Personality Disorder

Treatment Options for Teens With Paranoid Personality Disorder (PPD)

Paranoid personality disorder (PPD) is one of ten personality disorders currently recognized by the DSM-V. The characteristics of PPD center around mistrust and paranoia permeating one’s thoughts and behaviors. Teens struggling with PPD are extremely suspicious of others, often lash out, struggle to interact with others in a healthy way, and misinterpret random or innocent events, words, and gestures as somehow malicious and personal.

How do you treat someone who is fearful of everything around them, constantly worries about being manipulated, and suspects that there is a plot against them hiding behind every corner? Very carefully. Most of the treatment options for teens with paranoid personality disorder center around psychotherapy and rely on the quality of the relationship between the teen patient and their psychotherapist.

Experience with the condition and how best to treat it is an important premium in these cases, as therapists must gain their patient’s trust for any therapy to be effective. Insisting that each therapeutic session is a collaborative effort is a good first step. PPD patients are very unlikely to cooperate if they somehow perceive that therapy is something being done to them, rather than with them. It can take multiple attempts to find the right therapeutic fit for a patient, and establish the kind of long-term relationship needed when treating PPD.

Cognitive Behavioral Therapy for Paranoid Personality Disorder

Cognitive behavioral therapy (CBT) is often the first choice of talk therapy in the treatment of different disorders, ranging from major depression to general anxiety, alcohol abuse, eating disorders, and personality disorders. As a concept, cognitive behavioral therapy espouses the idea that we can learn to recognize disordered thinking, and address both our thoughts and behavior through a structured therapeutic process. This concept has even proven to be as effective or more effective than pharmacological means in the treatment of some mental health issues.

On a practical level, CBT is a heavily researched and studied therapeutic method that can be adapted to help patients form protocols and alternative coping methods to deal with unhelpful ways of thinking and behaving. A therapist takes time to work through these patterns with the patient to try and better understand why they occur, where they come from, how they are triggered, and what steps the patient might take to address them. This can include learning to re-evaluate negative thinking patterns in the light of reality, better understanding one’s own motivations, and developing problem solving skills to work through stressful situations without returning to a maladaptive method.

Cognitive behavioral therapy can play a central role in the treatment of paranoid personality disorder by helping a teen reflect on their thoughts and behaviors considering inalienable facts, understand and gain insight into the context behind how their actions have affected others, and learn to better control their own impulses and mood changes. CBT often also involves using breathing exercises to calm down when faced with anxious feelings or stressful situations. These therapeutic methods are meant to arm teens with the means to become their own therapists, in due time. A lot of CBT exercises are also treated as homework, to be repeated often outside of the therapy room.

Dialectical Behavior Therapy for Paranoid Personality Disorder

Dialectical behavior therapy (DBT) can be considered an offshoot of CBT but is more often considered its own type of talk therapy. It has its origins in the treatment of personality disorders, particularly borderline personality disorder, which some doctors felt was not adequately treated via the guidelines and concepts of CBT. It centers on self-destructive behavior. DBT incorporates a new idea into CBT based on dialectics. Dialectics are a philosophical concept that originates from truth-seeking discourse (dialogue, dialektikḗ in Greek) between individuals with different points of view.

The main characteristic behind DBT is a focus on the conciliation of opposite views, and the acceptance of these conflicts. Imagine, for example, loving someone very dearly, and being proud of them for working hard, but feeling resentment towards them for not being able to spend more time with you and your family. This is a conflicting situation where both thoughts are true and valid, and conciliating the two is a dialectical exercise. What we end up with is not just two separate thoughts, but an interpretation of the truth that takes both sides into account.

In this instance, DBT for paranoid personality disorder would try to tackle the contradictions created by wanting to develop a stronger sense of self-esteem and understanding that one’s thoughts can be deceiving or dangerous. This is especially important for paranoid personality disorder because the thought of changing can be frightening to many teen patients struggling with paranoia. Learning to both validate oneself and understand that there is room for improvement can lead to a more constructive treatment path.

Psychodynamic Therapy for Paranoid Personality Disorder

Psychodynamic therapy is centered on the traditional concepts of psychoanalysis, truncated to be simpler and more effective. It involves working with a patient to gain insight to their daily lives and how their thought patterns affect the decisions they make, considering factors such as belief systems and early life experiences. By sharing this process with the patient, the therapist helps them learn to evaluate and analyze themselves, understand how early-life experiences and beliefs shape their actions, and develop healthier responses.

Why Group Therapy Might Not Be the Best Option

One therapeutic treatment option that is rarely suggested for teens with paranoid personality disorder is group therapy. The one-on-one relationship between the patient and their therapist is central to the treatment of PPD, because of the innate importance of trust. Patients with PPD will be much less likely to open and agree to therapeutic suggestions while in a group with other teens.

What About Medication?

There are no medications specifically targeting PPD. However, some medications are used in the treatment of concurrent mental health issues, particularly anxiety disorders and depression. Antidepressants, for example, may help reduce the severity of symptoms that might be exacerbating a teen’s paranoia. It would not address the root issue but could act as an important supplemental tool along with therapy. Paranoid personality disorder is a complicated and difficult condition to treat. It takes time, commitment, and the right treatment plant.

Personality Disorder

How to Deal With a Narcissistic Teenager

Self-obsession is a natural trait in children. Toddlers are in a stage of personal development where they must learn to attend to (and defend) their own needs and identify sources of danger to their own well-being. As preteens and teens go through adolescence, they begin to develop independence, taking the time to define their sense of self.

