrico & Madhanagopal, 2024).

People rarely seek treatment unless another problem, such as depression, brings them in. Supportive psychotherapy or CBT that respects the person's need for distance can help with practical goals and social skills. Forcing social exposure is not helpful. Medication is used only for co-occurring conditions.

Fictional example: Sam, a junior in computer science, eats alone, skips every dorm event, and says calmly that he does not see the point of friendships.

• Believes random events or other people's talk are about them, without true delusions.
• Holds odd or magical beliefs, such as having special powers or a sixth sense, that shape behavior.
• Has unusual sensory experiences, such as sensing a presence in the room.
• Speaks in a vague, rambling, or unusual way.
• Is suspicious of others.
• Shows limited or unexpected emotional reactions.
• Dresses or acts in ways others see as strange.
• Has few close friends and feels strong social anxiety that does not fade with familiarity.

At least 5 of 9 listed features, starting by early adulthood and present across many situations. Not diagnosed if it occurs only during schizophrenia, another psychotic disorder, or autism spectrum disorder. Note: ICD-10-CM codes it as F21 (schizotypal disorder), outside the F60 block.

About 3.9% in community studies, slightly higher in males (4.2%) than females (3.7%) (Francois & Torrico, 2024, StatPearls).

Signs may appear in childhood or the teen years as social isolation and odd ideas. The course is fairly stable. Only a small share of people later develop schizophrenia.

Strong genetic links to schizophrenia (heritability about 30% to 50%), childhood trauma, and difficult social or economic conditions (Francois & Torrico, 2024).

• Schizophrenia and delusional disorder: involve beliefs held with full conviction or longer episodes of psychosis.
• Schizoid personality disorder: detached but without the odd thinking and perceptions.
• Paranoid personality disorder: suspicious but without eccentric behavior and magical thinking.
• Autism spectrum disorder: social difficulties begin in early childhood with restricted, repetitive interests.
• Effects of substances or medical conditions.

Often co-occurs with paranoid, schizoid, avoidant, and borderline personality disorders, depression, and substance use (Francois & Torrico, 2024).

No FDA-approved medication. Low-dose antipsychotics may ease odd or suspicious thinking for some people. Supportive therapy, CBT, and social skills training can help, though the evidence base is small. ICD-11 now classifies schizotypal disorder with the schizophrenia spectrum rather than with personality disorders.

Fictional example: Riley, a first-year student, wears a lucky charm to every exam, believes she can sense a classmate's mood through the wall, and feels uneasy in study groups even after weeks together.

• Repeatedly breaks rules or laws in ways that could lead to arrest.
• Lies, uses false names, or cons others for gain or fun.
• Acts on impulse and fails to plan ahead.
• Gets into fights or assaults others.
• Takes reckless risks with their own or others' safety.
• Fails to keep jobs or pay debts over and over.
• Shows little remorse after hurting or cheating someone.

At least 3 of 7 listed features since age 15. The person must be at least 18, and there must be evidence of conduct disorder that began before age 15. Not diagnosed if the behavior happens only during schizophrenia or bipolar disorder.

About 2% to 3% of the general population; about 3 times more common in males; much higher in prisons (Torrico & Hany, 2026, StatPearls).

Begins with conduct problems in childhood or early teens. Symptoms tend to peak in the late teens and twenties. Criminal behavior often decreases by the 30s or 40s, although core traits may remain (Torrico & Hany, 2026; MedlinePlus, 2024).

Genetic factors, childhood abuse or neglect, harsh or inconsistent parenting, childhood conduct disorder and ADHD, and gene-environment interactions such as MAO-A variants combined with maltreatment (Torrico & Hany, 2026).

