Diagnosing personality disorder

It’s incredibly tiring being on this rollercoaster and the emotions can fluctuate instantly, lasting only minutes, to hours, to days, but at this ever-revolving rate.

Why might I be diagnosed with personality disorder?

You may receive a diagnosis of personality disorder if all of these apply:

• The way you think, feel, and behave causes you significant problems in daily life. For example, you may not feel like you can trust others. Or you may often feel abandoned, causing you or others distress in day-to-day relationships. You may also struggle with your identity and self-worth.
• You experience these problems across different aspects of your life. For example, you may struggle to start or keep relationships, or control your feelings and behaviour. You may change your jobs, hobbies, goals or plans regularly. Some people self-harm or use drugs or alcohol to cope with intense emotions which feel frightening and overwhelming.
• These problems have lasted for a long time, usually over 2 years. They may have started when you were a child or teenager and carried on into your adult life.
• These problems are not caused by taking drugs or drinking alcohol, or by another medical condition.

Some of your problems may come from difficult or traumatic childhood experiences. For example, if you experienced abuse or neglect. Or if you experienced a sudden bereavement when you were a child. These can affect your feelings about yourself, other people and relationships.

But not everyone who has these experiences will be diagnosed with personality disorder. The support and care you had will make a difference.

Categories of personality disorder

Current UK guidance says that when a health professional diagnoses personality disorder, they should categorise it. The categories relate to how severely it impacts your day-to-day life. And how it affects your relationships with others.

You may hear one of these terms to describe your experiences:

• Personality difficulty
• Mild personality disorder
• Moderate personality disorder
• Severe personality disorder

You may not agree with healthcare professionals. Or you may feel like none of these diagnoses reflect your experiences.

For example, you may feel misunderstood if they describe your experiences as mild. They might not feel mild to you.

But these terms are meant to help find the best treatment for you. And the language is always changing.

I spend so much time wishing that I could get on a plane and fly away from my own mind.

Traits of personality disorder

If you're diagnosed with personality disorder, your behaviour or experiences may also be described using traits.

Traits are not specific diagnoses in themselves. But they may help professionals find the best treatment for you.

The traits describe sets of feelings and behaviours. And they can overlap. Your diagnosis might include one trait, or a few different ones.

But if you're diagnosed with personality disorder, this doesn't mean all of these traits apply to you.

Experiencing difficult emotions

Some doctors describe this trait as negative affectivity.

They might include this trait in your diagnosis if they believe that you:

• Experience emotions very intensely
• React very negatively to criticism, problems or setbacks
• Get easily frustrated and upset
• Have low self-esteem or self-confidence
• Find it difficult to trust other people

Feeling detached from others

Some doctors describe this trait as detachment.

They might include this trait in your diagnosis if they believe that you:

• Avoid social interactions, friendships, relationships and intimacy
• Look for opportunities that involve little or no contact with others
• Find it difficult to talk about or express how you feel
• Are unresponsive to things that others might find emotional
• Struggle to feel pleasure or take interest in things, or find things enjoyable

It’s exhausting having all these thoughts going round and round in my head so then I start to feel tired, irritable and emotionally distant.

Difficulty feeling empathy for others

Some doctors describe this trait as dissociality.

They might include this trait in your diagnosis if they believe that you:

• Put your needs and desires above other people's
• Believe that there are special reasons that make you different, better or more deserving than others
• Have problems with empathy – for example, not feeling or showing guilt if you hurt someone
• Show signs of manipulative behaviour
• Want attention, and get very upset when you feel like people don't notice you

Impulsive behaviour

Some doctors describe this trait as disinhibition.

They might include this trait in your diagnosis if they believe that you:

• Make immediate decisions without thinking about the consequences for yourself or others
• Act impulsively and do things that could harm you, such as gambling, self-harm, using drugs or driving dangerously
• Get easily distracted and find it difficult to stay focused on or complete tasks
• Get bored easily and frustrated with routines
• Find it difficult to keep to deadlines, for example struggling to pay bills and getting into debt

Perfectionism

Some doctors describe this trait as anankastia.