While empathic traits are also a normal part of being human – regardless of age – it is still normal for kids to generally put themselves first, feel jealous of others, and even seem egotistical. Narcissism becomes a dangerous trait in teens when they are self-centered and wholly incapable of showing interest or compassion for others.

The Roots of a Narcissistic Teenager

Narcissistic personality disorder, or narcissism as a psychiatric diagnosis, is not typically diagnosed in children under 18. This crucially includes most teens, as some signs of natural behavior may be misinterpreted as narcissistic behavior. There are still a few key differences between being self-centered and true diagnosed narcissism, or NPD.

A psychiatrist or doctor may refuse to diagnose your child unless they exhibit clear signs of disordered behavior, such as severe problems with interpersonal relationships, clear lack of empathy, signs of grandiosity across situations and settings, and explosive (dangerous) jealousy. In general, teens start to develop out of their self-centered mindset around ages 15 and 16.

Personal development is highly individual, so it is difficult to put an exact number on it. As your teen approaches the final stages of teenage life, they will likely change in behavior to show that they are beginning to grasp that the world does not revolve around them, that they have certain responsibilities to others. There is more to life than impressing others. But that does not mean these things happen overnight.

Parenting styles, experiences, and even advertising play a role in how your teen thinks of themselves, and the world. Your teen might not be a diagnosed narcissist, but their self-centered thinking may still be an undesirable or grating character trait that could be addressed through less drastic measures than full-on therapy. Consider speaking with a professional about how your parenting philosophy might influence a child to develop narcissistic tendencies, such as:

    • Exclusively tying consequences and punishments to possessions (causing your child to place too much value in material wealth).
    • Your teen’s media consumption or attitude towards advertising (advertisers and social network companies collaborate to instill superficial positivity into their customers, incentivize online engagement, and sell more).
    • Your family’s attitude towards the importance of charity, volunteering, and empathic community endeavors.

Narcissism vs. Narcissist Personality Disorder

After the Greek myth of the young man who accidentally drowned himself, narcissism is defined by self-obsession, enamored with his reflection in the water. Yet, a crucial and defining part of that myth (and definition) is the inability of the narcissist to love or care for anyone else.

Teens who put themselves first may be entitled or self-centered, but not necessarily narcissistic. A narcissistic teenager struggles to function as a partner, is impacted by their negative behavior at work or school, and is disruptive. About 6 percent of people above the age of 18 are diagnosed with a narcissistic personality disorder.

Signs of Narcissistic Personality Disorder (NPD)

Signs of narcissistic personality disorder include:

    • Inflated sense of superiority.
    • Exaggerating achievements and accomplishments.
    • Remorselessly manipulative behavior.
    • Lack of ability to empathize with others/cannot understand the needs of others.
    • Arrogant and haughty behavior.
    • Chases after status symbols.
    • Typically leans towards valuing cerebral superiority (believing themselves as omnipotent, incomparably brilliant) or somatic superiority (focused on looks and status, allure, sex appeal, and body).
    • Depression and anxiety issues.

Some risk factors associated with developing narcissistic personality disorder later in adulthood can include:

    • Learning how to manipulate others.
    • Sudden loss during childhood.
    • Severe emotional abuse.
    • An excessively critical or over-indulging environment.
    • Lack of consistent parenting/caregiving (had to fend for themselves part of the time or most of the time).

Building Empathy With Your Teen

Self-absorbed teens may be helped through a targeted parenting approach. By working to address each of the behavioral flaws your teen is exhibiting, you might be able to help them achieve a different outlook and tap into their inner sense of empathy and compassion.

Do not expect a child to mature into an adult over the course of a few weeks but know that being needlessly and constantly self-absorbed is not necessarily healthy or normal behavior either. You could try building empathy with your teen by bringing the topic up whenever it becomes relevant.

When your teen is angry that something did not work out in their favor, such as a friend canceling dinner plans due to a sudden family emergency, ask them to consider what their friend might be going through at that moment and the fear and sorrow they might be feeling. Encourage your teen to consider acting on their emotions by consoling their friend.

When something tragic happens in the news, ask your teen what they think it would be like to be in such a horrible situation. Or when they act in their self-interest while going against their word with a friend or betraying someone’s trust, compel them to take a moment to reflect on their actions and consider whether they feel guilty.

These exercises aren’t about teaching a teen to share or apologize in an earnest tone – they’re about getting them to take other people into account, take a look at the bigger picture, and grow.

Helping Your Narcissistic Teenager

A narcissistic teenager is a little more difficult to treat. A psychologist will interview and review your teen’s symptoms and behavior, run tests to rule out other potential causes, and prescribe a treatment plan. In general, true narcissists will not accept treatment and would not volunteer to be labeled as needing help. You cannot convince them that something is wrong.

However, they may be convinced to consider talk therapy and change their behavior to better fit in with others and reduce the challenges of interpersonal relationships. This can help a professional slowly get to the root of the patient’s behavioral issues and thought patterns, often ironically centered around insecurity and low self-esteem, and deep-seated self-resentment.

Teens diagnosed with NPD need friends and family to help support them by highlighting their therapy goals and reminding them that it is a long-term step-by-step journey. It takes time to learn to develop one’s empathy in cases of NPD and separate oneself from the problematic thought patterns that feed narcissism.

Personality Disorder

Understanding Borderline Personality Disorder in Teenagers

Borderline personality disorder (BPD) is one of ten recognized and categorized personality disorders in the Diagnostics and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), characterized largely by instability in two major aspects of life: self-image and interpersonal relationships. Other common characteristics include impulsivity, maladaptive or inappropriate behavior in different personal and social situations, and chronic feelings of emptiness.

