An Overview of Mixed Personality Disorder

What are personality disorders?

An Overview of Mixed Personality Disorder

Personality disorders are usually treated with group psychological treatments or talking therapies. Below we explain more about the different types of therapies.

The options for treating personality disorders are continuously developing.

You and your doctor or healthcare team should agree on a treatment plan that works best for you.

If your GP feels you have a complex personality disorder, they may refer you to a:

  • community mental health team, or
  • specialist personality disorder service or unit, if there is one locally.

These services are made up of professionals such as psychologists, psychiatrists and therapists. They will have experience in helping people with personality disorders. Sometimes you can contact these services yourself to get help.

It’s always worth asking why a certain treatment is being offered. And if there are other things that could help you to get better.

When thinking about what treatment to offer you professionals should consult guidelines NICE guidelines, if relevant. NICE stands for The National Institute for Health and Care Excellence. The NICE guidelines recommend treatment for conditions.

For personality disorders NICE only have guidelines for:

  • Borderline personality disorder (BPD), and
  • Anti-social personality disorder.

You can find these online, find link below:

Therapy for personality disorders is usually long term. You might have to complete the therapy to get the full benefit of it, to aid your recovery. If you are struggling with your therapy for any reason, you can tell your therapist this.

In some areas, services use pre-therapy preparation to help people understand the link between emotions and decisions. The aim is to help you recognise your emotions before starting therapy, and hopefully finish your sessions.

The following treatments can help if you have a personality disorder:

Cognitive behavioural therapy (CBT)

CBT can help you to change how you think and what you do. These are both linked to how you feel.

CBT looks at problems and difficulties in the ‘here and now’ more than your past or childhood.

CBT can help you understand how you think about yourself, the world and other people. And how that affects how you deal with things in your life.

Dialectical behaviour therapy (DBT)

DBT can help you learn to spot and control your emotions and behaviour.

It is adapted from CBT. It helps you recognise then change unhelpful behaviour by learning new skills. Unhelpful behaviour might include thinking about suicide, self harming, drinking alcohol or using drugs to cope with your emotions.

The National Institute for Health and Care Excellence (NICE) says DBT can be helpful if you have borderline personality disorder.

A course of DBT usually takes place over 18 months.

Cognitive analytical therapy (CAT)

CAT helps you recognise relationship patterns that can cause you problems and are difficult to change. You may have learnt these patterns while growing up to cope with difficult emotions.

You and the therapist will work together to recognise these patterns and then to try and change them. This therapy is the individual’s needs. And takes into account their current situation and the problems they are having.

This type of therapy can usually last between 4 – 24 weeks. But on average lasts 16 weeks.

You and your therapist will agree the end goal at the start of the therapy.

Mentalisation based therapy (MBT)

Mentalising is about making sense of what other people think, need, or want. It is about being aware of what’s going on in your own mind and in the minds of others. Mentalising refers to the fact that sometimes when you feel distressed, it can be harder to ‘mentalise.’

You would attend group and one-to-one therapy. This may help you better understand yourself and others and learn how to mentalise. Treatment programmes can last for 12 to 18 months.

Psychodynamic or psychoanalytic therapy

This type of long-term therapy is a therapeutic process which helps patients understand and resolve their problems. It does this by increasing awareness of their inner world and its influence over relationships both past and present.

It differs from most other therapies in aiming for deep seated change in personality and emotional development.

It helps people to understand and change complex, deep-seated emotional and relationship problems.

Therapeutic communities

A therapeutic community is a place you would get long-term group therapy.

You would visit, or sometimes stay, for a number of weeks or months. Sometimes you may visit for just a few days a week.

You learn from spending time with other people in the treatment group. It offers a safe place if there are any disagreements or upsets. People in a therapeutic community often have a lot of say over how the community runs.

There are only a few therapeutic communities in the UK. You could check with your local Patient Advice Liaison Service (PALS) if your NHS trust has one. You can search for your PALS office here:


There is no recommended medication for the treatment of personality disorders.

But your doctor may give you medication to help with symptoms such as anxiety, anger, or low mood. These might include antidepressants, mood stabilisers, or antipsychotics.

You can find out more about:

  • Antidepressants by clicking here.
  • Mood stabilisers by clicking here.
  • Antipsychotics by clicking here.

If you are given any medication, your doctor should tell you how it should help. And about any side effects that you might get.

Care Programme Approach

Having a personality disorder may put you at risk, mean you have a lot of needs, and need a high level of care. You can be supported through the Care Program Approach (CPA).

The CPA is used to plan and outline the support you need to manage complex needs and your mental health.

If you are on the CPA you will have a care coordinator. They will work with you to write a care plan. This will set out how the NHS will support you.

You can find more information about the ‘Care Programme Approach’ by clicking here.

