What are personality disorders?

Personality disorders are ways of describing dysfunctional personalities. They are persistent, life-long ways of behaving that are disruptive. Currently, personality disorders are placed in three clusters:

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Paranoid personality disorder is characterized by:

· 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

· An unreasonable fear that others will use information you confide against you

· Perception of innocent remarks or nonthreatening 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 is characterized by:

· 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

Schizotypal personality disorder is characterized by:

· Peculiar dress, thinking, beliefs, speech or behavior

· 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 incidents have hidden messages meant only for you

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

Antisocial personality disorder is characterized by:

· 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 is characterized by:

· Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating

· Unstable or fragile self-image

· Unstable and intense relationships

· Up and down moods, often as a reaction to interpersonal stress

· Suicidal behavior or threats of self-injury

· Intense fear of being alone or abandoned

· Ongoing feelings of emptiness

· Frequent, intense displays of anger

· Stress-related paranoia that comes and goes

Histrionic personality disorder is characterized by:

· 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

· Shallow, rapidly changing emotions

· Excessive concern with physical appearance

· Thinks relationships with others are closer than they really are

Narcissistic personality disorder is characterized by:

· Belief that you're special and more important than others

· Fantasies about power, success and attractiveness

· Failure to recognize others' needs and feelings

· Exaggeration of achievements or talents

· Expectation of constant praise and admiration

· Arrogance

· Unreasonable expectations of favors and advantages, often taking advantage of others

· Envy of others or belief that others envy you

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

Avoidant personality disorder is characterized by:

· Being overly 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 is characterized by:

· Excessive dependence on others & 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 is characterized by:

· 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

As you most likely suspect if you’ve read this far, a lot of this sounds like descriptions of ourselves and everyone we know. A good deal of psychiatric diagnosing exists for insurance billing purposes. I think I could find a DSM-5 diagnosis for almost every living human being.

So, please don’t label anybody.

These disorders only really matter when they cause pain or suffering to self or others. I’ve known obsessive-compulsive people who would be a pain for me to live with, but who make really good accountants. Schizoid personality disorder is easily confused with neurodivergent people. In fact, all of the symptoms bulleted above exist on a spectrum that ranges from “we all do that,” to “what a fun, creative, eccentric person,” to “it would be toxic to be in a relationship with that person.” We don’t want to go around labeling people just because they’re different.

There are, however, red flags when it comes to relationships.

Antisocial personality disordered people used to be called sociopaths, and before that, psychopaths. They make up the majority of career criminals. They lack a conscience. They can be dangerous.

Borderline PD people either love and adore you, or despise and hate you. There is no in-between. Some therapists refuse to treat borderlines because they know the time will come when they will file law suits against them. Borderlines not uncommonly engage in self-harm.

Histrionic PD people demand attention and make mountains out of molehills.

Those with dependent personality disorder enable addicts and allow themselves to be abused.

Many politicians and captains of industry are narcissistic. Narcissistic personality disordered people have no ability to empathize. They use others. Others exist only as means to their ends. They have no conscience. What is right is what benefits them.

Probably the majority of those with personality disorders do not seek help. They are comfortable with being the way they are and will only change through negative reinforcement. The antisocial PD person might eventually learn to stop his criminal behavior, but he does so because he’s tired of being locked up, not because he cares about others.

We now know that many psychiatric disorders of every kind involve an imbalance of brain chemistry, as well as deep early childhood woundedness. We now know that there is hope of recovery for everyone, or almost everyone. And we know that the pathway to recovery usually involves a combination of pharmacological and talk-therapy intervention. And, we know that other illnesses and injuries can cause similar symptoms, so treatment often involves MRIs, CT scans, blood tests, and complete physicals. Most psychiatrists no longer sit for years behind patients stretched out on couches free associating. Instead, they rule out physiological causes and prescribe medications that can reduce symptoms enough to allow a person to focus on talk-therapy with a psychologist.