While borderline personality disorder is a recognized and treatable condition in adults, its exact diagnostic criteria – specifically whether it can or should be diagnosed in children – remained up to debate for years. The International Statistical Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) and DSM-V provide clear outlines for defining these conditions. There are various ways to diagnose and treat them.

However, some experts continue to argue that teens should generally not be diagnosed with BPD at all. In contrast, others find that there are cases where it is useful to identify and begin early treatment of BPD, especially if that treatment can help the teen learn to adjust and improve their long-term behavior. Either way, research suggests that teens exhibit symptoms of BDP differently from adults. Understanding how and why borderline personality disorder in adolescents develops can help parents provide better care and support.

A Primer on Personality Disorders

Personality disorders are misunderstood and contentious. Rather than stigmatizing individual differences and temperaments, these disorders serve to identify rigid or inflexible maladaptive patterns in behavior and thinking, leading to self-destructive and hurtful behavior.

These disorders disrupt patients’ lives and those around them, sometimes to a disastrous degree, and can be affected through targeted therapies and treatments. Personality disorders are diagnosed when a person’s thoughts and behaviors actively cause problems at home and work. Treating personality disorders can be tricky.

Teens and adults diagnosed with a personality disorder will rarely agree that they need treatment and will often find ways to blame others for their problems. Because paranoia and trust problems often feature so heavily in personality disorders, treatment suggestions may be intrusive or offensive to some.

Personality disorders often co-occur alongside other mental health problems, most notably substance use. This can further complicate treatment and require more intensive residential care. While there are ten recognized personality disorders in the international psychiatric community, these are usually categorized into three major clusters:

    1. Eccentric disorders (Cluster A)
    2. Dramatic disorders (Cluster B)
    3. Anxious disorders (Cluster C)

Borderline personality disorder is characterized as a dramatic disorder.

Borderline Personality Disorder in Teenagers vs. Adults

One of the greatest challenges behind accurately diagnosing a personality disorder in teens is that instability and a flexible self-image are common in adolescent mental development. This makes it harder to separate problematic or disordered behavior and thinking from what might be considered a normal part of growing up. Statistics also indicate that teens are more likely to have a personality disorder than adults, meaning that some do grow out of it without professional intervention.

Other considerations include the fact that teens are likely to shift in and out of meeting the diagnostic criteria for borderline personality disorder and often display subclinical symptoms (i.e., not severe enough to require treatment), escalate, and then fall back down. Worries around pathologizing normal developmental behavior and avoiding stigmatizing the patient can also affect how and when a teen is treated. To that end, the DSM states that adolescents can and should be diagnosed with BPD, provided specific criteria are met.

These include pervasive and unusual maladaptive behavior, lasting at least a year and unlikely to be tied to the teen’s emotional or mental development. This generally means that the criteria for diagnosing BPD in teens are stricter than in adults, as psychiatrists must go through great lengths to ensure that a teen’s actions and thoughts are consistently disruptive over a period of at least a year.

Providing early treatment in the form of talk therapy, developing a support system, and healthy coping mechanisms can drastically help teens reduce the effects of their diagnosis, as the disorder is addressed at the onset. This can also help reduce reliance on medication in the long-term and may improve outcomes.

Identifying Borderline Personality Disorder in Teenagers

The symptoms of borderline personality disorder can be different for teens than adults. In general, borderline personality disorder can include symptoms such as:

    • Self-loathing.
    • Feelings of emptiness.
    • Mood swings and lashing out.
    • Self-harm or signs of depression.
    • Self-destructive and risk-taking behavior.
    • Struggling to manage and control emotions.
    • Misinterpreting social cues (often exaggerating their meaning).
    • Severe interpersonal trouble (arguments and rifts caused by emotional turmoil).

Individuals with BPD are often characterized by feeling intensely confused by their emotions and thoughts and lash out or seek validation to soothe their pain. This can feel manipulative and deliberately damaging towards others. Still, it is important to understand that these issues arise from constant inner turmoil and a lack of healthy emotional regulation skills.

How Are Personality Disorders Diagnosed?

Like any mental health disorder, a professional diagnosis is critical before beginning treatment. A qualified psychiatrist will discuss a teen’s thoughts and behaviors to gauge their emotions and responses and utilize various tests to rule out potential physical causes and alternate explanations for different symptoms.

A better understanding of a teen’s family life and family/medical history is also crucial for the diagnostic process. Certain areas of a teen’s life are specifically investigated for signs and symptoms of a borderline personality disorder, including:

    • Their own self-image.
    • Their relationships with others.
    • Impulse control and risk-taking.
    • Their grasp and awareness of self and reality.
    • Their ability to regulate thoughts and emotions.

Treating Teenagers With Borderline Personality Disorder

Treatment for teen borderline personality disorder involves rigorous and repeated talk therapy to identify and address maladaptive coping mechanisms, thoughts, and behaviors. Central to many BPD cases is a warped sense of self and trouble with emotions and co-occurring disorders such as depression and substance use disorder.

An individualized treatment approach utilizing different talk therapies and emotional regulation training can help teens address their problems closer to the disorder’s onset before they become much harder to treat. Individualized treatment can also help address multiple disorders concurrently, including a dual diagnosis, through residential or outpatient programs.

If you or your loved one struggles with BPD symptoms, do not hesitate to seek professional help. An early diagnosis can drastically improve quality of life in the long-term.

Mental Health Personality Disorder

Teen Schizotypal Personality Disorder Symptoms, Risks & More

More than just an unusual state of mind, teens with schizotypal personality disorder display consistent maladaptive behavior and thinking. Teen schizotypal personality disorder is one of ten personality disorders recognized in the DSM-5. It is one of three eccentric-type personality disorders (alongside schizoid personality disorder and paranoid personality disorder). Personality disorders are mental health conditions defined by specific and unhealthy patterns of thinking.

