Psychologists typically do not diagnose children with personality disorders. This is because their personality is still developing and can change quickly as they grow.
However, a child may show early signs of a personality disorder as it develops. For example, symptoms of borderline personality disorder can be evident from adolescence.
In the past, the Diagnostic and Statistical Manual of Mental Disorders (DSM) did not allow personality disorder diagnoses at all in people under age 18 years. However, the revised fifth edition (DSM-5-TR) does allow a diagnosis for most personality disorders if a person has symptoms for 1 year or longer.
Here, learn more about the possible early signs of personality disorders in children, other mental health conditions, and how doctors treat them.
The idea of children having personality disorders is controversial. Many psychologists and psychiatrists will not diagnose them in younger children as a rule.
The reason for this is that children’s personalities develop and change over time. What is a challenging behavior at one age may disappear at another.
For example, a
This is consistent with other research on the topic, suggesting that it is usual for children to have traits that can be part of personality disorders in adults. In most cases, they fade as the child matures.
Until mental health professionals are fairly sure the trait is fixed, long term, and pervasive, a diagnosis of a personality disorder can be difficult to make. If the trait remains consistent throughout adolescence, it could be an early sign of a personality disorder.
Below are the different personality disorders that exist and their key features:
| Cluster | Disorder | Common features |
|---|---|---|
| A | paranoid personality disorder | • difficulty trusting others • difficulty relaxing • perceiving threats and danger that others do not see |
| A | schizoid personality disorder | • difficulty forming relationships • preferring to be alone • emotional indifference |
| A | schizotypal personality disorder | • distorted thoughts and perceptions • unusual use of language • feeling anxious around others • believing they have a special power |
| B | antisocial personality disorder | • risky, possibly illegal behavior • aggression or fighting • behavior that hurts others • a conduct disorder diagnosis before a person is age 15 years |
| B | borderline personality disorder (BPD) | • emotional instability • impulsivity • self-harm and thoughts of suicide • no strong sense of self or identity • other mental health problems, such as anxiety |
| B | histrionic personality disorder | • needing to entertain and be the center of attention • constantly seeking others’ approval • easily influenced by others • reputation for being dramatic |
| B | narcissistic personality disorder | • feeling superior to others • needing attention and approval • putting own needs above others’ needs |
| C | avoidant personality disorder (APD) | • intense fear of rejection or negative judgment • avoidance of social situations • feeling inferior to others • difficulty forming relationships |
| C | dependent personality disorder | • feeling consistently helpless and dependent on others • allowing others to take care of their life • fear of being alone • low self-confidence |
| C | obsessive-compulsive personality disorder | • perfectionism and unrealistically high standards • following rules rigidly • a need for order and control • anxiety about making mistakes |
It is worth noting that some of these symptoms can be similar to those of other mental health conditions. For example, APD has symptoms that are similar to social anxiety.
Because clinicians do not usually diagnose personality disorders in children, there are no specific diagnostic criteria for the signs of personality disorders in children.
The symptoms of personality disorders can also vary significantly depending on the disorder.
Some of the potential symptoms of personality disorders in adults include:
- an intense fear of rejection, abandonment, or imperfection
- having unusual perceptions or beliefs, such as believing they can read minds
- a lack of empathy for others
- significant distrust of others
- disinterest in social relationships
- having flat or limited emotions
- unstable, exaggerated, or dramatic emotions
- wanting to be the center of attention at all times
- believing they are superior to others
- manipulative or abusive behavior
It is important to remember that many of these signs can be a typical part of child development. Many young children have big emotions, have difficulty empathizing with others, and can be manipulative on occasion. This does not necessarily indicate there is an issue.
If the behaviors are persistent, affect many aspects of life, and are markedly different from how other children behave, they may have a mental health condition.
However, differences can also be a product of neurodivergence or other mental health conditions that are not personality disorders. The only way to be sure is to ask a qualified mental health professional for advice.
Other mental health conditions that occur in children and adolescents include:
- anxiety disorders
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- depression
- eating disorders
- substance misuse
Some of these conditions can cause symptoms that are similar to those of certain personality disorders. For example, depression can cause a person to become withdrawn and less interested in social relationships.
Some behavioral disorders can also resemble antisocial personality disorder, such as oppositional defiant disorder and conduct disorder.
Talk therapy is the main treatment for personality disorders and many other mental health conditions.
Many types of talk therapy exist. Some have specific uses for specific conditions. For example, dialectical behavioral therapy can help with BPD. A child psychologist or psychiatrist can advise on the best approach after assessing a child for their symptoms.
The
The psychologist may work with the child alone or in a group. They may also involve the family, teachers, and other key figures in the child’s life.
Depending on the child’s age, therapy may involve talking, playing, and other activities to encourage the individual to talk about their feelings. In some cases, medication may be appropriate.
Learn more about therapy for children.
Anyone who has concerns about a young person’s mental health can speak with a mental health professional for guidance. They may be able to offer reassurance or advice on the next steps to take.
It may also be a good idea to try talking with the individual about their feelings. The child may have things going on in their life that adults are unaware of. Giving them an opportunity to talk, if they want to, can help open up a dialogue.
If they would prefer, they could also talk with a school counselor or another trusted adult.
If a young person is at risk of suicide, seek help at once.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Here are some questions people often ask about personality disorders in children.
How do I know if my child has a personality disorder?
Child mental health can be complex, so only a specialist can make this diagnosis.
At what age can a child be diagnosed with a personality disorder?
Previously, health professionals only diagnosed personality disorders in people over the age of 18 years. Now it is possible to diagnose below this age, but it is controversial.
Personality disorders are difficult to diagnose until a child becomes an adult. This is because, during childhood, the personality undergoes major changes.
Additionally, research has shown that many potential traits of personality disorders in children tend to decline as they get older. This may be a typical part of growing up.
This makes it challenging for mental health professionals to know what is a temporary symptom or phase, and what is not.
However, even when this is the case, mental health support may be beneficial for helping children manage symptoms such as anxiety, anger, or difficulty forming relationships. A specialist can also help with screening for other potential explanations, such as neurodivergence.