Personality disorders constitute a separate diagnostic category (Axis II) in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Unlike the major mental disorders (Axis I) which are characterized by periods of illness and remission, personality disorders are generally ongoing. They often first appear in childhood or adolescence and persist throughout an individual's lifetime. Aside from their persistence, the other major characteristic of personality disorders is inflexibility. Individuals affected by these disorders frequently have rigid personality traits and coping styles, are often unable to adapt to changing situations, and experience impaired social and/or occupational functioning. A further difference between personality disorders and the major clinical syndromes listed in Axis I of DSM-IV is that people with personality disorders may not perceive that there is anything wrong with their behavior thus are not motivated to change it.
The personality disorders that most commonly occur with body dysmorphic disorder include avoidant personality disorder and dependent personality disorder. Another personality disorder that we have observed frequently co-exists with body image disturbance is borderline personality disorder.
Avoidant Personality Disorder
Avoidant Personality Disorder has characteristics that resemble those of social anxiety disorder, including hypersensitivity to possible rejection and the resulting social withdrawal in spite of a strong need for love and acceptance. Individuals with this disorder are inhibited and feel inadequate in social situations. They are often extremely sensitive to negative evaluation.
Dependent Personality Disorder
Dependent Personality Disorder pertains to individuals who are extremely passive and tend to subordinate their own needs to those of others. Due to their lack of self-confidence, they avoid asserting themselves and allow others to take responsibility for their lives.
Borderline Personality Disorder
Individuals with borderline personality disorder (BPD) often experience intense and/or unstable relationships with other people and often swing between idealizing and devaluing others. People with borderline personality disorder may frantically try to avoid real or imagined abandonment and can be intolerant of being alone. They are frequently uncertain about their identity or self-image and may experience this as feelings of emptiness and boredom. Impulsivity is a common feature of borderline personality disorder and may include substance abuse, binge eating, erratic sexual relationships, compulsive spending of money/shopping, risk taking behaviors, or self-injurious behaviors such as cutting themselves, skin picking, and sometimes even cosmetic procedures. Individuals with BPD tend to see things in extremes, either all good or all bad.