This section contains definitions and clinical criteria for Personality Disorders as defined by the American Psychiatric Association and the World Health Organization.
Understanding the clinical criteria for personality disorders is a good first step. However, learning how to cope with or live with a loved one who suffers from a personality disorder is generally not covered in the diagnostic literature.
Therefore, rather than focusing exclusively on the clinical traits for diagnosis, it is our aim at Out of the FOG to approach personality disorders from the point of view of the Non-Personality-Disordered Individual (Non-PD). In other words - what is it like to live with a person with NPD or BPD? What’s it like to have a parent with a Histrionic or Dependent Personality Disorder? How do you cope when caring for someone with a Dependent Personality Disorder? How do you protect yourself when living with a person who suffers from Antisocial Personality Disorder?
Here in Out of the FOG, we have compiled a separate collection of the Top 100 Traits of Personality Disordered Individuals which is written from a Non-PD's perspective and includes ideas for coping which you will not find in the clinical information on personality disorders listed on this page. You are encouraged to review the common behaviors page where you may find examples which match your own experiences.
Another effective way for Non-PD's to learn about personality disorders is to hear from other people who have faced similar circumstances. It can be a relief to discover that your situation is not unique. Therefore, we strongly encourage you to visit our Support Forum.
DSM Personality Disorder Definitions
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) divides personality disorders into 3 clusters and 10 distinct diagnoses:
These are definitions which have been created by the American Psychiatric Association to give mental health professionals a set of shorthand labels to describe the pathology and behaviors of a particular category of patients.
The World Health Organization's International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) organizes personality disorder diagnoses in different groupings compared to the DSM as follows:
A number of studies have been conducted in recent years to determine the prevalence of personality disorders in the general US population.
According to a 2007 study, 9.1% of the US population (about 1 in 11 people) meet the DSM-IV criteria for a personality disorder. Two previous smaller surveys have estimated the percentage between 9.0% and 15.7%.
Comorbidity - Comorbidity is a psychological term used to describe the occurrence of more than one diagnosis in a single patient. Comorbidity is common in the diagnosis of psychological disorders.
The American Psychiatric Association (APA) publishes a book containing comprehensive definitions of mental disorders known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The DSM-IV-TR contains criteria for Personality Disorders which are broad with some overlap between different diagnoses. This overlap is known as "Comorbidity". A patient has to exhibit some, but not all of the traits of a particular disorder in order to be given that diagnosis. Many patients exhibit collections of criteria which allow them to be diagnosed with more than one disorder.
So, for example, it is possible for a person who suffers from Narcissistic Personality Disorder to exhibit some of the traits listed in the criteria for Borderline Personality Disorder. Likewise, it is possible for a person with Dependent Personality Disorder to behave a lot like a person with Obsessive Compulsive Personality Disorder. This overlapping nature of personality disorders is known as Comorbidity.
The Diagnostic and Statistical Manual (DSM-IV) uses a 5-axis system to categorize clinical psychology. Personality disorders are included in Axis II. The five DSM axes are:
Axis I: Major mental disorders, clinical disorders, developmental disorders and learning disabilities.
Axis II: Underlying pervasive or personality conditions & mental retardation.
Axis III: Medical conditions contributing to the disorder.
Axis IV: Psychosocial and environmental factors contributing to the disorder.
Axis V: Global Assessment of Functioning on a scale from 0 to 100.
What it Feels Like to be in a Personality-Disordered Relationship
This is a collection of articles describing what it can feel like to be in a relationship with someone who suffers from a personality disorder.
Feeling Isolated - It's common for people who have a relationship with someone who suffers from a personality disorder to systematically isolate themselves from other external relationships.
Feeling Trapped - Most people who have a relationship with someone who suffers from a personality disorder would like to bring an end to the relationship but are unable to or afraid to end it because they feel trapped in some way.
FOG - Fear, Obligation & Guilt - The acronym FOG, for Fear, Obligation and Guilt, was first coined by Susan Forward & Donna Frazier in Emotional Blackmail and describes feelings that a person often has when in a relationship with someone who suffers from a personality disorder. Our website, Out of the FOG, is named after this acronym.
