Diagnosis

If your doctor suspects you have a personality disorder, a diagnosis may be determined by:

  • Physical exam. The doctor may do a physical exam and ask in-depth questions about your health. In some cases, your symptoms may be linked to an underlying physical health problem. Your evaluation may include lab tests and a screening test for alcohol and drugs.
  • Psychiatric evaluation. This includes a discussion about your thoughts, feelings and behavior and may include a questionnaire to help pinpoint a diagnosis. With your permission, information from family members or others may be helpful.
  • Diagnostic criteria in the DSM-5. Your doctor may compare your symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Diagnostic criteria

Each personality disorder has its own set of diagnostic criteria. However, according to the DSM-5, generally the diagnosis of a personality disorder includes long-term marked deviation from cultural expectations that leads to significant distress or impairment in at least two of these areas:

  • The way you perceive and interpret yourself, other people and events
  • The appropriateness of your emotional responses
  • How well you function when dealing with other people and in relationships
  • Whether you can control your impulses

Sometimes it can be difficult to determine the type of personality disorder, as some personality disorders share similar symptoms and more than one type may be present. Other disorders such as depression, anxiety or substance abuse may further complicate diagnosis. But it's worth the time and effort to get an accurate diagnosis so that you get appropriate treatment.

Treatment

The treatment that's best for you depends on your particular personality disorder, its severity and your life situation. Often, a team approach is needed to make sure all of your psychiatric, medical and social needs are met. Because personality disorders are long-standing, treatment may require months or years.

Your treatment team may include your primary doctor or other primary care provider as well as a:

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

If you have mild symptoms that are well-controlled, you may need treatment from only your primary doctor, a psychiatrist or other therapist. If possible, find a mental health professional with experience in treating personality disorders.

Psychotherapy, also called talk therapy, is the main way to treat personality disorders.

Psychotherapy

During psychotherapy with a mental health professional, you can learn about your condition and talk about your moods, feelings, thoughts and behaviors. You can learn to cope with stress and manage your disorder.

Psychotherapy may be provided in individual sessions, group therapy, or sessions that include family or even friends. There are several types of psychotherapy — your mental health professional can determine which one is best for you.

You may also receive social skills training. During this training you can use the insight and knowledge you gain to learn healthy ways to manage your symptoms and reduce behaviors that interfere with your functioning and relationships.

Family therapy provides support and education to families dealing with a family member who has a personality disorder.

Medications

There are no medications specifically approved by the Food and Drug Administration (FDA) to treat personality disorders. However, several types of psychiatric medications may help with various personality disorder symptoms.

  • Antidepressants. Antidepressants may be useful if you have a depressed mood, anger, impulsivity, irritability or hopelessness, which may be associated with personality disorders.
  • Mood stabilizers. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.
  • Antipsychotic medications. Also called neuroleptics, these may be helpful if your symptoms include losing touch with reality (psychosis) or in some cases if you have anxiety or anger problems.
  • Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior, so they're avoided in certain types of personality disorders.

Hospital and residential treatment programs

In some cases, a personality disorder may be so severe that you need to be admitted to a hospital for psychiatric care. This is generally recommended only when you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else.

After you become stable in the hospital, your doctor may recommend a day hospital program, residential program or outpatient treatment.

Lifestyle and home remedies

Along with your professional treatment plan, consider these lifestyle and self-care strategies:

  • Be an active participant in your care. This can help your efforts to manage your personality disorder. Don't skip therapy sessions, even if you don't feel like going. Think about your goals for treatment and work toward achieving them.
  • Take your medications as directed. Even if you're feeling well, don't skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
  • Learn about your condition. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get active. Physical activity can help manage many symptoms, such as depression, stress and anxiety. Activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, jogging, swimming, gardening or taking up another form of physical activity that you enjoy.
  • Avoid drugs and alcohol. Alcohol and street drugs can worsen personality disorder symptoms or interact with medications.
  • Get routine medical care. Don't neglect checkups or skip visits to your primary care professional, especially if you aren't feeling well. You may have a new health problem that needs to be addressed, or you may be experiencing side effects of medication.

Coping and support

Having a personality disorder makes it hard to engage in behavior and activities that may help you feel better. Ask your doctor or therapist how to improve your coping skills and get the support you need.

If your loved one has a personality disorder

If you have a loved one with a personality disorder, work with his or her mental health professional to find out how you can most effectively offer support and encouragement.

You may also benefit from talking with a mental health professional about any distress you experience. A mental health professional can also help you develop boundaries and self-care strategies so that you're able to enjoy and succeed in your own life.

Preparing for your appointment

Because personality disorders often require specialized care, your primary doctor may refer you to a mental health professional, such as a psychiatrist or psychologist, for evaluation and treatment. Taking a family member or friend along can help you remember something that you missed or forgot.

What you can do

Prepare for your appointment by making a list of:

  • Your symptoms, including any that seem unrelated to the reason for the appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, including over-the-counter medications, vitamins, herbal preparations or other supplements that you're taking, and the doses
  • Questions to ask your doctor

Basic questions to ask your doctor include:

  • What type of personality disorder might I have?
  • How do you treat my type of personality disorder?
  • Will talk therapy help?
  • Are there medications that might help?
  • How long will I need to take medication?
  • What are the major side effects of the medication you're recommending?
  • How long will treatment take?
  • What can I do to help myself?
  • Are there any brochures or other printed material that I can have?
  • What websites do you recommend visiting?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

During your appointment, your doctor or mental health professional will likely ask you a number of questions about your mood, thoughts, behavior and urges, such as:

  • What symptoms have you noticed or have others said they notice in you?
  • When did you or they first notice symptoms?
  • How is your daily life affected by your symptoms?
  • What other treatment, if any, have you had?
  • What have you tried on your own to feel better or control your symptoms?
  • What things make you feel worse?
  • Have your family members or friends commented on your mood or behavior?
  • Have any relatives had a mental illness?
  • What do you hope to gain from treatment?
  • What medications, vitamins, herbs or supplements do you take?