Aspects of the 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. Avoidant Personality Disorder
3. Obsessive Compulsive 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 are 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 who does not have BPD is more likely to withdraw from overwhelming negative emotions and avoid harming the relationships they need, whereas a person with BPD may act out in relationships due to overwhelming negative emotions, and potentially be aggressive or develop extreme black and white beliefs about the value of the relationship to themselves. Those with BPD are more likely to experience severely chaotic relationships.
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 of HSPs are introverts (70%) who prefer smaller social circles of a trusted few, and may relish quieter spiritual or natural pathways rather than vibrant, exhuberant 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.
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 issue becomes a disorder when the behaviours become pervasive, at the expense of relationships, quality of life, productivity in other areas and when significant control issues are present or when the true meaning of the activity has become lost.
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. There can be a number of similarities between an HSP and someone with DPD, in which 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.
Many individuals with personality disorders also have
Post-Traumatic Stress Disorder.
Post-Traumatic Stress Disorder (PTSD) or Complex PTSD:
HSP’s in distress may appear to have some PTSD symptoms. Perhaps they have strong physical symptoms of anxiety and re-occurring frightening dreams or vivid memories of an upsetting time. PTSD requires that a trauma meeting specific criteria will have occurred, and there may also be detachment from others, excessive startle response, nightmares relating to the trauma, insomnia, insecure attachment, among other things. It is important to note that HSP’s have stronger emotional reactions than others, and therefore may recall events as more significantly impacting than a non-HSP’s memory of a similar event. Although distressed and impacted about the past, it is not PTSD unless the trauma meets particular criteria and these additional issues are present. Complex PTSD would be relevant for any person who has experienced multiple or reoccuring trauma in the past.
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.