Psychological Disorders

Personality Disorders

When personality traits get in the way of social and occupational growth and create psychological distress, they constitute a personality disorder.

Personality traits are enduring patterns of thoughts, feelings, or behaviors that appear across situations and over time. Every person has a unique combination of personality traits. Most traits are not either good or bad in and of themselves. For example, extraversion is often a positive trait at a party but may be a poor fit for a quiet and reserved workplace. Extreme personality traits are those that cause problems for the person with those traits or for the people around them. A personality disorder is characterized by stable patterns of thoughts, feelings, attitudes, or behaviors that cause significant distress or interfere with relationships or work. The DSM-5 includes 10 personality disorders, divided into three clusters. Personality disorders within each cluster often overlap, with people meeting diagnostic criteria for multiple disorders within a cluster.

Cluster A personality disorders involve odd or eccentric traits such as extreme social withdrawal, lack of emotional expression, and distorted thinking. This cluster includes paranoid, schizoid, and schizotypal personality disorders. People with paranoid personality disorder distrust everyone. They are sensitive to perceived insults or attacks on their self-image and fear humiliation. Not surprisingly, they have difficulty maintaining close relationships. People with schizoid personality disorder have trouble forming relationships and tend to avoid social contact. People with this disorder may want intimacy but not have the skills to create relationships. Schizotypal personality disorder manifests as odd behavior, appearance, and speech. For example, people with schizotypal personality disorder may believe they can read minds. All of Cluster A personality disorders show some symptom overlap with psychotic disorders and are more likely to occur in people related to someone with a psychotic disorder.

Cluster B personality disorders are alike because they involve dramatic, emotional, or unpredictable behavior and limited awareness of the impact of that behavior on others. Antisocial personality disorder (APD) is a personality disorder in which a person has no empathy and feels comfortable violating social norms by breaking rules, lying, being arrogant, violating the rights of others, acting impulsively, manipulating people, taking risks, and failing to learn from mistakes. Many people with APD engage in criminal behavior, but not all break the law or act violently. People with APD can be found among the ranks of national leaders and corporate CEOs. Some people with APD lack empathy for others and do not experience guilt when they harm people. Most people with APD have difficulty maintaining long-term relationships. Some people with APD would be considered sociopaths or psychopaths. These are not official diagnostic terms but have been used in research and the criminal justice system to describe people who lack empathy, rarely experience fear, and engage in reckless and harmful behavior.

A person with borderline personality disorder is characterized by unstable personal relationships, unstable sense of self, and impulsive, angry, and sometimes violent behavior. They experience frequent mood swings and feelings of emptiness. They are quick to feel abandoned or betrayed and suffer from unstable personal relationships. Borderline personality is also characterized by impulsive, angry, and sometimes violent behavior. Aggression may be directed at others or toward the self through suicide attempts, cutting, or other forms of self-harm. Narcissistic personality disorder is characterized by feelings of extreme self-importance. Narcissists lack empathy and are self-absorbed, intolerant, and insensitive toward the needs and feelings of others. People with histrionic personality disorder are theatrical and seek attention through showy emotional displays. They are easily hurt but also egocentric and unaware of the impact of their behavior on others.

Cluster C personality disorders are strongly linked to anxiety. People with avoidant personality disorder are socially inhibited and feel inadequate. They fear being criticized and rejected and tend to think of themselves in a negative light. Dependent personality disorder is characterized by a lack of self-confidence that causes people to cling to others in order to protect them and look after them. Obsessive-compulsive personality disorder does not involve obsessions and compulsions seen in OCD. Instead, people with this disorder tend to be perfectionistic, overly formal, overly detail-oriented, and inflexible. Their inability to tolerate ambiguity and complexity leads to difficulty in relationships at work.

People rarely seek treatment for these disorders, since their personality, however maladaptive, seems normal to them. Often, they assume that the problem lies with other people, rather than recognizing that their own behavior is the source of their social difficulties. It is estimated that about 9.1 percent of Americans suffer from a personality disorder.

Personality Disorder Clusters

Cluster A

Odd or Eccentric

Cluster B

Dramatic or Emotional

Cluster C

Anxious or Fearful

Paranoid Distrustful and suspicious Histrionic Dramatic and attention seeking Avoidant Socially inhibited, fear rejection, and hypersensitive to criticism
Schizoid Solitary, aloof, and emotionally unexpressive Narcissistic Entitled, status focused, and lack empathy Dependent Cling to others for support and fear being alone
Schizotypal Eccentric and socially disconnected Borderline Unstable moods, feelings of abandonment, impulsivity, and self-harm Obsessive-Compulsive Perfectionistic, rule-focused, and overly rigid
Antisocial Lack concern for others, impulsive, and violate rules

The DSM categorizes personality disorders into three broad clusters based on symptom similarity.