Personality disorders

Personality disorders are persistent and rigid patterns of behaviour that can cause significant difficulties in the lives of those affected. These patterns deviate from cultural expectations and lead to problems in various areas, including emotional regulation, thinking and interpersonal relationships. They are often inflexible and can significantly impair the ability to form healthy relationships, work and manage everyday life.

The current version of the International Classification of Diseases (ICD-11) no longer defines personality disorders as separate categories, but as a single disorder construct described according to its severity and specific characteristic features.

People affected often show difficulties in self-perception and self-regulation, which may present as insecurity, extreme fluctuations in self-esteem or impulsive decisions. Recurring problems also frequently occur in social relationships, including difficulties with attachment, excessive dependency or a suspicious, hostile way of interacting with others. Personality disorders are classified as mild, moderate or severe according to the extent of impairment.

The five main features of personality disorders according to ICD-11:

• Negative affectivity – marked emotional instability, anxiety and depressive moods.
• Dissocial traits – distinct lack of remorse or empathy, manipulative behaviour, aggressiveness or antisocial tendencies.
• Disinhibition – impulsivity, risk-taking behaviour and disregard for social norms.
• Anankastic (compulsive) traits – perfectionism, rigid thinking and an excessive need for control.
• Detachment – emotional coldness, social withdrawal and avoidance of interpersonal contact.

Personality disorders do not mean that a person is “bad” or “incorrigible”. Rather, people affected experience the world in a different way, which can present challenges both for themselves and for those around them. They often do not recognise their difficulties, because their patterns of thought and behaviour feel self-evident to them.

Causes and assessment

The development of a personality disorder is influenced by an interplay of genetic, environmental and psychological factors. Traumatic experiences, adverse childhood experiences or neurobiological factors may play a role. In assessment, professionals consider not only symptoms, but also the quality of life and adaptive functioning of those affected.

Treatment options

Therapy is usually a long-term process. Psychotherapeutic approaches such as cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT) are particularly effective, helping people to understand themselves better and to address emotional and interpersonal difficulties in a targeted way. In some cases, medication-based treatment may be necessary, especially when there are co-occurring conditions such as depression or anxiety disorders.

As personality disorders are usually enduring patterns, the main goal of treatment is not necessarily complete cure, but improving quality of life, emotional stability and social skills. An early, individually tailored therapeutic approach can help those affected to cope better with their challenges and lead a more fulfilling life.