Personality disorders are a class of mental health disorders characterized by pervasive, maladaptive and chronic patterns of thoughts, feelings, and behaviors that deviate from societal norms. These cause significant impairment in social, occupational, and other areas of functioning. Personality disorders typically manifest in early adulthood and continue throughout the individual’s life.
Personality disorders are classified in the DSM-5 (used by medical professionals to diagnose mental health issues) into three clusters based on their characteristics and symptoms.
Cluster A disorders include paranoid, schizoid, and schizotypal personality disorders. Individuals with these disorders are often perceived as odd or eccentric and may display symptoms of social detachment, suspiciousness, and unusual perceptual experiences.
Cluster B disorders include borderline, narcissistic, histrionic, and antisocial personality disorders. These disorders are characterized by dramatic, erratic, and emotional behavior and may involve impulsivity, manipulativeness, and a lack of empathy.
Cluster C disorders include avoidant, dependent, and obsessive-compulsive personality disorders. Individuals with these disorders may be anxious, fearful, and preoccupied with details and may have difficulty making decisions and forming relationships.
Symptoms of personality disorders can vary widely depending on the specific disorder and individual but generally include:
The World Health Organization estimated the prevalence of having a personality disorder to be 6.1%, with clusters A, B, and C at 3.6%, 1.5%, and 2.7%. As such, these disorders are relatively rare. Antisocial personality disorders are more likely to be men, whereas borderline, histrionic, and dependent are more often women.
Personality disorders are one of the most difficult disorders to treat in psychiatry. The patient will not see his or her behavior as being maladaptive but instead will feel egosyntonic. That is, they may not perceive anything wrong and view their perceptions and behavior as reasonable and appropriate. Believing this, the patient will have difficulty acquiescing to treatment. Most patients with personality disorders often have little to no insight in regards to their maladaptive behavior [1].
There are no medications currently approved to specifically treat any personality disorder. Effective treatment options for personality disorders may include:
Psychotherapy, particularly Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), are often used to help individuals with personality disorders develop coping skills and improve their interpersonal relationships.
Medications such as antidepressants, mood stabilizers, and antipsychotics may also be used to manage specific symptoms of personality disorders.
Hospitalization may be necessary in cases where individuals are a danger to themselves or others.
Because of the lack of insight by the patient, family and friends must remain vigilant and persuade the patient to seek treatment.
The causes of personality disorders are not well-understood. Personality disorders can develop due to a variety of factors, including environment, life experiences and genetics.
Cluster A disorders are characterized by odd, eccentric, and unusual behavior. There are three types of Cluster A disorders: paranoid, schizoid, and schizotypal. Additionally, individuals with these disorders may not necessarily exhibit all of the symptoms associated with them, and each person’s experience with the disorder may be unique.
People with PPD are suspicious and distrustful of others, believing that others are out to harm or deceive them. They often interpret other people’s motives as malevolent, and are hyper-vigilant for signs of betrayal or treachery. They may hold grudges and be unforgiving, and may be easily angered or provoked. PPD can make it difficult for people to form and maintain relationships with others, as their suspicious and mistrustful nature can lead them to be very guarded and defensive. They may also have difficulty accepting constructive criticism, and may feel that others are trying to undermine them.
People with SPD have a disinterest in forming close relationships with others, and often prefer solitary activities. They may have few close friends, and may seem indifferent to praise or criticism from others. They may also have little interest in sexual relationships, and may appear emotionally cold or distant to others. People with SPD may have a rich inner world, but have difficulty expressing their thoughts and feelings to others.
People with STPD may have unusual beliefs or behaviors, and may be superstitious or have magical thinking. They may have difficulty forming close relationships with others, and may have a tendency to withdraw from social situations. They may also have difficulty with communication, including unusual speech patterns or unusual or paranoid ideas. STPD can make it difficult for people to function in daily life, as they may have difficulty with personal hygiene, work, or other activities of daily living.
This typically involves a combination of therapy and medication. Cognitive Behavioral Therapy (CBT) can be particularly helpful for people with PPD, as it can help them challenge their mistrustful and suspicious thoughts and develop more positive relationships with others.
For people with SPD, social skills training and group therapy can be helpful in developing the skills necessary for building and maintaining relationships with others.
STPD can be particularly challenging to treat, but therapy can help individuals learn to manage their symptoms and develop coping strategies to manage their daily lives.