• Conduct disorder: used for people under 18.
• Narcissistic personality disorder: exploits others to protect a grand self-image but usually lacks the impulsive aggression and history of conduct disorder.
• Borderline personality disorder: impulsive and angry, but driven by emotional pain and fear of abandonment.
• Antisocial behavior that happens only while using substances.
• Psychopathy: a related research concept that adds shallow emotion and a lack of empathy. It is not a separate DSM-5-TR diagnosis.

Substance use disorders are very common. Mood disorders, ADHD, and other personality disorders (especially borderline and narcissistic) also often co-occur (Torrico & Hany, 2026).

There is no cure and no FDA-approved medication. Treatment targets harmful behavior and co-occurring problems. Options include CBT, mentalization-based treatment, anger-management programs, and substance use treatment. Early help for children with conduct problems, such as parent training, is the best-supported prevention.

Fictional example: Alex, a senior, has forged a professor's signature, sold classmates fake concert tickets, and shrugs when told that others lost money.

• Works very hard to avoid real or imagined abandonment.
• Has intense relationships that swing between idealizing and devaluing the other person.
• Has an unstable or shifting sense of who they are.
• Acts on impulse in risky ways, such as spending, substance use, or reckless driving.
• Engages in self-harm or makes suicidal threats or attempts.
• Has fast, intense mood shifts that usually last hours.
• Feels empty for long periods, has trouble controlling anger, or feels paranoid or detached under stress.

At least 5 of 9 listed features, starting by early adulthood and present across many situations.

About 0.7% to 2.7% in the community, about 6% in primary care, and 11% to 12% in outpatient psychiatric settings (Chapman et al., 2024, StatPearls).

Usually starts in the teen years or early adulthood. The outlook is better than once thought. About 60% of people no longer meet criteria after 5 to 15 years, but problems with work and relationships often last longer (Chapman et al., 2024).

Genetics (about 40% heritable), childhood abuse, neglect, or separation from caregivers, family conflict, and an emotionally sensitive temperament (Chapman et al., 2024).

• Bipolar disorder: mood episodes last days to weeks. Borderline mood shifts often last hours and are triggered by relationship events.
• Depressive disorders: sadness is an episode rather than a lifelong pattern of instability.
• Histrionic personality disorder: seeks attention but with less self-harm, emptiness, and intense anger.
• Complex PTSD or PTSD: centered on trauma memories, though the two often overlap.
• Personality change due to a medical condition, such as a head injury.

Commonly co-occurs with depression, anxiety disorders, PTSD, eating disorders, and substance use disorders (Chapman et al., 2024; NIMH, 2024).

Psychotherapy is first-line. Dialectical behavior therapy (DBT) has the strongest evidence and teaches mindfulness, emotion regulation, distress tolerance, and interpersonal skills. Mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), schema therapy, and good psychiatric management (GPM) also have research support. No medication is FDA-approved for borderline personality disorder. Medicines may be used for co-occurring conditions. Safety planning is important because of suicide risk.

Fictional example: Taylor, a sophomore, texts a new friend 30 times after an unanswered message, feels sure the friendship is over, then feels empty and angry for the rest of the night.

• Feels uneasy when not the center of attention.
• Acts in flirty or provocative ways that do not fit the setting.
• Shows emotions that shift quickly and seem shallow to others.
• Uses appearance to draw attention.
• Speaks in a dramatic but vague way.
• Is easily influenced by others or by trends.
• Treats casual acquaintances as if they were close friends.

At least 5 of 8 listed features, starting by early adulthood and present across many situations.

About 0.4% to 1.8% of the general population. Women are diagnosed about 4 times more often, which may partly reflect bias in how the traits are judged (Torrico et al., 2024, StatPearls).

Usually appears in late adolescence or early adulthood and tends to be long-lasting.

Genetic factors, childhood abuse or neglect, and parenting that rewarded dramatic behavior with attention (Torrico et al., 2024).

• Borderline personality disorder: adds self-harm, chronic emptiness, and identity disturbance.
• Narcissistic personality disorder: seeks admiration for being superior rather than any kind of attention.
• Bipolar mania or hypomania: dramatic behavior occurs in episodes with less need for sleep.
• Somatic symptom disorder: focus is on physical complaints.

