Personality disorders

Last reviewed: 25 Aug 2023
Last updated: 24 Jun 2022



History and exam

Key diagnostic factors

  • paranoia
  • odd thinking
  • restricted range of emotions
  • anger and irritability
  • excessive emotionality and unstable mood states
  • anxiety and tension
  • impulsive behaviors
  • grandiosity
  • evidence of self harm (e.g., scars, burns)
More key diagnostic factors

Risk factors

  • history of abuse
  • family history of schizophrenia
  • negative parenting interactions
  • emotional/disruptive disorder in childhood
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical interview
More 1st investigations to order

Investigations to consider

  • suicide risk screening questions
  • Standardized Assessment of Personality-Abbreviated Scale (SAPAS)
  • Millon Clinical Multiaxial Inventory-III (MCMI-III)
  • Structured Clinical Interview for DSM-5-TR Alternative Model for Personality Disorders Version (SCID-5-AMPD)
  • Structured Clinical Interview for DSM-5-TR Personality Disorders
  • MRI/CT scan of brain
  • urine drug screen
  • The Primary Care Evaluation of Mental Disorders (PRIME-MD)
  • Patient Health Questionnaire-9 (PHQ-9)
  • Mood Disorder Questionnaire
  • Generalized Anxiety Disorder-7 (GAD-7) and GAD-2
More investigations to consider

Treatment algorithm


at risk for harming self or others, or unable to attend to basic self-needs


cluster A (odd/eccentric): non-life-threatening

cluster B (dramatic): non-life-threatening

cluster C (anxious): non-life-threatening

multiple features of different personality disorders: non-life-threatening



Michael J. Schrift, DO, MA
Michael J. Schrift


Department of Psychiatry and Behavioral Sciences

University of Washington




MJS declares he has no competing interests.


Dr Michael J. Schrift would like to gratefully acknowledge Dr Crystal T. Clark, and the late Dr Maria Devens, previous contributors to this topic. He would also like to acknowledge Dr Eric Gausche, who contributed the psychopharmacology sections for the initial version, and Dr Richard Stringham, who reviewed and approved information on the use of imaging and laboratory tests in the diagnosis section in the initial version. MD was an author of references cited in this topic. CTC, EG, and RS declare that they have no competing interests.

Peer reviewers

Anthony W. Bateman, FRCPsych

Consultant Psychiatrist and Visiting Professor

Halliwick Psychotherapy Unit

St Ann’s Hospital




AWB declares that he has a bias towards the use of mentalization in the treatment of personality disorder.

Robin L. Kissell, MD


Borderline Personality Disorder Initiative

Semel Institute


Los Angeles



RLK declares that she has no competing interests.

Justin Trevino, MD

Medical Director

Opioid Treatment Program

Dayton Veterans Affairs Medical Center




JT declares that he has no competing interests.

Dietmar Winkler, MD

Department of Psychiatry and Psychotherapy

Medical University of Vienna




DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.

  • Differentials

    • Mood disorders
    • Psychotic disorders
    • Anxiety disorders
    More Differentials
  • Guidelines

    • Screening for suicide risk in adolescents, adults, and older adults in primary care
    • Antisocial personality disorder: prevention and management
    More Guidelines
  • Patient leaflets

    Personality disorders: what are they?

    Personality disorders: what treatments work?

    More Patient leaflets
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