Patient Advice and Liaison Service (PALS)

You could call the Patient Advice and Liaison Service (PALS) at your NHS trust if you:

  • feel unhappy with how your treatment or care is being handled,
  • You are struggling to get the right treatment, or
  • feel that the relationship between you and a professional is not working well.

They can try to sort out any problems or questions you have. You can find your local PALS’ details at


You can also complain if you aren’t happy. You can find out more about ‘Complaints’ by clicking here.


You might find an advocate helpful if you are unhappy with your treatment. You can get help from an NHS Complaints advocate.

An advocate is independent from mental health services. They can help to make your voice heard when you are trying to sort out problems. They might help you write letters or support you in appointments and meetings.

You can search online for a NHS Complaints advocate or the Rethink Mental Illness Advice Service could search for you.

You can find out more information about ‘Advocacy’ by clicking here.


Personality Disorders: Types, Causes, Symptoms, Diagnosis, Treatment

An Overview of Mixed Personality Disorder

People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. Personality Disorders

Personality is vital to defining who we are as individuals.

It involves a unique blend of traits—including attitudes, thoughts, behaviors, and moods—as well as how we express these traits in our contacts with other people and the world around us. Some characteristics of an individual’s personality are inherited, and some are shaped by life events and experiences.

A personality disorder can develop if certain personality traits become too rigid and inflexible.

People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal.

The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning.

People with personality disorders generally also have poor coping skills and difficulty forming healthy relationships.

Un people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control. Because they do not believe they have a disorder, people with personality disorders often do not seek treatment on their own.

How common are personality disorders?

Personality disorders are among the most common of the severe mental disorders and often occur along with other mental illnesses, such as substance abuse disorders, mood disorders (depression or bipolar disorder), and anxiety disorders. It is estimated that 10 percent to 13 percent of the world’s population suffer from some form of personality disorder.

Most personality disorders begin in the teen years, when the personality further develops and matures. As a result, almost all people diagnosed with personality disorders are above the age of 18.

Some personality disorders—such as borderline personality disorder and histrionic personality disorder—are more common in women, and others—such as antisocial personality disorder and obsessive-compulsive personality disorder—are more common in men. Many people in prison also have a diagnosable personality disorder.

What are the types of personality disorders?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard reference book for recognized mental illnesses, organizes personality disorders into three main categories, with several types of personality disorders in each category.

Eccentric personality disorders

People with these disorders often appear odd or peculiar. The eccentric personality disorders include:

  • Paranoid personality disorder. Paranoia is the hallmark of this disorder. People with paranoid personality disorder have a constant mistrust and suspicion of others. They believe that others are trying to demean, harm, or threaten them.
  • Schizoid personality disorder. People with this disorder are distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion.
  • Schizotypal personality disorder. People with this disorder display unusual thinking and behavior, as well as appearance. People with schizotypal personality disorder might have odd beliefs and often are very superstitious.

Dramatic personality disorders

People with these disorders have intense, unstable emotions and a distorted self-image. They also often tend to behave impulsively. These disorders include:

  • Antisocial personality disorder. People with this disorder are sometimes called “sociopaths” or “psychopaths.” This disorder is characterized by rash, irresponsible, and aggressive behavior, which often is expressed by a disregard for others and an inability to abide by society’s rules. People with this disorder often commit serious crimes and have a lack of remorse for their actions.
  • Borderline personality disorder. This disorder is marked by unstable moods, poor self-image, chaotic relationships, and impulsive behavior (such as sexual promiscuity, substance abuse, over-spending, and reckless driving).
  • Histrionic personality disorder. People with this disorder are shallow and constantly seek attention. They often are very dramatic, possibly even childish, and overly emotional.
  • Narcissistic personality disorder. This disorder is characterized by an exaggerated sense of superiority, and a preoccupation with success and power. However, this preoccupation is fueled by a fragile self-esteem. People with this disorder are very self-centered, tend to lack empathy, and require constant attention and admiration.

Anxious personality disorders

People with these disorders often are nervous or fearful. These disorders include:

  • Avoidant personality disorder. People with this disorder tend to avoid social contacts. This behavior is not the result of a desire to be alone but due to excessive concern over being embarrassed or harshly judged. They often miss out on many valuable social experiences because of their fear of being rejected.
  • Dependent personality disorder. This disorder is marked by dependency and submissiveness, a need for constant reassurance, feelings of helplessness, and an inability to make decisions. People with dependent personality disorder often become very close to another individual and spend great effort trying to please that person. They tend to display passive and clinging behavior, and have a fear of separation.
  • Obsessive-compulsive personality disorder. This disorder is characterized by a pattern of perfectionism and inflexibility, control and orderliness, with a strong fear of making mistakes. This fear often results in an inability to make decisions, difficulty finishing tasks, and a preoccupation with details.