They might include this trait in your diagnosis if they believe that you:

• Need to keep everything in order and under control
• Set unrealistically high standards for yourself and others
• Find it difficult to be flexible in how you think about things
• Believe very strongly in rules, and about what is 'right' or 'wrong'
• Think yours is the best way of doing things
• Worry about you or others making mistakes
• Feel very anxious if things aren't 'perfect'
• Find it difficult to make decisions
• Struggle to maintain relationships if others do not conform to these standards

I believe that my way is the right way to do everything. All tasks – big or small – must be done exactly how I need them to be done. Otherwise they're not done properly.

Borderline pattern

The borderline pattern trait has the same signs as borderline personality disorder (BPD).

Doctors might include this trait in your diagnosis if they believe that you:

• Feel very worried about people abandoning you, and either do anything to stop that happening or push them away
• Have intense emotions that can change quickly, such as feeling very happy and confident in the morning but low and sad in the afternoon
• Don't have a strong sense of who you are or what you want from life, with your ideas about this changing significantly depending on who you're with
• Find it very hard to make and keep stable relationships or friendships
• Act impulsively and do things that could harm you, such as binge eating, using drugs or driving dangerously
• Have suicidal feelings
• Self-harm
• Feel empty and lonely a lot of the time
• Get very angry, and struggle to control your anger
• Struggle to trust other people
• Experience other mental health problems, including anxiety, depression, eating problems and post-traumatic stress disorder

When very stressed, you might also:

• Feel paranoid
• Have psychotic experiences, such as seeing or hearing things that other people don't
• Feel numb or 'checked out', and not remember things very well after they've happened (known as dissociation)

The problem was being alone because that is when the thoughts would start. I would forensically take apart every interaction I'd had that day. What had I done wrong? How much of a fool had I acted? Who hated me and how much?

Types of personality disorder

In the past, doctors used to say there were 10 'types' of personality disorder. But in 2022, the guidelines on diagnosing personality disorder changed. Now doctors in the UK are more likely to talk about categories and traits – not types.

But some people might still talk about the 10 types of personality disorder. Including some doctors. And you might read about them online.

This may feel confusing. Especially if you're trying to understand your diagnosis. But if you were diagnosed using these types, you still deserve support.

The 10 personality disorder types were:

• Borderline personality disorder
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder
• Antisocial personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Avoidant personality disorder
• Dependant personality disorder
• Obsessive-compulsive personality disorder

Who can diagnose personality disorder?

Some mental health professionals can diagnose personality disorder. They must have experience of diagnosing and treating mental health problems. For example, this could be a psychiatrist or psychologist.

They'll ask you about your feelings and experiences. And about how this affects you. This is to make sure they can get you the right support.

Your GP cannot diagnose personality disorder. But you can speak to them about your mental health.

They can refer you for an assessment for personality disorder. This might be through your local community mental health team (CMHT) or another specialist team. Our introduction to mental health problems has more information about support services, including CMHTs.  

Misdiagnosing personality disorder

You might be diagnosed with personality disorder but feel it doesn't fit your experiences. You might think a different diagnosis suits you better.

This is more common between certain diagnoses. For example, the categories and traits of personality disorder can overlap with mental health problems like complex PTSD. They can also overlap with conditions like autism and ADHD.

If you've been misdiagnosed, it may take time to get the right treatment. This can be frustrating. You may feel like you're not being listened to.

If your diagnosis doesn't fit your experiences, you can discuss it with a mental health professional. You can also ask for a second opinion. Where possible, they should allow this.

We have more information about how to be more actively involved in your care and how to make yourself heard.

Published: 21 October 2024

Page amended: 24 October 2024

Next review planned: October 2027

References and bibliography available on request.

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