Personality traits vs. personality disorders

Everyone has a personality, and many people have traits that are strong or unusual. Being very shy, very organized, very blunt or very emotional does not mean you have a disorder. A personality disorder is something different. It is a pattern that is rigid, shows up almost everywhere in a person's life, and causes serious distress or problems for a long time.^1,2

This page explains where the line falls between a strong trait and a disorder. It describes the newer ways experts think about personality disorders as extreme versions of everyday traits. It also gives a short overview of how these conditions are assessed and treated, with links to our personality disorders topic for more.

When does a trait become a disorder?

The American Psychiatric Association describes a personality disorder as a way of thinking, feeling and behaving that differs from what a person's culture expects. It causes distress or problems functioning, and it lasts over time.¹ The pattern affects at least two of these four areas:¹

• How a person thinks about themselves and others
• How they respond emotionally
• How they relate to other people
• How well they control their behavior

Having a bad day, or acting out of character during a hard time, does not count. Traits become a concern when they are extreme and rigid.¹

Clinicians look for four main features:

The pattern also must not be better explained by another mental health condition, a brain disease, a medical condition, or the effects of a medicine or drug.³ It also must not be explained mainly by culture or by a person's social situation.³

The same traits, at the extremes

For a long time, personality disorders were treated as separate categories. Over the past few decades, research has suggested they are better seen as extreme versions of everyday traits.⁷

A review of many studies found that the 10 standard personality disorders lined up, mostly as expected, with patterns of extreme Big Five facets.⁶ Later studies found that four of the five trait groups used for personality disorders are extreme versions of four Big Five traits.^7,8 Tests for disorder-level traits are best at telling apart people at the high, troubled end. Everyday Big Five tests are better at the healthy, low end.⁷

Sources for this table: ^3,4,8. Some links are looser than others. For example, psychoticism, which covers odd beliefs and unusual experiences, matches openness only modestly.⁸

This view helps explain a few things. First, it is a matter of degree. There is no sharp, natural line between "normal" and "disordered."^3,7 Second, a person with a disorder is not a different kind of human being. They have the same traits as everyone else, in a form that has become painful and rigid. Learn more about the traits in The Big Five traits.

The newer, trait-based models

DSM-5-TR

The DSM is the manual U.S. clinicians use to diagnose mental health conditions. Its main section still lists 10 separate personality disorder types.⁹ See Other personality disorders.

Since 2013, the DSM has also included an Alternative Model for Personality Disorders in Section III. The 2022 text revision, DSM-5-TR, kept it there.^5,9 It has two main parts:^3,4

• Criterion A: personality functioning. How well a person's sense of self and relationships with others work. It is rated on a five-step scale, from no impairment to extreme impairment.
• Criterion B: traits. 25 specific traits grouped into five broad domains: negative affectivity, detachment, antagonism, disinhibition and psychoticism.

Many studies support the model's reliability and usefulness. Researchers are still working out how its two parts overlap.⁵

ICD-11

The ICD is the World Health Organization's list of diseases, used worldwide. Its newest version, ICD-11, came into effect on January 1, 2022.¹¹ It made a bigger change. It dropped the 10 separate types.³ Instead, a clinician decides:³

1. Is there a personality disorder, and how severe is it? The levels are mild, moderate and severe. The problems must have lasted more than two years.
2. Which traits stand out? There are five optional trait labels: negative affectivity, detachment, dissociality, disinhibition and anankastia (rigid perfectionism and control).
3. Is there a borderline pattern? Clinicians can add this label when a person's problems match borderline personality disorder.

ICD-11 also has a category called personality difficulty. It describes milder or on-and-off personality-related problems. It is not counted as a mental disorder.³ This is the clearest example of a gray zone between strong traits and a disorder.

How personality disorders are assessed

Only a trained mental health professional can diagnose a personality disorder. It takes careful conversations about a person's long-term patterns, not a single quiz.¹ A full assessment may include:

• Interviews about how the person has thought, felt and related to others over many years^1,3
• Questionnaires, such as the Personality Inventory for DSM-5 (PID-5), which can be filled out by the person or by someone who knows them well^3,4
• Reports from family or friends, which matter because people may not see their own patterns clearly^1,3
• Ruling out other causes, such as depression, substance use, medicines or brain illness³

An everyday Big Five test cannot diagnose a personality disorder. See Getting diagnosed and our page on personality tests.

How personality disorders are treated

Talk therapy is the main treatment. Common types include dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), psychodynamic therapy, group therapy and education about the condition.¹ There are no medicines made to treat personality disorders. But some medicines may help with symptoms such as depression or anxiety.^1,2

In the ICD-11 approach, severity may help decide how intensive treatment should be. The trait labels may help shape its focus and style.³ Read more in Treatment for personality disorders.

In later life

Diagnosing personality disorders in older adults can be hard. The standard criteria were built mostly from people aged about 18 to 40, so they may not fit how these problems look in later life.⁹ As a result, older adults may be both underdiagnosed and overdiagnosed. Experts suggest using several sources, including family reports, interviews and age-adjusted questionnaires.⁹

Also remember that a personality disorder starts early in life. A big personality change that first appears in your 60s, 70s or 80s is not a personality disorder. It needs a medical checkup to look for causes such as depression, medicine side effects or dementia. See Personality in later life and Personality disorders and personality change in later life.

Common questions

Is being a perfectionist a personality disorder?

Usually not. Being careful and orderly is part of normal conscientiousness. It becomes a concern only when it is so rigid that it harms your work, health or relationships over many years.^1,3

My partner seems self-centered. Do they have narcissistic personality disorder?

Only a trained professional can say. Many people have some self-centered traits. Labels can hurt relationships, so it is better to describe the specific behavior that worries you. See Supporting someone with a personality disorder.

Can a personality disorder get better?

Yes. With therapy, many people improve, especially those with borderline personality disorder.¹⁰ See our personality disorders overview.

When to get help

See a doctor or mental health professional if:

• The same painful patterns keep coming back in relationships, at work or with family
• Strong emotions, anger or impulses often feel out of control
• You feel empty, unsure who you are, or afraid of being left
• You have thoughts of hurting yourself

If you or someone you love is thinking about suicide, call or text 988 at any time. If someone is in danger right now, call 911. A safety plan can help in hard moments. See Get help now.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.