While medication is not typically used as a primary treatment for Cluster A disorders, certain medications may be helpful in managing specific symptoms associated with these disorders. For example, antidepressants may be helpful in managing depressive symptoms associated with SPD, while antipsychotic medications may be helpful in managing delusions or hallucinations associated with STPD.
Cluster B personality disorders are characterized by emotional dysregulation and dramatic or erratic behavior. Individuals with Cluster B personality disorders may struggle with impulse control, lack empathy for others, and experience intense emotional reactions.
There are four types of Cluster B personality disorders, including:
Individuals with BPD may struggle with intense and unstable relationships, impulsivity, identity disturbances, and affective instability. A high proportion engage in self-harm and some in suicidal behaviors. According to research, BPD affects approximately 1.4% of the population.
Individuals with NPD may have an exaggerated sense of self-importance, a need for admiration, and a lack of empathy for others. They may struggle with arrogance, entitlement, and exploitative behavior. Research suggests that NPD affects approximately 0.5-5% of the population.
Individuals with HPD may engage in attention-seeking behaviors, have an exaggerated emotional expression, and be overly concerned with physical appearance. They may also struggle with impulsivity, suggestibility, and the need for immediate gratification. According to research, HPD affects approximately 2-3% of the population.
Individuals with ASPD may engage in criminal behavior, disregard for the rights of others, and lack empathy or remorse for their actions. They may also struggle with impulsivity, aggression, and deceitfulness. Research suggests that ASPD affects approximately 0.2-3.3% of the population.
There are multiple causes of Cluster B personality disorders, with a combination of genetic and environmental factors contributing to their development. Childhood trauma and neglect, as well as certain parenting styles (e.g., overindulgence or neglect), have been linked to the development of Cluster B personality disorders. Additionally, individuals with these personality disorders may have experienced a lack of emotional validation and support during childhood, leading to a heightened need for attention and validation in adulthood.
Effective treatment for Cluster B personality disorders typically involves a combination of psychotherapy and pharmacotherapy. Dialectical Behavior Therapy (DBT) is a type of psychotherapy that has been shown to be effective in treating BPD. DBT emphasizes skills training in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
Cognitive Behavioral Therapy (CBT) has also been found to be helpful in treating NPD and ASPD. Pharmacotherapy, such as mood stabilizers or antipsychotic medications, may also be used in conjunction with psychotherapy to manage symptoms of Cluster B personality disorders.
Cluster C refers to a group of personality disorders that cause long-term feelings of anxiety and insecurity and impact much of life. They include avoidant, dependent, and obsessive-compulsive personality disorders [2].
People with AvPD have a deep-seated belief that they are unworthy or inferior. They believe that others believe this too. This causes an overwhelming fear of being negatively evaluated by others, even though they might long for connection.
To cope with these feelings, a person with AvPD may avoid: most social interactions, situations that might expose them to potential disapproval, trying new things or going to new places that might mean they have to talk to people. When they do interact with others, they often suppress their true feelings, opinions, or beliefs and are very sensitive to rejection or criticism.
People with DPD feel helpless and have an excessive fear of separation or being left alone, causing them to depend on other people to take care of them. Symptoms can include:
OCPD involves a preoccupation with control, orderliness, and perfection. People with OCPD believe that their way is the only “correct” way of doing things and set very high standards for themselves and others. Symptoms can include:
As with other personality disorders, the causes of cluster C personality disorders are complex. They likely occur due to a combination of factors, which may include: genetics, childhood experiences, temperament, culture.
Treatment for Cluster C personality disorders often involves a combination of psychotherapy and medications to help manage overlapping symptoms like anxiety and depression.
Most cluster C disorders benefit from cognitive behavioral therapy (CBT). This type of psychotherapy supports you in identifying unhelpful thoughts and behaviors — and then helps you to establish new, beneficial ones.Pharmacotherapy, such as mood stabilizers or antipsychotic medications, may also be used in conjunction with psychotherapy to manage symptoms of Cluster B personality disorders.
If you or a loved one are looking for a compassionate space to address mental health issues such as personality disorders, reach out to our Admissions team now at Corner Canyon Health Centers.
[1] Farib K. et al. 2023. Personality Disorder. National Library of Medicine. National Center for Biotechnology Information.
[2] Cluster C personality disorders: What to know. 2023. Medical News today
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