Understanding personality disorders: Symptoms and treatment

Personality disorders part one: narcissistic, antisocial, histrionic and borderline.


Our 'personalities' are made up of our thoughts, feelings and subsequent moods and behaviour. There are several different diagnoses for what are labelled “personality disorders”. Often present in emotionally abusive relationships, and projection plays such a major part in the manifestation and maintenance of the cycle of violence, topics upon which I have previously written.

Here I have listed four personality disorders alongside symptoms. Although listed separately, disorders and symptoms commonly overlap. 

Symptoms of narcissistic personality disorder (NPD)

  • Considered responses are lacking. The narcissist acts with overt or covert disproportionate anger on feelings of guilt, shame or humiliation, seeking retaliation for any real or perceived criticism. Grudge-bearing.
  • Manipulative, taking advantage of others to reach a goal. In such manner, they are motivated to take power any which way they can.
  • An exaggerated sense of self. A complete inflation or elevation of self-importance. Superior, grandiose and attention-seeking.
  • An exaggeration of any achievements, talents and abilities.
  • Unrealistic fantasies about success, power, beauty, intelligence or romance. Becomes intensely angry at threat of exposure of the (often opposite) reality.
  • Expects favourable or different treatment, sense of entitlement means they often operate outside the “rules”. Nothing is ever enough - insatiable, lacks boundaries.
  • Can pretend to be generous to feed their fake image, or to make others feel obligated, although inside they are mean and do not want to follow the normal rules of reciprocity.
  • Comes across as arrogant and cocky. Expert at playing the victim in their drama, they easily hook others into their army. Appoints self as General, whilst acting like Machiavelli.
  • Will exploit others for personal gain, especially to help in complaints/litigation (where they use the “rules” to their advantage) often turning on the helper(s) once their purpose has been served.
  • A stream of broken promises outside of the "here and now" - either grand gestures such as booking a luxury holiday or a change in behaviour or attitude or, on a smaller scale, doing the washing up or completing outstanding paperwork.
  • Ranks everyone. Feels superior and looks down on people they believe are ranked below them. Although they seek affiliation with anyone ranked higher, they are deeply envious, harbouring and sometimes acting on a wish to wipe them off the face of the earth.
  • Will seek to devalue others so they look good.
  • Demands in a covert or overt manner constant attention, admiration and positive reinforcement from others.
  • Is prone to overwhelming feelings of jealousy and rage.
  • Capable of completely disregarding the feelings of others, yet an accomplished mimic so can appear empathic.
  • Is competitive, judgmental, obsessive and self-interested.
  • Only interested in pursuing selfish goals whilst maintaining the outward appearance of acting “for the greater good”.
  • Stories of self are framed around a zero to hero narrative.

Symptoms of antisocial personality disorder (APD):

  • Lack of empathy, care or concern for the distress of others.
  • Lack of guilt or remorse for the harm caused by self to others.
  • Rigid and inflexible black and white thinking.
  • Compulsive lying.
  • Difficulty in maintaining long-term relationships.
  • Poor frustration tolerance and anger impulse control.
  • Inability to sit with feelings of guilt and shame leads to repetition of destructive patterns as cannot develop emotional maturity due to failure to learn from their mistakes.
  • Every mistake or problem will always be blamed on others.
  • Gaslighting.

Symptoms of histrionic personality disorder (HPD):

  • Becomes anxious when not noticed, thinking they are being ignored and therefore feeling angry.
  • Compelled to seek centre stage at whatever cost.
  • Grooms and manipulates others to achieve goals.
  • Can attempt to seduce by inappropriate flirting or provocative clothing or other forms of risky behaviour.
  • Emotions and therefore moods fluctuate quickly dependent on attention.
  • Are self-centred, self-absorbed and uncaring for others.
  • Overtly or covertly seeking approval and reassurance from others.

Symptoms of borderline personality disorder (BPD):

  • Feeling overwhelmed by feelings such as distress, anxiety, worthlessness or anger.
  • A cut-off or disassociation from overwhelming feelings.
  • Feeling empty, paranoid, unsafe.
  • Discomfort avoidance.
  • Inability to manage intensity of feelings so prone to self-harm including cutting, risky relationships, eating disorders, drug or alcohol abuse, overdose or threats of harm to others.
  • Stable and close relationships are difficult and therefore often elusive.
  • Periods of loss of contact with reality, slipping between “neurosis” and “psychosis”. for example, swinging between maladaptive symptoms of acute anxiety and consequent desire to control the environment to a wish to completely escape from unnerving feelings of unreality.

Treatment of personality disorders

Maybe you recognise some of the symptoms above and can identify that you are facing more than just depression or anxiety. Perhaps you are worried about a loved one, a friend or colleague?

In my professional opinion, your recovery, away from stuck patterns that cause you pain towards a pleasurable life, depends on finding a therapist that you can connect with and trust. A therapist who can be real with you, who is prepared to take a risk that may dislike them, as you work through your 'projections', often transferred onto the therapist. One who doesn’t make you sit in silence, alone with your thoughts.

In such manner you will feel safe in the knowledge that there is a person who cares enough to refuse to collude with you, providing relief from the wounds of your life's traumas. All the therapist needs to have is your best interests at heart, so they can be free to work collaboratively with you, thereby viewing you not as a label or as a set of symptoms, but as an individual.

Although a range of interventions exist, including DBT, CBT, IPT and Gestalt work, alongside Schema therapy and psychotherapy, it is my belief that regardless of intervention, it is the strength of the therapeutic relationship that is key to recovery.

"When we are no longer able to change a situation, we are challenged to change ourselves" - Viktor Frankl.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Leigh-on-Sea SS9 & Basildon SS13
Written by Amanda Perl, Psychotherapist Counsellor MSC BACP Accred CBT Practitioner
Leigh-on-Sea SS9 & Basildon SS13

I am a BACP accredited counsellor and psychotherapist, a CBT Practitioner and Member of the British Psychological Society. I am the Course lead for a Stage 4 BACP Accredited Counselling Diploma. My private practice reflects my belief that each of us is unique with the potential for growth and development and can move forward in our own way.

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