Many definitions for personality disorders closely resemble the personality trait of high sensitivity. There is a level of impairment, inflexibility and pervasive distress that differentiates personality disorders from an innate trait of high sensitivity, that need to be clarified to prevent misdiagnosis.
Four Personality Disorders that may co-occur with the high sensitivity trait are:
1. Borderline Personality Disorder
2. Obsessive Compulsive Personality Disorder
3. Avoidant Personality Disorder
4. Dependent Personality Disorder
Borderline Personality Disorder (BPD):
Highly sensitive people and those with BPD might at first glance seem quite similar, for example, the intense emotionality, reactivity of mood, low self-esteem, and the efforts to avoid real or imagined abandonment. However, some key features differentiate an highly sensitive person from those with a diagnosis of BPD, most notably the level of impairment regarding mood instability. Those with BPD may lack the ability to regulate their own emotions, and may experience hyperirritability, exaggerated or chaotic responses, impulsivity, aggression, unstable/fluctuating self-image, and attachment insecurity. Two additional common features for BPD is the impact of severe childhood trauma, and self-harming behaviours. These cases are where you are most likely to see a co-occurrence of BPD with high sensitivity. An HSP is more likely to withdraw from overwhelming negative emotions and avoid harming the relationships they need, whereas a person with BPD may act out due to overwhelming negative emotions, and potentially be aggressive and develop extreme black and white beliefs about the value of the relationship to themselves.
Obsessive Compulsive Personality Disorder (OCPD):
All HSP’s are likely to identify with some of the criteria for OCPD, particularly those features that identify with the need to do things the right way. Needing to do things “the right way” is not in itself an issue if it means that work is thorough and effective, and in some balance with life. This becomes a disorder when the behaviours become pervasive, at the expense of relationships, quality of life and productivity in other areas are affected, significant control issues are present or when the true meaning of the activity becomes lost.
Avoidant Personality Disorder (APD):
Highly Sensitive People may be quiet, reserved, overly cautious and concerned about being judged, particularly when it comes to group situations and unfamiliar people. The majority, (70%) of HSPs are introverts and prefer smaller social circles of a trusted few, and may relish quieter spiritual or natural pathways rather than vibrant social contact. However, avoidant personality disorder occurs with extreme preoccupations with avoiding criticism, disapproval, rejection, and overall negative evaluation. There may be a reluctance to participate in close relationships, or take risks that do not have guaranteed outcomes. Unrealistic fears inhibit social interaction, even low-risk situations, and there may be strong feelings of social inadequacy.
Dependent Personality Disorder (DPD):
There is some speculation that Dependent Personality Disorder will be omitted from the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), however for now it is in the current DSM V (5). There can be a number of similarities between an HSP and someone with DPD. Both may lack life skills and have a strong need for others to help support them with decisions making, financial management or being the family spokesperson. However someone with DPD may not be able to make decisions independently if they had to and will avoid circumstances that are over stimulating for them. The dependency is rooted in a debilitating sense of shame where low self-esteem has manifested and self-expression has become restricted. There is often a relationship with a trauma that has impacted the individuals confidence, an insecure attachment style from early development and/or a patriarchal family upbringing where a prominent family figure was the provider for the dependents in the family.
Dr Elaine Aron has distinguished the difference between high sensitivity and personality disorders in a book she has written for Psychotherapists. This page offers a very brief comparison based on her distinctions to assist your understanding. Please note that this information is not intended to substitute professional medical treatment and is not adequate for a diagnosis of an Personality Disorder.