Personality Disorders

Diagnosis

Determining whether you have a personality disorder involves several steps:

• Physical exam. Your doctor may check your overall health and order lab tests or screening for alcohol and drug use to rule out underlying conditions.
• Mental health evaluation. A mental health professional may assess your thoughts, feelings, and behavior. Questionnaires and input from family members may be used with your permission.
• Comparing symptoms to standard guidelines. Mental health professionals may use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to classify symptoms.
• Neuropsychological testing. Testing by a neuropsychologist or clinical psychologist can help understand how you perceive and interact with the world.

Overlapping symptoms with other mental health conditions, such as depression, anxiety, post-traumatic stress disorder, eating disorders, or substance use, can make diagnosis challenging. Accurate diagnosis is important to ensure proper treatment.

Treatment

Treatment for personality disorders depends on the specific type, severity, and individual circumstances. Care often involves a team approach and may last months or years. Your treatment team may include:

• Doctor
• Psychiatrist
• Psychologist or therapist
• Psychiatric nurse
• Pharmacist
• Social worker

Dialectical behavioral therapy (DBT)
DBT, a form of talk therapy, is the main treatment for personality disorders. It focuses on:

• Treating dangerous behaviors, including those that may lead to suicide
• Addressing behaviors that interfere with treatment or quality of life
• Weekly one-on-one sessions with a therapist for about a year
• Modules on controlling emotions, handling distress, practicing mindfulness, and relating effectively with others
• Coaching support between sessions to apply therapy in daily life

Medicines
No medications are FDA-approved specifically for personality disorders, but psychiatric medicines may help manage symptoms:

• Antidepressants for depression, anger, impulsivity, or irritability
• Mood stabilizers to reduce mood swings, irritability, and impulsive or aggressive behaviors
• Antipsychotics for symptoms such as psychosis, anxiety, or anger
• Anti-anxiety medications to manage agitation or sleep problems, though these may increase impulsivity in some cases

Hospital and residential programs
In severe cases, hospitalization may be needed if you cannot care for yourself or are at risk of harming yourself or others. After stabilization, ongoing care may involve:

• Day hospital programs
• Residential treatment programs
• Outpatient therapy and support