Often co-occurs with depression, substance use, and other Cluster B personality disorders. Suicide risk is increased (Torrico et al., 2024).

Psychotherapy is the main treatment, including supportive, psychodynamic, and cognitive approaches, though the evidence is limited. No FDA-approved medication exists. Medicines may treat co-occurring depression or anxiety.

Fictional example: Morgan, a theater major, turns every class discussion toward her own stories, tears up and laughs within minutes, and calls a classmate she met yesterday her best friend.

• Has an inflated sense of their own importance and talents.
• Daydreams about unlimited success, power, beauty, or ideal love.
• Believes they are special and should only associate with high-status people.
• Needs a lot of admiration.
• Feels entitled to special treatment and uses others to get ahead.
• Has trouble recognizing or caring about others' feelings.
• Envies others or thinks others envy them, and acts arrogant.

At least 5 of 9 listed features, starting by early adulthood and present across many situations.

Community estimates range from 0% to 6.2%, with higher rates in males (Mitra et al., 2024, StatPearls).

Narcissistic traits are common in teens and often fade with age. The disorder itself is chronic, and people may struggle more as aging, illness, or career setbacks challenge their self-image (Mitra et al., 2024).

Genetic factors, early experiences of rejection or harsh criticism, or, in contrast, excessive praise and being treated as special (Mitra et al., 2024).

• Antisocial personality disorder: more impulsive aggression, rule breaking, and a history of conduct disorder.
• Histrionic personality disorder: wants any attention, and shows emotions more openly.
• Borderline personality disorder: marked by an unstable self-image and self-harm.
• Bipolar mania or hypomania: grandiosity occurs in episodes with less need for sleep.
• Healthy self-confidence: high self-esteem without the lack of empathy and the impairment.

Often co-occurs with depression, substance use, and other Cluster B personality disorders. Suicide risk rises after major setbacks (Mitra et al., 2024).

Psychotherapy is the main treatment. Transference-focused psychotherapy, mentalization-based treatment, and schema therapy have shown promise. People often come in for depression or relationship problems rather than for narcissism itself. No FDA-approved medication exists.

Fictional example: Casey, a pre-law student, insists he deserves an A because he is smarter than the professor and gets angry when a classmate gets praise.

• Avoids jobs or activities with lots of social contact out of fear of criticism.
• Keeps a distance from people until sure of being accepted.
• Stays guarded even with a partner or close friend, fearing embarrassment or ridicule.
• Worries a lot about being criticized or rejected in social settings.
• Feels inadequate and holds back in new social situations.
• Sees self as socially awkward or less appealing than others.
• Avoids new activities or risks because they might be embarrassing.

At least 4 of 7 listed features, starting by early adulthood and present across many situations.

About 2.4% in general population studies and about 14.7% of psychiatric outpatients (Torrico & Sapra, 2024, StatPearls).

Shyness often starts in childhood, but here it does not fade with age. The course is chronic, though some people improve over time (Torrico & Sapra, 2024).

Genetic factors, a shy or inhibited temperament, childhood rejection, bullying, or neglect, and insecure attachment (Torrico & Sapra, 2024).

• Social anxiety disorder: overlaps heavily, but avoidant personality disorder is broader and affects how the person sees themselves in almost every relationship.
• Schizoid personality disorder: people are not interested in relationships. People with avoidant personality disorder want them but fear rejection.
• Dependent personality disorder: centers on needing to be cared for, not on fear of rejection.
• Agoraphobia: avoidance is driven by fear of panic or being trapped, not by fear of judgment.

Commonly co-occurs with social anxiety disorder, depression, other anxiety disorders, dependent personality disorder, and substance use (Torrico & Sapra, 2024).

