The referral pathways guide
Read with intention
Meet the cliniciansEvery personality disorder, in plain language.
Ten DSM-5-TR diagnoses, three clusters, and a different system in ICD-11. What each one actually describes, in plain language, without pretending a website can tell you which, if any, is yours.
Ten diagnoses, three clusters.
The clusters group the ten by how the pattern tends to look from outside. They are a filing system, not a hierarchy, and most people who meet criteria for one meet criteria for more than one.
Guardedness and distance
Patterns that show up as mistrust, withdrawal or being read by others as odd. They are often the least likely to bring someone to therapy, because the pattern itself argues against seeking help.
Paranoid personality disorder
A settled expectation that other people intend harm. Ordinary remarks are read as slights, confidences are withheld in case they are used later, and loyalty is tested rather than assumed.
Schizoid personality disorder
Detachment from close relationships with a narrow range of expressed emotion. Solitude is preferred rather than feared, which is what separates it from avoidant personality.
Schizotypal personality disorder
Discomfort with closeness alongside unusual beliefs, perceptions, speech or appearance. The experiences are real to the person and fall short of psychosis.
Intensity, impulse and identity
Patterns where emotion, relationships and self-image are unstable or extreme. These are the diagnoses most often given, most often argued about, and the ones with the strongest treatment evidence.
Borderline personality disorder
Instability of emotion, self-image and relationships, intense fear of abandonment, and impulsive acts that bring relief for an hour and cost for a week. The best-researched of the ten, and the most treatable.
Narcissistic personality disorder
Grandiosity, a need for admiration and limited empathy, frequently sitting over a fragile sense of worth that collapses under criticism. A quieter, vulnerable presentation is at least as common as the loud one.
Histrionic personality disorder
Excessive emotionality and discomfort when not the centre of attention, with relationships experienced as closer than they are. Rarely diagnosed now and widely criticised as a category.
Antisocial personality disorder
A long-standing disregard for the rights of others (deceit, impulsivity, aggression and absence of remorse), with evidence of conduct problems before age fifteen. Usually managed in forensic and specialist services, not general private practice.
Fear, control and reassurance
Patterns driven by anxiety: about being judged, being left, or losing control. These respond well to therapy and are often mistaken for an anxiety disorder that will not shift.
Avoidant personality disorder
Social inhibition, a settled sense of inadequacy and acute sensitivity to criticism. The wish for closeness is strong, which is precisely what makes the avoidance painful.
Dependent personality disorder
An excessive need to be looked after, leading to submissive and clinging behaviour and real difficulty making ordinary decisions alone. Fear of separation drives it, not laziness.
Obsessive-compulsive personality disorder
Preoccupation with order, perfectionism and control at the cost of flexibility, efficiency and enjoyment. Unlike OCD, it usually feels right to the person and wrong to everyone else.
- Personality change due to another medical condition. A persistent change in personality following a brain injury, stroke, epilepsy or another medical cause. Assessed differently, and often a question for neuropsychological assessment rather than therapy alone.
- Other specified & unspecified personality disorder. Used when the pattern clearly causes significant difficulty but does not match any single category. In practice that is extremely common and is a large part of why ICD-11 abandoned the categories.
These are descriptions, not criteria. A personality disorder is only diagnosable when the pattern is pervasive, long-standing and present across situations rather than in one relationship. It must also not be better explained by trauma, substance use, another condition, or the circumstances someone is living in right now. That last clause matters more than it sounds. Patterns that look like a personality disorder inside an abusive relationship or an untreated illness often resolve when the situation does.
Nobody is diagnosed from a website, and nobody is diagnosed from a questionnaire. If you want a considered answer, that is what an assessment is for.
The system that abandoned the categories.
Australia codes to ICD, and ICD-11 took a different route: no ten types. Instead there is a severity rating of mild, moderate or severe, based on how much the pattern costs the person and the people around them. Five trait domains are then scored by degree. Only one categorical label survived, a “borderline pattern” qualifier, and it survived because clinicians would not give it up.
Negative affectivity
How readily and how strongly distressing emotions arrive: anxiety, anger, shame, low mood, emotional volatility.
Detachment
How far someone withdraws from other people and from their own emotional experience; reserve, distance, flatness.