The 5 Stages of Grief - The 5 Stages of Grief - Denial, Bargaining, Anger, Depression and Acceptance - were first introduced by Elisabeth Kübler-Ross to describe a process which many people go through when dealing with a significant tragedy or loss.
Complex Post-Traumatic Stress Disorder (C-PTSD) - Complex Post-Traumatic Stress Disorder is a psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.
Adult Children - An adult child is a term commonly used to describe any grown adult who was exposed to emotional, physical or sexual abuse as a child.
Lightbulb Moment - A Lightbulb Moment is the description many non-personality-disordered individuals use when they first discover the existence of personality disorders. For the first time, they have discovered a plausible explanation for the strange and frightening behaviors of a loved-one or family member who suffers from a personality disorder and learn that their situation is not uncommon. It is as if a light were just turned on.
Common Myths About Personality Disorders
Myth: People with a Mental Illness all have a low IQ - this myth perpetuates the prejudice and associated stigma that people with a mental illness are "stupid". This stigma can discourage a person from admitting that they have a problem, getting the help they need or taking medication.
Fact: Personality Disorders affect the Entire Intelligence Spectrum -Here at Out of the FOG, we speak about low-functioning and high-functioning people in an attempt to differentiate between those who demonstrate high IQ and low IQ. We have seen examples of people with severe cases of personality disorders who are extremely intelligent, hold down jobs with high levels of responsibility or authority in government and in business and social groups.
Myth: Only Females have HPD and BPD - Only Males have NPD and APD.
Fact: BPD and HPD are more commonly diagnosed in women, and NPD and APD are more commonly diagnosed in men - but there are millions of people from both genders in all of the disorder categories.
Myth: All People with Personality Disorders were abused as children
Fact: About 75% of people with Personality Disorders were physically, emotionally or sexually abused as children. That leaves a huge number - about 1 in 4 - that were not.
Myth: People everywhere are basically the same.
Fact: Each person's thinking is as unique as the DNA inside them. - You can't interpret the thoughts and behaviors of a personality disordered individual based on your own logic or based upon what you would have to be thinking in order to act that way.
Myth: Personality Disorders aren't Real Mental Illnesses
Fact: Personality Disorders have been scientifically linked to observable neurological differences and we disregard them at our own peril.
Myth: People with personality disorders are basically just selfish.
Fact: Personality Disorders have been shown in some studies to be rooted in neurological differences in the way different regions of the brain communicate with each other.
Myth: People with personality disorders can get better if they just try harder.
Fact: Although management of symptoms is possible through a combination of medications, therapy and personal work, they can't make the disorder disappear altogether. Personality disorders are mental illnesses based on neurological differences for which there is no known cure.
Note that we are not suggesting here that people with personality disorders shouldn't be held accountable for their own behaviors - they absolutely should. But it would also be a mistake to regard people who suffer from personality disorders simply as mentally healthy people who are being selfish
Myth: People With Personality Disorders Never Get Better
Fact: A number of studies have shown that while there are no outright cures for personality disorders, many symptoms can be effectively managed through combinations of medications, therapy and hard work.
Myth: People With Personality Disorders get better as they get older.
Fact: Some Do and some Don't. See our section on Personality Disorder Recovery
Myth: You can bring about recovery in a person with a personality disorder through your own actions.
Fact: Personality Disorders are Real Mental Illnesses - and they don't depend on what we do, or don't do, or say, or don't say. You can't cure a personality disorder with love, anger, submission or ultimatums any more than you can cure a food allergy with a feather duster.
Myth: All People with Borderline Personality Disorder are Suicidal or commit acts of self injury
Fact: Self Injury is only one of 9 possible criteria. 5 of the 9 are required for a diagnosis of BPD. - See BPD DSM Criteria
On August 31 2012, the Out of the FOG Support Forum crossed two significant milestones - 100,000 member posts and 10,000 topics. Thanks to all who participate and contribute to the OOTF support board, which is a unique source of support to non-personality-disordered individuals all over the world.