Someone with a personality disorder displays consistent maladaptive behavior and thinking across different settings and circumstances. For someone to be diagnosed with a personality disorder, their behavior cannot be explained by culture, upbringing, substance use, or other diseases/conditions. Because personality disorders are often long-term or lifelong conditions, an early diagnosis and treatment plan is important.

What Is Teen Schizotypal Personality Disorder?

Teens with schizotypal personality disorder are prone to unusual thinking and behavior, but they rarely have symptoms of psychosis. This means that, while they may think and behave in odd ways, they aren’t prone to hallucinations or delusions. The characteristics revolve around strange behavior and bizarre or unusual beliefs. Schizotypal personality disorder shouldn’t be confused with a schizoid personality disorder, schizoaffective disorder, or schizophrenia.

Teen Schizotypal Personality Disorder Signs and Symptoms

Teens with a schizotypal personality disorder may appear incredibly eccentric in how they talk, in what they say, and in the things they do. Other personality disorders can also display eccentricity signs, but the abnormal or strange behavior in teens with a schizotypal personality disorder is a central element of the illness.

Schizotypal personality disorder is also characterized by severe social and communication issues and trouble maintaining or building relationships of any kind, from platonic to romantic. They may be extremely paranoid of others and display extreme social anxiety. While delusions and hallucinations are rare, teens with schizotypal personality disorder still interpret the world in odd ways while misinterpreting things so that they see unusual patterns in places where there aren’t any (especially with regards to themselves).

In other words, teens with a schizotypal personality disorder may be prone to seeing conspiracies everywhere and believing that certain events reinforce their strange world view, even when they should be doing the opposite. Their strange beliefs may (but don’t always) extend into superstitious thinking and other “magical thinking,” such as belief in the paranormal and the supernatural. Magical thinking is defined as believing your actions have an influence on unrelated events without changing the circumstances.

Some other signs and symptoms commonly associated with teen schizotypal personality disorder include:

    • Solitary lives
    • No close friends
    • Trouble with relationships
    • Ideas/delusions of reference
    • Social anxiety linked to extreme paranoia
    • Strange and odd beliefs, not reinforced by surrounding cultural beliefs

One of the difficulties in diagnosing a teen with this disorder is that it shares many similarities with other conditions, including social anxiety disorder, histrionic personality disorder, mood disorders, and other disorders on the schizophrenia spectrum. However, despite these similarities, there are defining combinations of symptoms that make it a unique condition in need of its own treatment type.

Teen Schizotypal Personality Disorder Risk Factors

Risk factors are circumstances that correlate with certain disorders and may cause them or are related to their cause. The more risk factors a teen displays, the higher the likelihood of diagnosis. Risk factors are usually either internal (heritability) or external (environmental factors). Heritability plays a significant role. Teens are much more likely to be diagnosed with the condition if someone they are closely related to has been diagnosed with similar or closely related personality disorders.

Relevant environmental risk factors tend to come from early childhood experiences. Experiences of abuse, emotional neglect, a cold or distant parent, and extreme or chronic childhood stress are more common in teens diagnosed. Other risk factors include being prematurely tasked with adult responsibilities, having a parent with magical/odd thinking, and a financially unstable background.

Diagnosis and Treatment Options

Diagnosis must be very in-depth and usually involves a lengthy mental health interview to identify possible symptoms, discern medical history, and rule out other potential causes, from different personalities to certain mood disorders, influencing factors, and drug use. There are self-tests, but these are meant to prompt teens and adults to visit a mental health professional for treatment rather than an adequate diagnosis.

An accurate diagnostic interview takes a teen’s behavior, thinking, and experiences into account as a whole before making an official diagnosis. Treatment for schizotypal personality disorder requires a long-term plan with professional help. Home remedies aren’t recommended because of how pervasive the illness can be, and it takes a long time to learn to recognize and manage symptoms.

Psychotherapy or talk therapy is the most effective way of tackling schizotypal personality disorder, usually in a specialized treatment setting such as inpatient or outpatient care. Cognitive-behavioral therapy and psychodynamic psychotherapy are two commonly used types of talk therapy for helping a teen identify and separate the symptoms of their disorder from other healthier ways of thinking and behaving.

Teen Schizotypal Personality Disorder and Other Disorders

While schizotypal personality disorder shouldn’t be confused with schizophrenia and schizoid personality disorder, it can be considered part of a larger schizophrenia spectrum. These are conditions characterized by a level of detachment from reality, symptoms of delusional thinking, and psychosis.

These disorders are more common than most people would think and are largely misunderstood. Psychotic behavior is not necessarily dangerous or violent. Most people struggling with disorders under this umbrella lead solitary lives and are seen or known to be odd, unusual, or eccentric. Delusions and ideas of reference are a common hallmark of these conditions.

Ideas of reference are a phenomenon wherein innocuous events are misinterpreted as somehow referring to oneself, driving, or reinforcing strange beliefs and conspiracies. They sign that the person experiencing them is fundamentally seeing the world differently (and not entirely accurate) way. These delusions can cause paranoia as the person experiencing them is convinced that they are correct and that everyone else is conspiring against them.

Getting Help

Schizotypal personality disorder, like other personality disorders, can be a long-term or lifelong diagnosis. Early diagnosis and treatment can help drastically improve a teen’s quality of life and reduce the disorder’s impact in later life. When tackling any condition, a professional and individually catered treatment plan is important.