Dissociality
Disregard for others’ feelings and rights; entitlement, callousness, and the use of people as means.
Disinhibition
Acting on the moment: impulsivity, distractibility, irresponsibility, difficulty holding to a plan.
Anankastia
Rigid perfectionism and control, of oneself, of others, and of how things must be done.
Everybody sits somewhere on all five. That is the point of a dimensional model: the question stops being which one am I and becomes how much, and at what cost. Read more about the traits on personality difficulties.
Structured therapy, not general counselling.
Personality patterns do not shift with supportive listening alone. There are specific approaches for this with real outcome evidence, and which one suits you depends on the pattern and how long it has been running.
Dialectical Behaviour Therapy
Skills for the moment the feeling peaks: distress tolerance, emotion regulation, and staying in a conversation that is going badly. The strongest evidence base for borderline pattern.
Schema Therapy
Works on the beliefs underneath (abandonment, defectiveness, mistrust, subjugation) that formed early and keep regenerating the pattern. Effective across avoidant, dependent and obsessive-compulsive presentations as well as borderline.
CBT-PD and CBT for OCPD
Longer, schema-informed cognitive behavioural work for patterns that predate the current episode, plus a specific protocol for the perfectionism and over-control of OCPD.
Assessment first
Two to three sessions before anyone recommends a therapy or writes a diagnosis. You leave with a formulation you can read, and you can decline the label and keep the treatment.
If self-harm or suicidal thinking is part of this, it is addressed first and directly, with a plan you help write. It is a reason to start, not a reason to be turned away. If things are urgent right now, our urgent help page has the numbers.
Check in with yourself.
Free, private tools to try before or alongside sessions. They are not a diagnosis.
Free · 5 to 10 min
Take the Mind Health Check
Short questionnaires, scored privately in your browser. We have ticked the ones most related to this page, and you can change them.
Fact sheet: Emotional regulation
A plain-language guide with practical steps. Free to download.
Try this week
- Notice strong feelings and name them before acting on them.
- Use a pause: count to ten or step away when emotions surge.
- Keep a short list of people and things that help you feel steady.
Need help now? Our urgent help page has who to call, day and night.
What people ask about the labels
Can I be diagnosed from this page?
No, and you should be suspicious of anywhere that suggests otherwise. Everything above is a plain-language description, not a set of criteria. A personality disorder is only diagnosable when the pattern is pervasive, long-standing, present across situations rather than one relationship, and not better explained by trauma, substance use, another condition or the circumstances someone is currently in. That judgement takes a clinical assessment across more than one session.
Why does ICD-11 not have the ten categories?
Because they overlapped so heavily that they stopped being useful. Most people who met criteria for one met criteria for several, and the most-used category was “unspecified”. ICD-11 replaced them with a severity rating and five trait domains, keeping only a borderline pattern qualifier. Australia codes to ICD, so you may see either system depending on who is writing.
What is the difference between OCD and OCPD?
OCD involves unwanted intrusive thoughts and compulsions the person usually recognises as excessive and wishes would stop. OCPD is a long-standing style of perfectionism, order and control that generally feels correct to the person and costly to everyone around them. They share a name and very little else. See OCD treatment if it is the first one.
Are these treatable?
Yes, and better than the labels suggest. Borderline personality disorder has one of the strongest evidence bases in psychology for structured therapy, and long-term outcome research is more hopeful than its reputation. Avoidant, dependent and obsessive-compulsive patterns respond well to schema-informed and cognitive behavioural work. Treatment is measured in months rather than weeks.
Do you treat antisocial personality disorder?
Generally no. It is usually managed in forensic and specialist services rather than a general private practice, and we would rather say that at the first phone call than after you have paid for an assessment. It is on the list above because it is one of the ten, not because it is on offer.
Do I need a diagnosis to get help here?
No. Both therapies used for these patterns, DBT and Schema Therapy, work on the pattern itself and do not require a label to be useful. If you would rather read about this without the diagnostic frame, personality difficulties is the same subject written differently.
Can I get Medicare rebates for personality disorder treatment?
How long does treatment take?
Questions about a diagnosis? Let’s talk it through.
Tell us what’s going on and we’ll match you with a psychologist who works with emotional intensity and relationships, usually after a free triage. No referral needed to begin.
