On several occasions, I have heard people refer to a coworker, friend, family member. Or simply an acquaintance in the following terms: “They’re always like that. I think they have a personality disorder.” They are alluding to certain behaviors, attitudes, beliefs, and ways of reacting that an individual has.
Which are very different from the expectations of their sociocultural environment and which interfere with their ability to function in interpersonal relationships. At work, and in other contexts. From my point of view, this is one of the most complex issues in clinical practice in psychiatry.
In many cases, the person with a personality disorder is unaware of it because the way they think and behave seems natural to them. They may also believe that others are responsible for the difficulties they face.
Individuals with a healthy personality are able to cope with the stressful situations of daily life. And do not have major problems relating to family, friends, and coworkers.
“Personality, the most personal thing we humans have”
Personality disorders are characterized by patterns of thought, feeling, and behavior. That are stable and predictable over time, making daily life difficult for the individual and those around them. They are not “bad behavior” or simple mood swings. So they are deep-seated and ingrained ways of understanding the world, emotions, and relationships. Which generate suffering, conflict, and limitations.
What exactly are personality disorders?
Broadly speaking, a personality disorder involves:
- Persistent patterns of inner experience and behavior that differ markedly from the expectations of the individual’s culture.
- Onset in adolescence or early adulthood.
- Significant impairment in areas such as interpersonal relationships, emotional regulation, impulse control, and self-image.
- Distress or impairment in various areas of life (work, family, social life).That is not due to another mental disorder, substance use, or other medical condition.
According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition, revised) of the American Psychiatric Association (APA). There are three clusters of personality disorders, based on predominant characteristics.
1- Cluster A (eccentric triad): odd or atypical traits. Such as extreme mistrust, persecutory ideas, or poor social contact.
2- Cluster B (dramatic triad): intense emotions and problematic relationships. With a tendency toward impulsivity and attention-seeking.
3- Cluster C (anxious triad): fear, insecurity, and excessive self-control that can limit spontaneity and decision-making.
It is essential to keep in mind that these categories aim to describe general patterns. Each person is unique and may present significant variations. Furthermore, most individuals with a personality disorder are not patients with a single trait. Rather have a set of experiences that require understanding and empathy.
Common Traits and Warning Signs
- Difficulty maintaining stable relationships: frequent conflicts, repeated misunderstandings, fear of abandonment, or a need for excessive control.
- Intense emotions or difficulty regulating them: rapid mood swings, irritability, or disproportionate outbursts of anger.
- Unstable self-image: weak sense of self, chronic guilt, or a feeling of emptiness.
- Impulsive or risky behaviors: repetitive actions with negative consequences for health or safety.
- Unusual thoughts or perceptions in stressful situations: unrealistic ideas, mistrust, or mild paranoia.
- Rigid thought patterns: difficulty adapting to changes, rules, or social norms.
It is important to avoid stigmatization: they are not inherently “bad people”. Their daily functioning is affected by patterns that can be modified with professional support and sustained treatment.
How are they diagnosed?
Diagnosis is not made with a single interview. It requires a detailed medical history. A thorough longitudinal biographical exploration, an evaluation of interpersonal relationships and emotional management. As well as an assessment of functional impact (work, studies, family life, social relationships).
Treatment and Management
Although personality disorders are usually chronic, there are effective approaches to reduce suffering and improve quality of life:
-
Structured psychological therapy: Cognitive behavioral therapy focused on personality, dialectical behavior therapy (DBT) for emotional regulation and impulsivity, and psychodynamic approaches can be helpful. In many cases, a long-term therapeutic plan is recommended.
-
Relationship-based and social skills therapies: Social skills training, conflict management, and assertive communication.
-
Treatment of comorbidities: attention to depression, anxiety, substance use, and other conditions that often accompany these disorders.And that can worsen the prognosis if left untreated.
-
Medication: there are no drugs specifically approved for personality disorders. However, medications can be used to alleviate specific symptoms (e.g., depression, anxiety, irritability) when comorbidities are present.
- Support and continuity plan: consistency in care, adherence to treatment, and support from loved ones (family, friends, caregivers) are key to therapeutic success.
What can loved ones do to provide support?
- Listen without judgment and avoid making value judgments about behaviors that seem confusing.
- Learn about the disorder to understand that certain patterns are part of the personality, not a “malicious intent.”
- Maintain clear and consistent boundaries to protect your own emotional health and that of the affected person.
- Encourage seeking professional help and support them through the process, without pressuring them.
When to seek help?
If you notice that the thought and behavior patterns cause significant distress to you or someone close to you. Or interfere with daily functioning for an extended period (weeks or months).
If there is a risk to yourself or others (self-harm, suicide, violence).
If there is addiction, problematic substance use, or other issues that complicate managing the symptoms.
In these cases, consulting a mental health professional (psychologist or psychiatrist) can help clarify the situation. Offer a treatment plan, and provide support throughout the process of change.
Personality disorders are complex, but treatable, conditions. Understanding that these are not voluntary choices or character flaws, but rather patterns of experience that profoundly influence people’s lives. It is the first step toward approaching those who exhibit them with empathy and support. With appropriate treatment, most people can significantly improve their functioning, relationships, and overall well-being.
- Personality Disorders: Understanding to Support and Accompany - 25 de February de 2026
- A Guide to Improving Our Mental Health - 16 de January de 2026
- How to Make Your New Year’s List - 5 de January de 2026