CBT is the most studied treatment, especially with gradual exposure to feared social situations and social skills training. Schema therapy and psychodynamic therapy also show promise. No FDA-approved medication exists, but antidepressants used for social anxiety may help some people.

Fictional example: Jamie, a first-year student, wants to join the photography club but never goes because she is sure the members will think her work is bad.

• Has trouble making everyday choices without a lot of advice and reassurance.
• Lets others make the big decisions in their life.
• Rarely disagrees with others out of fear of losing their support.
• Struggles to start projects alone because of low self-confidence.
• Goes to great lengths, even doing unpleasant things, to keep others' support.
• Feels lost or anxious when left on their own.
• Quickly looks for a new relationship when one ends, and worries a lot about being left to care for themselves.

At least 5 of 8 listed features, starting by early adulthood and present across many situations.

About 0.6% of the general population, based on the DSM-5-TR estimate cited by Hansen et al. (2024, StatPearls), with slightly higher rates in women.

Usually appears in late adolescence or early adulthood. Traits may slowly lessen with age.

Genetic factors, an anxious temperament, overprotective or authoritarian parenting, chronic childhood illness, and ongoing separation anxiety in childhood (Hansen et al., 2024).

• Avoidant personality disorder: fear of rejection leads to withdrawal. In dependent personality disorder, the person clings to relationships.
• Borderline personality disorder: dependency swings with anger and instability.
• Separation anxiety disorder, panic disorder, and agoraphobia: dependency is limited to specific fears.
• Depression: helplessness appears during an episode, not as a lifelong style.
• Cultural expectations: in some cultures, deference and relying on family are normal, and clinicians should not treat them as pathology.

Commonly co-occurs with depression, anxiety disorders, adjustment disorders, and avoidant or borderline personality disorders (Hansen et al., 2024).

Psychotherapy is the main treatment. CBT and psychodynamic therapy can build independence, assertiveness, and decision-making skills. Therapy should be careful not to let the therapist become a new source of dependence. SSRIs or SNRIs may treat co-occurring anxiety or depression. No FDA-approved medication exists.

Fictional example: Drew, a sophomore, texts his roommate to choose his classes, his meals, and his major, and panics when the roommate goes home for the weekend.

• Gets so caught up in rules, lists, and details that the main point of a task is lost.
• Holds such high standards that tasks do not get finished.
• Puts work and productivity ahead of friends and free time.
• Is overly strict about morals or values.
• Keeps old or useless things, even ones with no sentimental value.
• Will not share tasks unless others do things exactly their way.
• Is very careful with money, and is rigid and stubborn.

At least 4 of 8 listed features, starting by early adulthood and present across many situations.

About 3% to 8% of the general population, making it one of the most common personality disorders (Rizvi & Torrico, 2023, StatPearls).

Often appears in late adolescence or early adulthood and tends to be stable over time.

Genetic factors (heritability estimates range widely, about 27% to 78%), a cautious and persistent temperament, and strict or controlling family environments (Rizvi & Torrico, 2023).

• Obsessive-compulsive disorder (OCD): involves unwanted intrusive thoughts and rituals the person usually sees as a problem. OCPD traits usually feel right to the person (ego-syntonic).
• Hoarding disorder: saving causes severe clutter and is not part of a broader need for control.
• Autism spectrum disorder: rigid routines come with social communication differences from early childhood.
• Healthy conscientiousness: high standards that do not cause major distress or impairment.

Often co-occurs with OCD, anxiety disorders, depression, and eating disorders, especially anorexia nervosa (Rizvi & Torrico, 2023).

Psychotherapy is first-line, including CBT, psychodynamic therapy, and schema therapy. Treatment often targets perfectionism and rigid thinking. People often seek help for depression or stress first. No FDA-approved medication exists. SSRIs have been studied with limited evidence.

Fictional example: Pat, a junior, rewrites the first page of a group report ten times, will not let teammates edit it, and misses the deadline.