Personality Disorder

Teen Drama vs. Histrionic Personality Disorder

Teens can be dramatic, and they are often preoccupied with themselves. But at what point is such behavior normal and understandable, and at what point does it become a disorder? Disorders do not characterize or differentiate annoying from acceptable behavior, and part of the process of going through adolescence includes mood swings, identity changes, irritability, and a tendency towards hyperbole.

But certain behaviors fall outside the scope of “normal,” hinting at a developing problem that may be better managed in later life if addressed and treated early. Histrionic personality disorder, for example, is a lifelong mental health condition characterized by excessive dramatization, constant attention-seeking, and inappropriate behavior. Its onset tends to coincide with early adolescence. Despite similarities to normal teen behavior, specific characteristics tend to be blown out of proportion in teens with histrionic personality disorder.

What Is Histrionic Personality Disorder (HPD)?

Histrionic personality disorder (HPD) is one of ten major personality disorders identified and characterized in the Diagnostic and Statistical Manual of Mental Disorders (5th edition), under a cluster of personality disorders centered around dramatic and attention-seeking behavior (cluster B). At its root, it is defined by overly dramatic and theatrical (i.e., histrionic) behavior. This disorder’s history is long and varied.

Its early meaning has little to do with modern psychiatry, dating back to when male doctors blamed “unmanageable” female behaviors on “hysteria.” For a time, HPD was known as hysterical personality. We have since learned that the causes and contributing factors in most personality disorders are varied and complex, from environmental agents to genetics and early childhood experiences, and have nothing to do with uteri or most other believed causes of hysteria.

Where teens might exaggerate for the sake of calling attention to themselves or experiment with boundaries, a teen with histrionic personality disorder will consistently engage in outrageous and inappropriate behavior to remain in the center of attention at all times, and they may be visibly upset if they aren’t the center of attention. Some characteristic behaviors for teens with a potential histrionic personality disorder include:

    • Intentionally provocative or seductive behavior.
    • Rapidly shifting and changing emotions.
    • Overtly shallow expressions (i.e., acting).
    • Consistently alters and uses physical appearance to draw attention.
    • Jumps from relationship to relationship, quickly consider relationships to be more intimate than they are.
    • Extreme self-dramatization, exaggerated storytelling and expressions, and a shallow style of speech.
    • May resort to extreme statements to draw attention, including repeatedly threatening suicide and very rash decision-making.
    • Very susceptible to suggestion, easily influenced by others.
    • Symptoms are consistent across settings, i.e., displays the same behavioral issues at home, at work, and elsewhere.

A teen with HPD may not necessarily be consistently disruptive. Many grow up to remain “high-functioning” in the sense that they can hold a job and get through life. Yet, their behavior remains odd and can negatively impact relationships, friendships, and more. To be diagnosed according to the DSM-5, a teen would have to display at least five or more of the following signs:

    1. Discomfort when not the center of attention.
    2. Seductive behavior.
    3. Shifting emotions.
    4. Using appearance to draw attention.
    5. Vague, impressionistic speech.
    6. Exaggerated emotions.
    7. Suggestible.
    8. Considers relationships more intimate than they are.

It is also important to note that identifying and diagnosing a personality disorder is not a simple process. Individual cases rarely fit neatly into textbook definitions, and only a trained mental health professional can make a diagnosis and prescribe treatment if needed. There may also be co-occurring mental health issues such as irritability or “affective dysregulation,” which can complicate the diagnosis with depression and anxiety symptoms.

Part of the process also involves ruling out any other potential explanations or causes for a teen’s symptoms. Teens with histrionic personality disorder may be very reluctant to consider anything “wrong” with their behavior and may sometimes dissociate from their actions or words as a defense mechanism.

Histrionic Personality Disorder vs. Other Personality Disorders

The main characteristic that sets histrionic personality disorder apart from other personality disorders in its cluster focuses on overly dramatized speech and behavior and the need to remain the center of attention. Other similar personality disorders include:

Borderline Personality Disorder (BPD)

Borderline personality disorder is characterized by unstable and rapidly changing moods and self-image.

Antisocial Personality Disorder (ASPD)

Antisocial personality disorder is characterized by a lack of empathy and constant manipulation of others.

Narcissistic Personality Disorder (NPD)

Narcissistic personality disorder is characterized by self-grandeur, often accompanied by the need to put others down.

What Causes Histrionic Personality Disorder?

The causes of histrionic personality disorder are varied, depending on the teen’s circumstances and history. Genetics seem to play at least some role, as does gender – while the prevalence for histrionic personality disorder is less than two percent in the general population, it is four times more common in women than men.

While identities and behaviors evolve, temperament is mostly determined early on and may play a role in how the disorder develops. Upbringing may also be necessary – children who were only awarded affection and attention in specific ways after performing certain tasks may learn to behave that way into their teen years.

Can Histrionic Personality Disorder Be Treated?

Yes, although it cannot be “cured.” Like most personality disorders, histrionic personality disorder can be treated and managed through therapy, specifically by helping teens differentiate between maladaptive thinking and their other thoughts, identifying the condition before it translates into behavior and action. It can take time for a patient to learn the difference.

Various approaches may be utilized to get to that point, including group therapy, dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and family therapy. In cases where histrionic personality disorder is also accompanied by severe mood issues or an anxiety disorder, medication can help alleviate significant symptoms to make therapy more effective. There may be evidence that some personality disorders – particularly ones in the same cluster as HPD – generally improve with age, especially with treatment.

Personality Disorder

How to Identify Personality Disorders in Teens

Personality disorders in teens develop in childhood and adolescence, and benefit from early detection and treatment. But unlike in adults, it can be more difficult for parents to differentiate telltale signs of a personality disorder from “typical teenage behavior”. We expect adults to be more “in control” of their behavior and accept teens sometimes push the limits of what is accepted or expected to learn more about themselves and the world around them.

