3 Overlooked Signs of Personality Disorders

Source: Andrea Piacquadio

If you ask for signs of personality disorder (PDO), you're probably going to hear things like "difficult person," "entitlement," and "dependency." While these are not wrong per se, they're better categorized as symptoms of particular PDOs. These can also be fleeting experiences, such as during an episodic illness or at points in life, like adolescence.

Believe it or not, you don't necessarily have to be well-versed in the specific personality pathologies to recognize whether a patient, employee, friend, or loved one may be suffering from a personality disorder.

While someone's maladaptive interactional habits/traits, like those mentioned above, may lead you to wonder about a possible personality disorder, there are other things to consider as well. By the same token, even if one does not have an astute eye for diagnostic criteria, noticing more general things can indicate a personality disorder is possibly at play.

First, let's examine what a personality is and the basic meaning and foundation of personality disorder.

What is a Personality?

Personality is essentially our relational style; how we view and interact with ourselves, the world, and others. This is dictated by a combination of temperament and character. The former is a collection of genetically-inherited components known as traits, and the latter consists of learned material we call habits (Shannon, 2013).

Some researchers use the concept of a core schema to explain how people learn to see and interact with the world. (e.g., Martin & Young, 2003; Shannon, 2019). For example, some people grow up in an environment where independent thinking isn't encouraged and is perhaps even punished. It isn't surprising that some of them develop a core belief that they are incapable of thinking for themselves and must rely on others to make their decisions. This typifies the dependent personality.

Components of a Disordered Personality

It has generally been agreed upon that disordered personalities have a long-standing baseline presentation of significant impairment across several domains. These are the person's thoughts, moods, matters of impulse control, and interpersonal relationships (e.g., Yudofsky, 2005; Shannon, 2019; APA, 2022.) This is exemplified in borderline personality disorder (BPD).

People with borderline personality traits are hypersensitive to rejection/abandonment. At the slightest perception (thought) of rejection, such as someone not calling them on time, they flare with anger (mood). Given an inherent propensity for amygdalar hypersensitivity, meaning they defensively and angrily react in rapid form upon threat perception (lack of impulse control), the person with BPD lets their acquaintance have a piece of their mind.

The acquaintance, naturally, is stunned/feels attacked and avoids the person or returns fire out of defense, and thus a tumultuous interpersonal cycle has begun. This happens across relationships and settings to one degree or another, creating a self-fulfilling prophecy regarding rejection/abandonment, maintaining the very thing they fear most.

The Three Key Signs

Perhaps more importantly, and even more telling than specific symptoms associated with particular disorders, are matters of duration, rigidity, and globalism of the vexing behaviors.

A chief sign or two of a particular PDO in one setting, with only particular people, or at only one point in time isn't enough to warrant a PDO diagnosis. It's crucial to remember the edict of Emil Kraepelin, father of modern psychiatric diagnostic conceptualization, that “A single symptom, however characteristic it may be, never justifies a diagnosis by itself…” (Spitzer et al., 2002, page 487).

For example, a patient observed to be moody and triangulate staff while hospitalized isn't enough to warrant a BPD diagnosis, and an inmate exhibiting questionable morals and refusing to take responsibility doesn't clinch an antisocial personality profile.

A PDO diagnosis must include the following regarding the behaviors:

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1. Baseline behavior

Assessing the history of the package of troubling behaviors is essential. According to PDO expert Joseph Shannon, Ph.D. (2013), personality is solidified no later than age 13. To be considered a disorder of personality, the pervasive traits/characteristics must be consistent and long-standing, as in years.

While someone with a PDO may experience an exacerbation of symptoms during stressful periods, it is crucial to make sure that someone's problematic interactional style isn't isolated to stressful periods, such as during a depressive spell or in the case of an adjustment disorder with mixed disturbance of mood and conduct.

Further, teens commonly exhibit narcissism and histrionic characteristics. If there was no evidence of these before adolescence, there's probably no need to become alarmed that they're evolving into the next Miranda Priestly (Meryl Streep's character in "The Devil Wears Prada").

2. Inflexibility

People with a personality disorder may recognize that their life is fraught with complicated interpersonal matters, but they nonetheless adhere to a maladaptive modus operandi and don't learn from their mistakes. They project blame and complain that the problem is everyone else. This is perhaps best illustrated with pathological narcissism, which is often compensation for fragility associated with shame (e.g., McWilliam, 2013; Burgos, 2015.)

If there's any possibility of appearing damaged, it topples the sense of superiority that they rely on so much. Hence, they are not likely to seek psychotherapy, as that's for people with flaws. That said, McWilliams (2013) pointed out that some may indeed initiate therapy because they see it as an opportunity to perfect themselves.

3. Global complications

Just because someone presents challenging behaviors to certain individuals doesn't mean they are personality-disordered. There needs to be pervasive relating complications across relationships. For example, many teens and young adults I evaluate are oppositional/defiant and reactively irritable in the home environment.

At first glance, this could be seen as a budding passive-aggressive personality. However, upon talking to school personnel, coaches, and providers, they present no such challenges and report feeling good about relationships outside the home. A personality-disordered individual would exhibit passive-aggressive behaviors wherever they went. There would be consistent peer drama, school infractions, and a sense that others in general are against them.

Cheat Sheet Summary

A personality disorder is only when thoughts, moods, and impulse problems are pervasive, long-standing/inflexible, and wreak havoc on the person’s ability to have satisfying relationships across settings.

Disclaimer: The material provided in this post is for informational purposes only and not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care from an individual's provider or formal supervision if you’re a practitioner or student.

To find a therapist near you, visit the Psychology Today Therapy Directory.

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