An introduction to Personality Disorders …

When we hear the word “disorder” we tend to think something isn’t functioning either as expected or “properly.” That’s the general idea when we look at what are described as personality disorders.

The American Psychiatric Association has a simple definition for Personality Disorder: “A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work, and school

There are 10 specific types of personality disorders usually divided into three different “clusters.” Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. Personality disorders affect at least two of these areas:

• • Way of thinking about oneself and others.
  • Way of responding emotionally.
  • Way of relating to other people.
  • Way of controlling one’s behavior.

CLUSTER A PERSONALITY DISORDERS:
Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include:

Paranoid Personality Disorder (PPD) – People with Paranoid Personality Disorder often appear odd or peculiar. The essential characteristic of people with PPD is paranoia, a relentless mistrust and suspicion of others without adequate reason to be suspicious. Researchers at Mayo Clinic offer more specific symptoms of PPD as possibly including:

• • Pervasive distrust and suspicion of others and their motives.
  • Unjustified belief that others are trying to harm or deceive you.
  • Unjustified suspicion of the loyalty or trustworthiness of others.
  • Hesitancy to confide in others due to unreasonable fear that others will use the information against you.
  • Perception of innocent remarks or non-threatening situations as personal insults or attacks.
  • Angry or hostile reaction to perceived slights or insults.
  • Tendency to hold grudges.
  • Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful.

Schizoid Personality Disorder – People who experience Schizoid Personality Disorder are often described as distant or withdrawn and tend to avoid social situations that involve interaction with other people. They find it difficult to express emotions and lack the desire to form close personal relationships. Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• • Lack of interest in social or personal relationships, preferring to be alone.
  • Limited range of emotional expression.
  • Inability to take pleasure in most activities.
  • Inability to pick up normal social cues.
  • Appearance of being cold or indifferent to others.
  • Little or no interest in having sex with another person.

Schizotypal Personality Disorder – Symptoms of Schizotypal Personality Disorder include odd speech, behavior, and appearance, as well as strange beliefs, difficulty forming relationships, and may experience excessive social anxiety. Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• • Odd perceptual experiences, such as hearing a voice whisper your name.
  • Flat emotions or inappropriate emotional responses.
  • Social anxiety and a lack of or discomfort with close relationships.
  • Indifferent, inappropriate or suspicious response to others.
  • “Magical thinking” — believing you can influence people and events with your thoughts.
  • Belief that certain casual incidents or events have hidden messages meant only for you.

CLUSTER B PERSONALITY DISORDERS:
Cluster B personality disorders are characterized by dramatic, emotional, or erratic thinking or behavior. They include:

Antisocial Personality Disorder – While personality disorders begin to show up by adolescence or early adulthood, Antisocial Personality Disorder tends to show up earlier than the other disorders by often beginning in childhood. Symptoms include a disregard for rules and social norms and a lack of empathy for other people. Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• • Disregard for others’ needs or feelings.
  • Persistent lying, stealing, using aliases, conning others.
  • Recurring problems with the law.
  • Repeated violation of the rights of others.
  • Aggressive, often violent behavior.
  • Disregard for the safety of self or others.
  • Impulsive behavior.
  • Consistently irresponsible.
  • Lack of remorse for behavior.

Borderline Personality Disorder (BPD) – People diagnosed with Borderline Personality disorder experience wide mood swings and can display a great sense of instability and insecurity. Per the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), diagnostic framework, some key signs and symptoms may include:

• • Frantic efforts to avoid real or imagined abandonment by friends and family.
  • Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”). This is also sometimes known as “splitting.”
  • Distorted and unstable self-image, which affects moods, values, opinions, goals and relationships.
  • Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse or reckless driving.
  • Self-harming behavior including suicidal threats or attempts.
  • Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
  • Chronic feelings of boredom or emptiness.
  • Inappropriate, intense or uncontrollable anger, often followed by shame and guilt.
  • Dissociative feelings — disconnecting from thoughts or sense of identity or “out of body” type of feelings — and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.

Histrionic Personality Disorder – People with Histrionic Personality Disorder display a pattern of excessive emotion and attention seeking. They may be uncomfortable when they are not the center of attention, and may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions. Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• • Constantly seeking attention.
  • Excessively emotional, dramatic, or sexually provocative to gain attention.
  • Speaks dramatically with strong opinions, but few facts or details to back them up.
  • Easily influenced by others.
  • Excessive concern with physical appearance.
  • Thinks relationships with others are closer than they really are.

Narcissistic Personality Disorder (NPD) – Individuals with Narcissistic Personality Disorder exhibit at least five or more of the following symptoms:

• • A grandiose sense of self-importance.
  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  • Belief that one is special and can only be understood by or associate with special people or institutions.
  • A need for excessive admiration.
  • A sense of entitlement (to special treatment).
  • Exploitation of others.
  • A lack of empathy.
  • Envy of others or the belief that one is the object of envy.
  • Arrogant, haughty behavior or attitudes.

You can learn more about this personality disorder in my previous blog post, “An Introduction to Narcissistic Personality Disorder,” here.

CLUSTER C PERSONALITY DISORDERS:
Cluster C personality disorders are characterized by fearful or anxious thinking or behavior. They include:

Avoidant Personality Disorder – This is another disorder that can show up during childhood, and is characterized by a disregard for rules and a lack of empathy and remorse. The American Psychiatric Association describes a person with Avoidant Personality disorder as someone who exhibits “a pattern of extreme shyness, feelings of inadequacy and extreme sensitivity to criticism. People with Avoidant Personality Disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept.” Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• • Too sensitive to criticism or rejection.
  • Feeling inadequate, inferior, or unattractive.
  • Avoidance of work activities that require interpersonal contact.
  • Socially inhibited, timid, and isolated, avoiding new activities or meeting strangers.
  • Extreme shyness in social situations and personal relationships.
  • Fear of disapproval, embarrassment, or ridicule.

Dependent Personality Disorder – This personality disorder involves a fear of being alone and often causes those who have the disorder to do things to try to get other people to take care of them. Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• Excessive dependence on others and feeling the need to be taken care of.
• Submissive or clingy behavior toward others.
• Fear of having to provide self-care or fend for yourself if left alone.
• Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions.
• Difficulty starting or doing projects on your own due to lack of self-confidence.
• Difficulty disagreeing with others, fearing disapproval.
• Tolerance of poor or abusive treatment, even when other options are available.
• Urgent need to start a new relationship when a close one has ended.

Obsessive-Compulsive Personality Disorder – Obsessive-compulsive Personality Disorder is different than Obsessive-Compulsive Disorder; the personality disorder is characterized by a preoccupation with orderliness, perfection, and control of relationships. Researchers at Mayo Clinic offer more specific symptoms as possibly including:

• • Preoccupation with details, orderliness and rules.
  • Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don’t meet your own strict standards.
  • Desire to be in control of people, tasks, and situations, and inability to delegate tasks.
  • Neglect of friends and enjoyable activities because of excessive commitment to work or a project.
  • Inability to discard broken or worthless objects.
  • Rigid and stubborn.
  • Inflexible about morality, ethics, or values.
  • Tight, miserly control over budgeting and spending money.

CONCLUSION: Personality disorders are treated through psychotherapy. There isn’t a medication for a specific personality disorder, but some types of medications such as mood stabilizers, antidepressants, anti-anxiety, and anti-psychotic medications may be prescribed to treat certain symptoms of a personality disorder.

Scotty