But when a teen’s behavior hints at a potential personality disorder, early treatment can be the key to developing the necessary coping mechanisms to help them lead fulfilling and happier lives. Left undiagnosed or misdiagnosed, a personality disorder can turn a person’s life upside down, ruining relationships and career opportunities, and isolating them from those who love and care for them. And the longer such a condition develops – especially in the growing mind of a teenager – the more difficult it can be to treat.

Understanding Personality Disorders in Teens

Personality disorders in teens are a series of conditions characterized by thinking and behavior that deviates quite extremely from the norm, to the point it causes long-term distress over months and years, and affects day-to-day functioning across multiple settings (home, school, work, etc). A personality disorder is more than just a strange character trait or an annoying quirk.

A teen diagnosed with an emerging personality disorder is consistently experiencing thoughts (and thereby engaging in behavior) that are dangerous, unacceptable, and/or unhealthy, and that remain rigid and unchanging even in the face of earnest disapproval and multiple adverse experiences. This isn’t their fault. It is a mental health condition often developing as a result of both internal factors (genetic likelihood) and external factors (life experiences and traumatic situations).

Types of Personality Disorders

Personality disorders in teens do not always fit a textbook definition, but years of accumulated research and learning in the field of psychiatry has helped develop three distinct clusters within which most cases fall. These clusters each have their own set of different diagnoses based on very distinct key behaviors and patterns, but individual cases may come with their own unique elements or quirks.

Ultimately, these definitions can help us understand how and why certain thoughts lead to resulting behaviors, but it’s important to know that any one teen will require a wholly individual profile and treatment process. The three main clusters of personality disorders are:

Cluster A – Odd, Magical or Eccentric

Cluster A personality disorders are characterized by “magical” or odd thinking, and examples of strange or distorted perceptions of reality, paranoia, or erroneously seeing connections or patterns where there are none. The three personality disorders in Cluster A are:

    • Paranoid Personality Disorder: Characterized by consistent paranoia and unjustified suspicion, as well as aggressiveness in response to perceived or misinterpreted insults.
    • Schizoid Personality Disorder: Characterized by a detached and seemingly emotionless state, lack of interest in other people romantically or sexually, and little to no emotional expression.
    • Schizotypal Personality Disorder: Characterized by odd and peculiar thinking, superstition, belief in magical occurrences or concepts, and strange or unnatural experiences (including auditory hallucinations).

Cluster B – Overly Dramatic or Unpredictable

Cluster B personality disorders are characterized by impulsive and/or dramatic behavior, intense interpersonal conflict, or issues with empathy. The four personality disorders in Cluster B are:

    • Antisocial Personality Disorder: Characterized by “antisocial behavior”, particularly repeatedly disregarding other people’s feelings and needs, unwarranted aggressiveness, lack of remorse, and impulsiveness.
    • Borderline Personality Disorder (BPD): Characterized by pervasive and repeated instability in mood and behavior, borderline personality disorder is named such because its definition evolved over decades, starting out as a condition on the “borderline” between other conditions. Other characteristics include threats of suicide, signs of depression, significant ups and downs, risk-taking behavior, and outbursts.
    • Histrionic Personality Disorder: Characterized by attention-seeking behavior, including grand displays of emotion and provocative behavior, such as inappropriate or sexually-suggestive behavior. Other symptoms include repeatedly and consistently making grand statements with little to no substance and being overwhelmingly shallow with one’s thoughts and opinions.
    • Narcissistic Personality Disorder: Characterized by an overwhelming sense of self-importance, delusions of grandeur, extreme arrogance, and aggressiveness in response to any perceived threats to one’s superiority. Narcissistic personality disorder is also characterized by extremely manipulative behavior, and a failure to recognize anyone else as special or worth respecting.

Cluster C – Anxious or Fearful

Cluster C personality disorders are characterized by intense anxiety and fearful thinking, avoidance, or excessive dependence. The three personality disorders in Cluster C are:

    • Avoidant Personality Disorder: Characterized by a crippling level of fear regarding interpersonal contact and social perception, including fear of disapproval and ridicule in every setting, and constant feelings of inadequacy.
    • Dependent Personality Disorder: Characterized by a level of dependence that interferes with normal, everyday function, including being unable to start or continue projects or endeavors alone, lacking any form of self-confidence, and immediately starting new relationships when old ones break down.
    • Obsessive-Compulsive Personality Disorder (OCPD): Not to be confused with obsessive-compulsive disorder (OCD), OCPD is a personality disorder characterized by an incredibly rigid ruleset, extreme perfectionism, and desire to be in control always.

Personality Disorder Causes

Personality disorders in teens are understood to be caused by a combination of genetic predisposition and certain external risk factors that may trigger their development. Personality is a complex concept, one which in part is informed by our thoughts and behaviors, how they shape the world around us, and how that world feeds back into our mental framework.

While the genetic component implies that there is a neurological difference between people with and without personality disorders, researchers have not identified all the contributing genes, and how they function or cause personality disorders. Neurotransmitters, such as dopamine and serotonin, may play an important role. Current research on genetic epidemiology simply indicates that all currently recognized personality disorders are at least modestly heritable.

Could My Teen Have a Personality Disorder?

Personality disorders in teens are not easy to identify. Emergent personality disorders may appear as little more than strong personality traits, especially in teenagers, who are still developing in every sense. However, if you have serious concerns regarding your teen’s interpersonal skills, sense of self, and other characteristics mentioned previously, it may be a good idea to talk to a professional and ask your teen about visiting a psychiatrist together. They may be confused about their own thoughts and behaviors and frustrated about how hard it is to fit in with others.

