What Are the First Signs of a Personality Disorder?

Personality disorder symptoms vary depending on the personality disorder, which can include paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive.

A personality disorder is a type of mental disorder that is characterized by personality traits so inflexible and maladaptive they impair one’s thoughts, feelings, and behaviors. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) groups 10 recognized personality disorders into three clusters based upon descriptive similarities:

• Cluster A characteristics: Individuals often appear odd and eccentric
• Paranoid personality disorder
  • Some of the first signs of paranoid personality disorder may include:
    • Being cold and distant from others
    • Angry or violent behavior 
    • Distrust and suspiciousness of others and interpretation of motives as vindictive or unkind 
    • The assumption that people will harm or deceive them 
    • Holding grudges
    • Unwillingness to see the good in others 
    • Shifting blame 
    • The belief that one’s spouse is unfaithful
• Schizoid personality disorder
  • Some of the first signs of schizoid personality disorder may include:
    • Restricted range of expression of emotions 
    • Choosing to be alone
    • Daydreaming a lot
    • Detachment from social relationships 
    • No desire for sexual contact
    • Does not seem to care about praise or criticism from others
    • Prefers to work in solitude
• Schizotypal personality disorder
  • Some of the first signs of schizotypal personality disorder may include:
    • Discomfort with and reduced capacity for close relationships
    • Tendency to overanalyze situations and which strains relationships
    • Emotions are displayed in a way that seems strange to others
    • Odd ways of speaking, dressing, or behaving
    • Odd beliefs
    • Cognitive or perceptual distortions 
    • Depression and anxiety
    • Excessive social anxiety
    • Experiences that others have trouble understanding or relating to
    • Belief in a supernatural influence on others
• Cluster B characteristics: Individuals often appear emotional, dramatic, or erratic
  • Antisocial personality disorder
    • Some of the first signs of antisocial personality disorder may include:
      • Violent behavior
      • Disregard for others
      • Problems with authority or the law
      • Issues with keeping a stable job
      • Frequent isolation and solitude
      • Not conforming to social norms
      • Lying and deceit, stealing
      • Impulsivity
      • Defaulting on debts
      • Neglecting children 
• Borderline personality disorder
  • Some of the first signs of borderline personality disorder may include:
    • Impulsive behavior
    • Unstable relationships
    • Stress-induced lack of reality
    • Poor self-image 
    • Feelings of emptiness and hopelessness
    • Mood swings 
    • Intense emotions
    • Poor impulse control
    • Suicide attempts
      • If you or someone you know is in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. Or you may visit http://www.suicidepreventionlifeline.org
• Histrionic personality disorder
  • Some of the first signs of histrionic personality disorder may include:
    • Attention seeking 
    • Discomfort when not the center of attention 
    • Rapidly shifting or exaggerated emotions 
    • Manipulating others
    • Lack of concern for others
    • Dressing provocatively
    • Sensitivity to constructive criticism or in general
    • Being swayed easily by other’s opinions
    • Strong opinions but lack of evidence to support them
    • Mood swings
    • Suicidal tendencies
• Narcissistic personality disorder
  • Some of the first signs of narcissistic personality disorder may include:
    • Grandiosity (in fantasy or behavior)
    • No empathy for others
    • Need for admiration
    • Sense of entitlement
    • Taking advantage of others
    • Lack of empathy
    • Exaggerate their lives to elevate their image
• Cluster C characteristics: Individuals often appear anxious or fearful
  • Avoidant personality disorder
    • Some of the first signs of avoidant personality disorder may include:
      • Social inhibition
      • Extreme shyness
      • Low self-esteem
      • Lacking social abilities
      • Seeing themselves as not good enough 
      • Hypersensitivity to criticism
      • Fear of rejection
      • Unwilling to become involved with others unless certain they will be liked
      • Highly self-critical
  • Dependent personality disorder
    • Some of the first signs of dependent personality disorder may include:
      • Fear of separation
      • Need for reassurance from others
      • Inability to make their own decisions
      • Avoids responsibility
      • Sensitivity to feedback
      • Negative outlook on life
      • Belief they cannot take care of themselves
      • Feelings of inadequacy
      • Submissiveness
      • Accepts abuse and mistreatment from others
      • Clingy behavior
      • Avoidance of confrontation for fear of losing a source of support 
  • Obsessive-compulsive personality disorder (this is not the same as obsessive-compulsive disorder, or OCD, which is an anxiety disorder that rarely affects how one treats or thinks of others)
    • Some of the first signs of obsessive-compulsive personality disorder may include:
      • Preoccupation with perfectionism, order, cleanliness, and control at the expense of flexibility, openness, and efficiency
      • Unwilling to receive help from others
      • Inflexibility in morality and values 
      • Hoarding
      • Rigid control over spending and finances
      • Excessive focus on details and rules
      • Works excessively without allowing time for leisure or friends

To be diagnosed with a personality disorder, a person’s thoughts, displays of emotion, impulsiveness, and interpersonal behavior must deviate significantly from the expectations of that individual's culture. Personality disorders are diagnosed by mental health professionals and are usually not diagnosed until a person is over age 18, because personalities are still developing before that.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria patients must meet in order to be diagnosed, including:

• An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
  • Cognition (i.e., ways of perceiving and interpreting self, other people, and events)
  • Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response) 
  • Interpersonal functioning
  • Impulse control 
• The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
• The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
• The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
• The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

The DSM-5 also includes diagnostic criteria for each of the individual personality disorders.