Personality disorders are mental health conditions that are characterized by pervasive and enduring patterns of thinking and behaving in ways that deviate from cultural norms and cause distress, either for the individual and/or for those who interact with them. Personality disorders generally present most clearly in adolescence or early adulthood and are relatively stable over time. These patterns of behavior may be manifested in symptoms that relate to cognitions (perceptions and thoughts), affectivity (emotional responses), interpersonal functioning (relationships), and/or impulse control, and cannot be better explained by another mental disorder, the physiological effects of a substance, or another medical condition.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists 10 unique personality disorders that each have specific diagnostic criteria, risk and prognostic factors, prevalence, and developmental course. These personality disorders are clustered into 3 groups based on descriptive similarities. Cluster A includes personality disorders that are characterized as odd and eccentric, cluster B includes personality disorders that are characterized as dramatic, emotional, or erratic, and cluster C includes personality disorders that are characterized as anxious or fearful.
Cluster A Personality Disorders
Paranoid personality disorder involves a core sense of suspiciousness and distrust of others. Individuals diagnosed with this disorder tend to be preoccupied with questions of loyalty and trustworthiness and are typically reluctant to confide in others due to their unwarranted fear that the person will use the information to intentionally hurt them. They have a tendency to hold grudges and to read into relatively benign comments and interactions as evidence of threat, exploitation, or other forms of malicious intent.
Schizoid personality disorder is characterized by intense detachment from social relationships and emotional responsiveness. Individuals diagnosed with schizoid personality disorder do not desire or enjoy close relationships. Rather, they demonstrate a strong preference for solitary activities and appear indifferent towards most, if not all, activities and relationships. They do not take pleasure in praise nor do they tend to feel hurt by criticism and outside of first-degree relatives, they rarely have any close friends or confidants.
Schizotypal personality disorder differs from schizoid personality disorder in that the individual often desires relationships, but feels intense anxiety and discomfort interacting with and relating to others. Individuals diagnosed with schizotypal personality disorder have marked challenges with socializing that coupled with eccentricities and other unusual experiences and behaviors often lead to isolation, suspiciousness, and interactions with others that appear odd or unusually restricted. Delusions, such as believing they have special powers, are common features of this diagnosis, which tends to further differentiates them from those who more easily fit within the social norms expected of their cultural group.
Cluster B Personality Disorders
Antisocial personality disorder is often misunderstood in common vernacular as it does not describe an individual who simply prefers to be alone due to being more introverted than extroverted. Instead, antisocial personality disorder describes an individual who displays a consistent pattern of disregard for the rights of others and a tendency to openly violate these rights or to superficially rationalize their behaviors as reasonable or warranted. These individuals fail to conform to many social norms and engage in deceitful, impulsive, manipulative, and/or aggressive actions that demonstrate irresponsibility and relative limitations in their ability to prioritize and respect the rights, feelings, and wishes of others.
Borderline personality disorder is marked by significant instability and impulsivity in a variety of emotional and behavioral contexts. The core features of instability manifest in interpersonal relationships, self-image, and emotional experiences and responses in ways that trigger fears of abandonment or rejection and that ultimately increases the likelihood that these feared outcomes will occur. Individuals diagnosed with borderline personality disorder engage in impulsive behaviors that are often self-damaging, such as overspending, binge eating, and engaging in risky sexual interactions and substance use. Suicidal behaviors, gestures, and threats are common as are chronic feelings of emptiness, anger, and stress-related paranoia.
Histrionic personality disorder involves an excessive display of emotionality and attention-seeking. Individuals diagnosed with histrionic personality disorder are uncomfortable in situations where they are not the center of attention and, therefore, tend to engage in behaviors that draw attention to themselves, such as through dressing provocatively or speaking in a dramatized or exaggerated fashion. These individuals appear lively and charming and often initially come across as the “life of the party.” However, over time, their need for attention and tendency to express superficial emotions that rapidly shift from moment-to-moment lead many to eventually interpret them as desperate, dramatic, inauthentic, or overwhelming, which leads many individuals to distance themselves from these relationships.
Narcissistic personality disorder is another diagnosis that is often misused in our common vernacular. While narcissism can be used to describe someone who is acting selfishly or arrogantly, narcissistic personality disorder is a much more pervasive sense of grandiosity, need for admiration, and lack of empathy. Individuals diagnosed with narcissistic personality disorder tend to be consumed with fantasies of success, beauty, brilliance, or power. They believe they are special and that only other individuals with their level of status or talent are able to understand them and are invited to associate with them, regardless of whether their achievements are commensurate with their perceived degree of self-importance. They come across as entitled because they unreasonably expect favorable treatment and default compliance, and often display arrogant behaviors and attitudes. They can be interpersonally exploitative and are generally unwilling to recognize or identify with the feelings and needs of others.
Cluster C Personality Disorders
Avoidant personality disorder involves a pervasive pattern of social inhibition, characterized by intense feelings of inadequacy and fears of rejection, disapproval, criticism, or embarrassment. These individuals are hypersensitive to the behaviors of those around them and are often unwilling to interact with others unless they’re certain of being liked and accepted. They tend to view themselves as inferior and socially inept, which furthers their reluctance to take risks in interpersonal situations or opportunities that may lead to shame or ridicule. Rather than risk disapproval or criticism, these individuals demonstrate a strong pattern of avoidance and tend to appear shy, quiet, or otherwise inhibited in social settings and interactions.
Dependent personality disorder is characterized by a deep need for others to care for them in ways that lead to submissive and clingy behaviors that reflect their desperate attempt to avoid being alone or helpless. Individuals diagnosed with dependent personality disorder experience a pervasive fear of losing support and thus avoid expressing disagreement with others or engaging in any behaviors that might increase the risk of rejection or abandonment. They will often go to great lengths to ensure support from certain individuals, including engaging in behaviors they strongly dislike and seeking guidance and reassurance from others before making most decisions.
Obsessive-compulsive personality disorder is distinctly different than obsessive-compulsive disorder (OCD), which is characterized by the presence of obsessions (recurrent thoughts, images, or urges), compulsions (repetitive behaviors or mental acts aimed at preventing or reducing distress), or both. Conversely, obsessive-compulsive personality disorder is marked by an intense preoccupation with orderliness, perfectionism, and control, which comes at the expense of flexibility, openness, and efficiency. Individuals diagnosed with obsessive-compulsive personality disorder are excessively devoted to productive pursuits, often at the exclusion of leisure activities and friendships. They tend to be black-and-white thinkers who value clear rules, strict standards, and rigid approaches to ethics and morality. These views influence miserly spending habits, a reluctance to delegate to anyone who does not explicitly comply with their rules, and an overall rigid and stubborn approach to life and relationships.
Next week, we will be posting an interview with Rachel McMurray, MA, LMFT, who specializes in the treatment of individuals diagnosed with cluster B personality disorders (antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder). Please check in with us next week to learn much more about the common misconceptions, contributing factors, and effective strategies for improving the lives of the individuals diagnosed with these disorders!