Treatment for a personality disorder is not simple, either. There is no cure, and many of these conditions last for a lifetime. Your teen may struggle more with some symptoms and thoughts than others, and most treatment centers around one-on-one therapy with a professional to address, describe, and cope with these thoughts, and control the resulting behaviors. Some symptoms, such as strong feelings of anxiety or depression, may be alleviated through certain medications.

Addiction ADHD Adolescence Anxiety Bipolar Disorder Depression Mental Health Obsessive-Compulsive Disorder (OCD) Personality Disorder Recovery Social Anxiety Stress

Mental Health and Substance Abuse

Mental illness is a frequent partner of substance abuse and addiction, although the cause-and-effect between the two isn’t always clear. However, the issue is a prevalent one that needs to be considered anytime treatment is sought for substance abuse, because diagnosing both correctly is a key component to a healthy recovery process. There are a number of different types of mental illnesses that are often seen in combination with substance abuse and addiction.

Depression is one of the most common mental illnesses associated with substance abuse. In some cases, substances may be used to mask the symptoms of depression. Other times, substance abuse may bring on the depression symptoms or make them worse. Symptoms of depression might include:

  • Feelings of worthlessness or hopelessness
  • Persistent feelings of sadness or guilt
  • Loss of interest in or ability to enjoy activities
  • Diminished energy levels and fatigue
  • Difficulty thinking clearly or concentrating
  • Changes to sleep or appetite
  • Suicidal thoughts or ideations

Anxiety disorders are also a frequent problem for those struggling with substance abuse. There are different types of anxiety disorders, including obsessive-compulsive disorder, social anxiety and panic attacks. Substances may be used to lessen the symptoms at first, which often only serves to make the symptoms more intense over time. Symptoms of these conditions might include:

  • Feelings of restlessness or nervousness
  • Excessive and ongoing worry and tension
  • Irritability and fearfulness
  • Sweaty palms, racing heart, shortness of breath
  • Headaches, dizziness or nausea

Attention-Deficit Hyperactivity Disorder
ADHD is a disorder often diagnosed in adolescents and frequently associated with substance abuse. This disorder is characterized by three basic components:

  • Hyperactivity – difficulty sitting still, excessive talking, always seems to be “on the go”
  • Inattention – disorganization, lack of focus, forgetfulness, distraction
  • Impulsivity – impatience, blurting out answers, guessing instead of solving problems

Bipolar Disorder
Bipolar disorder, also known as manic-depressive illness, is a mental disorder characterized by extreme swings of mood and energy levels. During the manic phase, the individual exhibit the following symptoms:

  • Excessive irritability
  • Bursts of energy, requiring little sleep
  • Distracted easily
  • Engage in impulsive, high-risk behaviors

Manic phases are typically followed by depressed states, which may include the following symptoms:

  • Extended periods of sadness or hopelessness
  • Low energy, excessive fatigue
  • Significant changes to appetite and sleep patterns
  • Thoughts and ideations of suicide

When mental illness accompanies a substance abuse disorder, it is imperative to address both disorders simultaneously to give the patient the best odds for a successful recovery. At Visions Adolescent Treatment Centers, we are experienced in treating both of these conditions at the same time, a situation known as dual diagnosis. Our team of healthcare professionals is equipped to work through both disorders and give our patients the best odds of successful sobriety and improved mental health. To learn more about dual diagnosis or our treatment programs, contact Visions Adolescent Treatment Centers at 866-889-3665.

Mental Health Personality Disorder Recovery

New Study: Omega-3 Fatty Acids and Borderline Personality Disorders in Adolescents

In recent news, a study from the Dr. Paul Ammiger and his esteemed colleagues recently published the results of their study, which investigated whether or not Omega-3 fatty acids would “improve functioning and psychiatric symptoms in young people with borderline personality disorder (BPD) who also meet ultra-high risk criteria for psychosis.” The study showed a decrease in the severity of symptoms in young adults who were at high risk for developing psychosis. The study studied 81 young people between the ages of 14-18 who were at “high risk for psychosis.” From this group, they found 15 who had borderline personality disorder.


For a period of 12 weeks, half of the group took 700 mg of EPA and 480 mg of DHA a day, while the other half took a placebo. Of those taking the placebo, 29% showed signs of psychosis. However, those taking the Omega-3 fatty acids showed significant improvement.


This is really encouraging. Borderline personality disorders are tricky and can be hard to address. The major symptoms revolve around interpersonal interactions, negative sense of self, significant mood swings, and impulsivity. The work involved in treating all mental illness requires a nexus of therapeutic support and a desire for positive change from the patient themselves. We’ve learned that applying Dialectical Behavioral Therapy (DBT), for example, has shown positive results in the treatment of Borderline Personality Disorders–recent studies have confirmed this, showing lower suicide rates, less self-harming incidents, and less self-removal from treatment.


Psychiatry is still a relatively young science, and growth and change are happening quickly as practitioners eagerly seek resolution to some of the most challenging psychological issues. Dr. Ammiger’s discovery regarding the use of Omega-3 fatty acids is profound. The study, though small in scope, produced impressive results: the data “suggests that omega-3 fatty acids, at the right doses for a long-enough period of time, can significantly improve the quality of life for people with borderline personality disorder.”


More research around the use of Omega-3 fatty acids will need to be done to ultimately determine the long term efficacy of Omega-3 fatty acids, but Ammiger’s study has shone a light into what is a dark corner for many.


References used for this blog:

Omega-3s in adolescents with borderline personality disorder

Omega-3 fatty acid supplementation in adolescents with borderline personality disorder and ultra-high risk criteria for psychosis: a post hoc subgroup analysis of a double-blind, randomized controlled trial.


