129. CCA Study Notes: Personality Disorder Types, Symptoms & Client Support

The Big Picture

Personality disorders affect how people think, behave, react to situations, and relate to others. These patterns can be difficult to change and may cause problems in everyday life and relationships.

There are different types of personality disorders. Some involve distrust of others. Others involve strong emotional reactions, difficulty making decisions, or trouble forming relationships.

As a Continuing Care Assistant (CCA), your job is to treat clients with care and respect. You also need to communicate professionally, follow the care plan, and maintain appropriate boundaries.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

1. What Are Personality Disorders?

Personality disorders are a group of conditions involving rigid patterns of behaviour that are considered socially unacceptable or unexpected within a person’s culture.

These patterns affect how a person experiences situations and behaves around other people. They can make it difficult to maintain relationships and function well in society.

A personality disorder involves a widespread pattern that differs from what is considered normal in at least two of these four areas:

• Thinking: How a person thinks about situations and experiences.
• Mood: A person’s emotional state.
• Personal relations: How a person interacts with other people.
• Control of impulses: How a person manages urges to act.

This means the difficulties are not limited to one behaviour or situation.

How Personality Disorders Affect Everyday Life

People with personality disorders may show behaviours such as:

• Being demanding or hostile toward others.
• Trying to manipulate other people.
• Having difficulty adjusting their behaviour.
• Behaving in ways that do not fit social expectations.
• Showing antisocial behaviour or difficulty following social rules.

These patterns can interfere with relationships and participation in society.

Personality disorders are described as different from illnesses that directly disrupt emotional, intellectual, or perceptual functioning ⓘ. Their main feature is a lasting pattern of experience and behaviour.

Most personality disorders that begin as problems in personal development and character reach their peak during adolescence.

People with personality disorders may also struggle to lead satisfying, fulfilling lives or reach their personal potential.

2. The Main Types of Personality Disorders

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) is published by the American Psychiatric Association. Health professionals throughout North America use it to classify mental health disorders.

Several main types of personality disorders are described below.

Antisocial Personality Disorder

Antisocial personality disorder involves disregard for moral or legal standards in a person’s culture, or a marked inability to get along with others or follow society’s rules.

The terms psychopath and sociopath are sometimes used to describe people with this disorder.

Key difference: This disorder involves difficulty respecting social expectations and rules.

Avoidant Personality Disorder

Avoidant personality disorder involves strong social inhibition, feelings of inadequacy, and extreme sensitivity to criticism.

A person may:

• Feel that they are not good enough.
• Be extremely sensitive to criticism.
• Show strong hesitation or discomfort in social situations.

Key difference: Social situations are difficult, and the person is especially sensitive to how others judge them.

Borderline Personality Disorder

Borderline personality disorder involves instability in several areas of a person’s life.

Characteristics include:

• An unclear or unstable sense of identity.
• Rapid changes in mood.
• Intense and unstable relationships.
• Impulsive behaviour ⓘ.
• Unstable reactions to situations.
• Changes in how the person views themselves.

A person’s emotions, relationships, reactions, and self-image may all be affected.

Key difference: Borderline personality disorder involves several forms of instability, rather than only changes in mood.

Dependent Personality Disorder

Dependent personality disorder involves an extreme need to depend on other people.

This dependence can become so strong that the person is unable to make any decisions or take an independent stand.

Characteristics include:

• Fear of separation from other people.
• Submissive behaviour ⓘ.
• Difficulty making decisions.
• Low self-confidence.
• An extreme need for other people’s support or involvement.

Key difference: The person’s extreme dependence can prevent independent decision-making.

Histrionic Personality Disorder

Histrionic personality disorder involves exaggerated emotional reactions during everyday situations.

These emotional displays may seem theatrical or inappropriate for the situation.

A person may:

• Show exaggerated emotional reactions.
• Express emotions in a dramatic manner.
• Change emotional expressions suddenly and rapidly.

Key difference: The main feature is exaggerated and quickly changing emotional expression.

Narcissistic Personality Disorder

Narcissistic personality disorder involves difficulty understanding other people’s feelings and viewpoints, along with a strong need for admiration.

Characteristics include:

• A general lack of empathy for others.
• A need to receive admiration.
• Difficulty understanding another person’s perspective.
• Extreme sensitivity to other people’s opinions.

Key difference: The person may strongly seek admiration while having difficulty recognizing how others feel or see a situation.

Obsessive–Compulsive Personality Disorder

Obsessive–compulsive personality disorder involves perfectionism and inflexible behaviour.

A person may be:

• Strongly focused on perfection.
• Unwilling or unable to adjust established patterns.
• Preoccupied with patterns of thought and action that they cannot control.

Key difference: Perfectionism and inflexibility are central characteristics.

Paranoid Personality Disorder

Paranoid personality disorder involves strong distrust and suspicion of other people.

The person may believe, without reasonable evidence, that others are trying to exploit, harm, or deceive them.

Characteristics include:

• Distrusting other people.
• Believing others intend to cause harm.
• Suspecting that people are being dishonest.
• Believing others are betraying them.
• Looking for hidden meanings in messages.

The related term paranoia means extreme suspicion about a person or situation.

Key difference: The central feature is distrust, including suspicion of harmful intentions without reasonable evidence.

Schizoid Personality Disorder

Schizoid personality disorder involves a limited range of emotions and indifference toward social relationships.

A person may:

• Experience a narrow range of emotions.
• Show little emotional expression.
• Appear indifferent toward relationships with others.

The limited emotional range affects both what the person experiences and what they express.