People might have mixed symptoms of more than one personality disorder.

Personality disorders are among the least understood and recognized of the mental disorders. It is believed that both genetics and environment play a role in the development of personality disorders.

Certain personality disorders seem to be linked to a family history of mental illness.

For example, people with antisocial personality disorder are more ly to have family members who also have personality disorders; and a family history of depression might be a risk factor for borderline personality disorder or obsessive-compulsive personality disorder.

Although research on personality disorders has been limited, no study has been able to show that a person is born with a personality disorder. As is the case with many other mental disorders, the tendency to develop a personality disorder might be inherited, not the disorder itself. The disorder arises when something interferes with the development of a healthy personality.

Personality disorders might develop as a way of coping with a troubling situation or unreasonable stress.

For example, a person who was abused or neglected as a child might develop a personality disorder as a way of coping with the pain, fear, and anxiety that exists in his or her surroundings.

One thing is known: personality disorders develop over time. A person does not suddenly “come down with” a personality disorder.

What are the symptoms of a personality disorder?

Symptoms vary depending on the type of personality disorder. They can range from mild to severe.

It is important to understand the difference between personality styles and personality disorders. A person who is shy or s to spend time alone does not necessarily have an avoidant or schizoid personality disorder. The difference between personality style and a personality disorder often can be determined by assessing the person’s personality function in certain areas, including:

  • Work
  • Relationships
  • Feelings/emotions
  • Self-identity
  • Awareness of reality
  • Behavior and impulse control

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses.

Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder. The doctor or therapist bases his or her diagnosis on the person’s description of the symptoms and on his or her observation of the person’s attitude and behavior.

The therapist then determines if the person’s symptoms point to a personality disorder as outlined in the DSM-5.

People with personality disorders might not seek treatment on their own; and as a result, many go untreated. One reason for the failure to seek treatment might be that many people with personality disorders can function normally in society, outside of the limitations of their disorder.

Most personality disorders are constant and unrelenting, and very hard to cure. However, treatment can help relieve some of the disturbing symptoms of many types of personality disorders.

Treatment varies depending on the type of disorder, but psychotherapy (a type of counseling) is the main form of treatment. In some cases, medication might be used to treat extreme or disabling symptoms that might occur. Medications that might be used include antidepressants, anti-psychotics, anti-anxiety drugs, and impulse-stabilizing medications.

Psychotherapy focuses on evaluating faulty thinking patterns, and teaching new thinking and behavior patterns. Therapy also aims to improve coping and interpersonal skills.

What are the complications of personality disorder?

Untreated, personality disorders can result in great personal and social costs, including lost productivity, hospitalizations, significant unhappiness, and imprisonment. People with untreated personality disorders also are at risk for alcohol or drug abuse, and violent or self-destructive behavior, even suicide.

At this time, there is no known way to prevent personality disorders, but many of the related problems might be lessened with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family, and friendships.

It is difficult to accurately assess the outlook, because people with personality disorders often do not follow the treatment recommendations.

Last reviewed by a Cleveland Clinic medical professional on 02/02/2018.



An Overview of Mixed Personality Disorders: Definition, Diagnosis, and Criteria

An Overview of Mixed Personality Disorder

Mixed personality disorder refers to a type of personality disorder that does not fall into the ten recognized personality disorders.

 It is possible for people to have traits or symptoms of more than one personality disorder at the same time, while not meeting the criteria for any single one of them.

In DSM-IV, this was referred to as “Personality Disorder Not Otherwise Specified (NOS).

This has been replaced in the DSM-5 by Personality Disorder—Trait Specified (PD-TS). and the traits are listed out.

PD-TS is not a surprising category as there is significant overlap between the symptoms of several of the personality disorders.

Though we don’t understand all of the causes of personality disorders, there are causes as well which ly underlie more than one of these disorders.

Since this is in a way a “catch all” category for people with some symptoms of many different personality disorders, there is a wide range of symptoms among people carrying this diagnosis.

What Are Personality Disorders?

Most people have a fairly flexible personality that allows them to adapt to a variety of circumstances, people and events.

People with personality disorders, instead, get stuck in fairly rigid ways of relating to people and events.

These rigid thoughts may affect how they think about themselves and the world around them, how they experience emotion, how they function socially, and how well they can control their impulses.

How Are Personality Disorders Diagnosed?

In order to be diagnosed with a personality disorder, an individual must exhibit symptoms that meet the diagnostic criteria established in the DSM-5, including:

  • These patterns of behavior must be chronic and pervasive, affecting many different aspects of the individual’s life, including social functioning, work, school and close relationships.
  • The individual must exhibit symptoms that affect two or more of the following four areas:
    1. Thoughts
    2. Emotions
    3. Interpersonal functioning
    4. Impulse control
  • The pattern of behaviors must be stable across time and have an onset that can be traced back to adolescence or early adulthood.
  • These behaviors cannot be explained by any other mental disorders, substance abuse or medical conditions.