Mental Health Personality Disorder Recovery Therapy Treatment

Do I Have Narcissistic Personality Disorder?

We’ve all done it: called the arrogant, self-righteous, unsympathetic person we know a

Narcissus (oil on canvas) (Photo credit: Wikipedia)

“narcissist” and we may have even felt pretty confident that they are most certainly suffering from a Narcissistic Personality Disorder.  It’s a buzzword for the selfish and self-indulgent people we have difficulty with. We may even be right on occasion. I know I have, much to my chagrin. We never really want our laymen’s assessment to be true, do we?


While it’s true that someone can have narcissistic tendencies, to receive a diagnosis for Narcissistic Personality Disorder, you have to meet some significant traits and they have to have been present for some time. Because of this, adolescents aren’t typically diagnosed with this particular personality disorder because their brains are changing so rapidly. However, if an adolescent presents with the traits of Narcissistic Personality Disorder, they have to be actively present for at least a year.  I do think it’s important to remember that Narcissistic Personality Disorder is diagnosed as a result of it being a long-standing, enduring behavior.


It’s not common for someone with any personality disorder to seek help. Often times, one ends up in treatment or in a therapist’s office for something else and it’s determined then. Rather than trying to diagnose someone who is innately selfish, ensure that you have firm boundaries and limits around this difficult person.


I asked Noelle Rodriguez to give me some clinical insight on Narcissistic Personality Disorder:


“A narcissist is only interested in what reflects on them. All she/he experiences is a reflection of self, denial of profound feelings and grandiose fantasy as a shield from unworthiness caused by not feeling truly loved by their parent. A narcissist attacks separateness in everyone with whom he must have a relationship; either they fit into his ego-supporting mold or they are excluded from his life.

Narcissistic rage and aggression is based on fear. His entitlement and absolute control over others must go unchallenged.”

Noelle went on to expand on part of the child’s development that may contribute to Narcissistic Personality Disorder and where parental neglect or denial is a factor, “The child’s natural growth sets off a parental alarm: he or she is blamed for their emerging individuality as if it were a crime. He is made to feel that there is something wrong with such development.”


According the DSM-V, Narcissistic Personality Disorder is described thusly:


  • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
  • Requires excessive admiration.
  • Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  • Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
  • Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  • Is often envious of others or believes that others are envious of him or her.
  • Shows arrogant, haughty behaviors or attitudes.”

For more information about personality disorders, please speak to a therapist, or medical professional skilled in working within this genre of mental illness.



Mental Health Mood Disorders Personality Disorder Recovery Self-Care

Mental Health is Mental Wealth

When someone suffers from mental illness, there is a deprivation of the joy and emotional wealth that’s present when there is ideal mental health. Mental illness can drain our joie de vivre, and make for a muddy emotional existence. Relationships with loved ones tend to be difficult, and there tends to be a propensity for loneliness and isolation. Worse yet, when mental illness is left untreated, the toll it can take on the one suffering and their loved ones can be taxing and sometimes devastating.


Some types of mental illness are more straightforward in their treatment: anxiety and depression, for example, are often treated with various modalities of psychotherapy and balanced with medication. Personality disorders are complex and there are some instances where the patient doesn’t recognize their illness despite their deep suffering. The work involved in treating all mental illness requires a nexus of therapeutic support and a desire for positive change from the patient themselves. The question many have is, Why are personality disorders so challenging?


Personality disorders are grouped into three clusters:

  • Cluster A personality disorders are “characterized by odd, eccentric thinking or behavior.” The disorders that fall into this category are:  paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder
  • Cluster B personality disorders are “characterized by dramatic, overly emotional or unpredictable thinking or behavior.” The disorders that fall into this category are: antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.
  • Cluster C personality disorders are “characterized by anxious, fearful thinking or behavior.” The disorders that fall into this category are: avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.


Psychotherapy is the most common treatment for all types of mental illness; the most efficacious modality is determined by the needs of the client. Findings show that DBT (Dialectical Behavioral Therapy) in particular is the most effective therapeutic treatment for personality disorders and bipolar disorders. Other effective tools used in treatment may include:

  • Individual psychotherapy
  • MBSR (Mindfulness Based Stress Reduction)
  • Yoga
  • Meditation
  • Somatic Experiencing
  • Neurofeedback


To date, the FDA hasn’t approved of any medications to treat personality disorders. However, medications are often used to treat symptoms that are detrimental to the individual’s recovery. Medications like:


  • Antidepressents: for depressed mood, anger, irritability, mood swings, impulsivity and hopelessness.
  • Mood stabilizers: to even out mood swings, and to reduce impulsivity, irritability and aggression.
  • Antipsychotic medications (also known as neuroleptics): if symptoms include losing touch with reality (psychosis), and sometimes anxiety and difficulty with anger
  • Anti-anxiety medications: For anxiety, agitation or insomnia. Note, in some cases, they may increase impulsive behavior and are avoided with some personality disorders.


Treating mental illness requires the cultivation of balance. Participation from the client, a cohesive treatment team, and the correct combination of medication can create the desired environment of mental health.  It takes work, dedication, and a willingness to unveil one’s difficulties in order to create a healthy shift toward mental health. I have experienced the shadow side of untreated mental illness with family members who are unwilling to get help. It does, in fact, take a toll on everyone involved. I have learned that one of the key pieces for my own recovery is developing clear communication skills, creating firm, compassionate boundaries, and building consistent program of self-care. Families struggling with mental illness need to ensure that their own wells are filled, that they are getting their own needs met, and that they have a community of support around them.