Key difference: The person shows little interest in social relationships and has a limited range of emotional experience and expression.

3. Common Signs and Symptoms of Personality Disorders

Personality disorders can affect how people view themselves, understand others, respond emotionally, and behave in relationships.

The following signs and symptoms may occur.

Difficulties With Self-Awareness and Relationships

• Self-centred behaviour: A person may focus mainly on personal needs and adopt a “me first” attitude.
• Lack of personal accountability: A person may blame other people, society, or outside circumstances for their problems instead of accepting personal responsibility.
• Difficulty understanding others: A person may struggle to recognize another person’s perspective or show empathy.
• Manipulative or exploitative behaviour: A person may try to influence or take advantage of others to meet personal needs.

These difficulties can affect how a person interacts with others.

Emotional and Mental Health Difficulties

People with personality disorders may experience:

• Unhappiness or depression.
• Other mood disorders.
• Anxiety disorders.
• Vulnerability to other mental health problems, including obsessive–compulsive tendencies and panic attacks.

These problems can occur alongside the person’s existing behavioural patterns.

Difficulty Recognizing Personal Behaviour

Some people have a distorted or superficial understanding of themselves and how others perceive them.

For example, they may have difficulty recognizing:

• Behaviour that others find objectionable or unacceptable.
• Behaviour that damages relationships.
• Actions that are harmful to themselves.
• Personal experiences or problems that may have contributed to their disorder.

This limited self-understanding can make it difficult for the person to recognize what needs to change.

Difficulty Adapting to Social Expectations

A person may struggle to adjust their behaviour to fit the expectations of others.

Instead, they may attempt to change situations to suit their own needs.

This can include:

• Changing established rules.
• Introducing new conditions into situations.
• Trying to influence other people or the surrounding environment to meet personal needs.

This is an example of socially maladaptive behaviour, meaning behaviour that does not adjust well to social situations.

4. Changing Behaviour Patterns and Getting Support

Personality disorders involve long-standing patterns, which can be difficult to change.

Healing is possible, but it requires personal involvement and commitment.

The Desire to Change

First, the person must want to change.

A person needs to recognize the importance of changing established behaviour patterns.

Without this desire, breaking those patterns can be difficult.

Understanding Personal Experiences and Behaviour

Another important part of change is developing insight, or a better understanding of personal experiences and behaviour.

This may involve examining:

• Past experiences that affected the person.
• Personal feelings and reactions.
• Repeated patterns of behaviour.
• Experiences involving severe or repeated childhood trauma, such as abuse.

By gaining insight, a person can begin to understand their long-standing patterns more clearly.

Commitment and Support Systems

Changing established patterns also requires the person to take responsibility for making changes and remain committed to that process.

Support systems are usually necessary for full treatment.

Support systems may include therapy, self-help groups, friends, family, and medication.

These supports can be part of the person’s efforts to change and manage their difficulties.

5. Supporting Clients With Personality Disorders

As a CCA, your responsibility is to provide respectful, professional care within the client’s care plan.

Some clients with personality disorders may have difficulty understanding their feelings or managing them in the moment.

Your approach should remain caring and consistent.

Accept Clients Without Judgement

CCA action: You must accept clients in a caring, nonjudgemental manner.

This means treating the person respectfully, even when their behaviour creates difficulties.

A client may not fully understand their feelings or may be unable to manage those feelings at a particular moment.

Maintain a caring approach rather than judging the person.

Communicate in a Factual, Professional Manner

Speak to the client using factual, professional language.

Keep your communication focused on the situation and the care being provided.

A professional approach helps maintain appropriate interactions with the client.

Follow the Client’s Care Plan

CCA action: Provide care and support as directed in the client’s care plan.

Your care should be:

• Respectful.
• Efficient.
• Consistent with the established care plan.

The client’s personality disorder does not change the need to follow the planned care instructions.

Maintain Consistency Among Staff Members

All staff members need to interact with the client as consistently as possible.

Inconsistent approaches can create problems.

For example, a client may attempt to play one staff member against another when workers respond differently.

In a facility, this can cause confusion and disruption throughout the unit.

Consistency helps staff maintain a more unified approach when supporting the client.

Maintain Professional Boundaries

Professional boundaries apply to clients with personality disorders, just as they do to other clients in any care setting.

Avoid: Do not give the client your:

• Home telephone number.
• Personal email address.
• Private-life information.

Sharing these details may lead the client to believe you are inviting personal correspondence outside the care relationship.

Keep your professional role separate from your private life.

Do Not Accept Gifts or Money

CCA action: Do not accept gifts, money, or other items from clients.

A client may misunderstand your acceptance of a gift.

They might interpret it as:

• A sign of personal affection.
• An indication that they will receive special treatment.

The restriction applies to clients in all care settings.

Consult Family Members or Close Friends

Family members or close friends may know approaches that work well with the client.

Consult with them about ways to interact with and support the person successfully.

This can provide useful guidance when dealing with the client’s established patterns of behaviour.

Common Mix-Ups

These personality disorders have some characteristics that may sound similar, but they are not the same.

Wrong Idea	Better Idea
Avoidant and schizoid personality disorders describe the same social behaviour.	Avoidant involves social inhibition and sensitivity to criticism. Schizoid involves indifference to relationships and limited emotional expression.
Borderline personality disorder involves only rapid mood changes.	Borderline also involves instability in identity, relationships, reactions, impulsiveness, and self-image.
Histrionic and borderline personality disorders are identical because both can involve changing emotions.	Histrionic focuses on exaggerated, rapidly changing emotional displays. Borderline involves broader instability across several areas.