While the DSM-5 retained the DSM-IV’s categorical approach to diagnosing personality disorders, it developed an alternate model, which is suggests could be an area for future study.

Using this alternate, hybrid model, clinicians would assess personality and diagnose a personality disorder a combination of specific difficulties in personal functioning, as well as the general patterns of pathological personality traits.

Types of Personality Disorders

A personality disorder is defined as a chronic and pervasive mental disorder that affects thoughts, behaviors and interpersonal functioning. The DSM-5 recognizes ten distinct personality disorders , which are arranged into three clusters:

Cluster A: Odd, Eccentric Disorders

  • Paranoid Personality Disorder—Paranoid personality disorder is marked by a chronic fear and distrust of other people combined with a belief that others are deceiving or exploiting them. It occurs in one to two percent of the population and overlaps in some ways with schizophrenia.
  • Schizoid Personality Disorder—Schizoid personality disorder is marked by an indifference to other people. Those with this disorder often have very little interest in forming close relationships with other people.
  • Schizotypal Personality Disorder—Schizotypal personality disorder, a condition which affects around three percent of the population, is marked by eccentric thoughts and behaviors. People with the disorder often engage in magical thinking, for example, believing they can read the future. and suffer from tremendous social anxiety as well.

Cluster B: Dramatic, Emotional, or Erratic Disorders

  • Antisocial Personality Disorder—It’s thought that 7.6 million Americans suffer from antisocial personality disorder, a disorder in which people may intentionally harm others and are indifferent to the pain experienced by anyone other than themselves. A lack of empathy (lack of concern for others) combined with a lack of remorse (little conscience about their cruel activities) often contributes to criminal behaviors.
  • Borderline Personality Disorder—Borderline personality disorder often leads to unstable and intense relationships due to anger and aggression towards others combined with a deep fear of abandonment. These people often engage in risky behaviors, and may engage in self harming behaviors.
  • Histrionic Personality Disorder—Histrionic personality disorder affects around 1.8 percent of the population and involves a combination of shallow emotions combined with attention seeking and manipulative behaviors. Suicide gestures are commonly not related to depression, but rather as a way to manipulate others.
  • Narcissistic Personality Disorder (NPD)—Narcissistic personality disorder is characterized by extreme self-centeredness, an exaggerated sense of their own importance, and a lack of empathy or concern for others. The disorder is often recognized first not in the person who has the disorder, but through the emotional damage which occurs to those people with whom the person with NPD relates.

Cluster C: Anxious or Fearful Disorders

  • Avoidant Personality Disorder—Avoidant personality disorder is characterized by extreme shyness and sensitivity to criticism from others. It is often associated with other mental health conditions such as anxiety disorders and social phobia.
  • Dependent Personality Disorder—Dependent personality disorder is characterized by an intense fear and inability to make decisions. This disorder is the ultimate in the need to be a “people pleaser” and can result in near paralysis and inability to make the daily decisions (without the input of others) necessary for functioning well in the outside world.
  • Obsessive-Compulsive Personality Disorder—Around 2.5 percent of the population is expected to suffer from obsessive compulsive personality disorder at some point in their life. It is characterized by obsessions which are dealt with in turn by compulsions. Obsessions are often an irrational fear, perhaps the fear of disease, which are dealt with by compulsions, such as repeated hand washing to the point in which the compulsion causes inability to live normally.

Differential Diagnosis of Mixed Personality Disorder

Before a clinician can diagnose a personality disorder, she must rule out other disorders or medical conditions that may be causing the symptoms. This is very important, but can be difficult as the symptoms that characterize personality disorders are often similar to those of other disorders and illnesses. Personality disorders also commonly co-occur with other illnesses.

The following are potential differentials that must be ruled out before diagnosing an individual with a personality disorder:

  • Substance Abuse
  • Anxiety Disorders
  • Depression
  • Dissociative Disorders
  • Social Phobia
  • Post Traumatic Stress Disorder
  • Schizophrenia

Living With and Treatment for Mixed Personality Disorder

Since the symptoms and characteristics of mixed personality disorder span a wide range, there is not one specific treatment which is helpful to all people with PD-TS. The particular symptoms present are often treated as if a person did meet the criteria of one of the personality disorders described above.

For example, if a person meets some, but not all of the criteria for borderline personality disorder, treatments for borderline personality disorder such as psychotherapy may be pursued. In general, the treatment of personality disorders is difficult, and requires the person with the disorder wishing very much to pursue therapy. Psychotherapy is often more effective than medications.


Clark, L., Vanderbleek, E., Shapiro, J. et al. The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity. Psychopathology Review. 2015. 2(1):52-82.


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