Personality disorders are common, interesting, ambiguous to diagnose, and can cause significant distress to the individual. There are lots of types and every person will almost certainly find traits in multiple categories which they feel reflect their own personality. But when is it a disorder?
Inflexible thought patterns
Repeated episodes of behaviour, which may be destructive – those with a personality disorder may end up in the same problematic situations over and over again even though they know it is not good for them
Longstanding impairment of functioning as a result of these difficulties in adapting thoughts and behaviours.
To diagnose a personality disorder, the sufferer must display significant distress or impairment across multiple situations – including personal, social, romantic, and occupational.
The sufferer of personality disorders often lead reasonably functional lives, but struggle with maintaining stable jobs, relationships or friendships. They may not seek psychological help, as their personality vulnerabilities are so integral to them as a person that they don’t realise that they have a condition or that they can be helped.
When a mental health professional meets a client who they feel might have a personality disorder, they consider whether the client has any of four criteria. The diagnostic criteria state that they must have at least two, and they must be “significant” (having a major impact) and “enduring” (lasting for a long period of time).
Distorted thinking patterns
Problematic emotional responses
Over- or under-regulated impulse control
They must also consider the individual characteristics that form the criteria for each disorder in order to propose that the client has one of the 10 personality disorders. Often they might fit into more than one category and end up with multiple diagnoses.
Discussing personality disorders as “clusters” is a matter of preference and varies between healthcare networks, but for the purposes of education they are quite useful. A cluster is a group of similar disorders that share common characteristics are:
Cluster A (the “odd, eccentric” cluster);
Cluster B (the “dramatic, emotional, erratic” cluster); and,
Cluster C (the “anxious, fearful” cluster).
Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders
The common features of Cluster A disorders are social awkwardness and social withdrawal.
The Paranoid Personality Disorder
Distrust and suspicion of other people
This can be a belief that people want to harm, abuse, take advantage of or defame them in some way
They often get into a habit of protecting themselves from others both physically and emotionally and may even pre-empt perceived attacks
Find it very hard to confide in others
Often hold grudges and feel people’s intentions are malevolent
They may struggle with relationships due to pathological jealousy
The Schizoid Personality Disorder
Social detachment and isolation
Narrow range of emotions/expression
“Loners” who prefer individual to group activities
Find it hard to digest both criticism and praise
Others might describe them as “cold” or detached
Difficulties understanding social expectations and relations so struggle to integrate
Schizotypal Personality Disorder
Social and interpersonal limitations
Isolative and distant, struggle with close one on one relationships
Experience semi-psychotic symptoms, but not to the extent that they reach the criteria for acute psychosis. These can include seeing lights or shadows in their vision, or having odd beliefs such as the ability to read other people’s minds or other beliefs outside of social norms
Cluster B: Borderline, Narcissistic, Histrionic, and Antisocial Personality Disorders
Common traits: poor impulse control and emotional regulation. Can be dramatic, emotional, and erratic.
The Antisocial Personality Disorder
Do not respect the rights of other people or societal laws
Can appear hostile and/or aggressive
Can be deceiving and manipulative, and this often starts in childhood (ie bullying, juvenile convictions such as graffiti, arson, property damage)
Often starts as Conduct Disorder
May be involved in crimes, accidents, financial and legal difficulties in adulthold
Put selves at risk through lack of consideration of the consequences of their actions, and poor impulse control
Often can feign remorse if it is beneficial for them to do so
May partake in victim-blaming
Histrionic Personality Disorder
Very emotional people who often require the attention of others to validate their own distress
Question their own self worth if they are not the centre of attention
Can be perceived as flirtatious, theatrical, flamboyant
Might not be very good at displaying specific emotions, making them seem “fake” to others
This makes it hard for them to engage in truly intimate relationships because they struggle to show empathy over their own feelings, and in turn the other person feels they are not being heard. However, they can feel uncomfortable when they are alone.
Narcissistic Personality Disorder
Very entitled and feel they are highly important or significant
One if the few states of mind where people experience an inflated sense of self worth
Feel they should be treated in a different way to others, which can often seem disrespectful to an outside perspective and can be viewed as arrogant
May appear obsessed with success or beauty
Can be devastated if they are faced with evidence that they are not as special, successful or well liked as they believed
Often require the admiration of others to fuel their self image. Can be very manipulative to achieve this
Borderline Personality Disorder
Borderline Personality Disorder deserves its own page! It accounts for up to 7% of the population, and can be seriously debilitating for sufferers, in addition to causing significant distress for their friends and families. It is often poorly understood even by healthcare professionals, as these thoughts, traits and behaviours can be very ingrained into the person’s lifestyle. Sometimes they are labelled as “manipulative” or “attention-seeking”. However they are not bad people, and this is a condition that is very treatable.
People with Borderline personality disorder can have:
Tend to experience intense and unstable emotions and moods that can shift quickly
Reduced ability to self-soothe and so if they get upset it’s difficult to calm them down
Intense mood swings including outbursts of anxiety, anger and depression
This can be associated with impulsive behaviour, to try to “level out” these very big emotions. Impulsive behaviours may include drugs, alcohol, risky sex, self-harm, overspending and overeating
Self-harm and suicide attempts are common. Unfortunately 10% ultimately take their own life (sometimes on purpose and others by accident, through self-harming).
They often recognise that these behaviours are destructive in the long term, and want to stop, but the draw and short-term gain is too overwhelming to stop
Unstable Relationships with Others
Often have a very black-and-white view of the world. For example, people are either good, or bad; their circumstances are either great or terrible, and there is little room for the grey area in the middle
Struggle to moderate their emotional reactions toward others because of this all-or-nothing response
Relationships (all kinds – friendships, romantic, professional, etc) can be turbulent with lots of ups and downs. Friends are easily picked up and easily discarded. They may feel like every romantic partner is “the one”.
Unstable Sense of Self
Struggle to know who they are and can find this very distressing
Sometimes have dissociative symptoms, such as losing touch with reality and feeling cut off
Have mixed feelings of being a good person, and a bad person, and struggling to reconcile this
Tend to regularly change significant life events, like their job, romantic partner, friends, accommodation, goals, etc. This further reduces their self of stability
Feel neglected, alone, misunderstood, chronically empty or bored
Due to this unstable sense of self, when others are leaving, it becomes highly distressing. In response they tend to go to extreme measures to prevent abandonment (even if it is only imagined abandonment). This can include threats of suicide and self-harm.
What Are Some Causes of Borderline Personality Disorder?
Invalidation of emotions in childhood
Early trauma, including physical, sexual and psychological abuse
Neglect in early childhood
Genetics and biological factors
Cluster C: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders
The common characteristics are feelings of anxiety, fear, social phobias and inadequacy.
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The Avoidant Personality Disorder
Feel inadequate and avoid social interactions at all costs
Very sensitive to criticism
Constantly anxious that others will mock them, dislike them, or think they are not good at what they are doing or not a good person
This can develop into severe social anxiety and can come across as distant or shy
Often don’t have many friends
Dependent Personality Disorder
Feel like they need to be taken care of by other people
May come across as clingy because of their fear of not being looked after
The fear of losing a relationship may keep them attached to abusive or manipulative relationships
Struggle to disagree
Struggle to make independent decisions and actions
Being alone is incredibly frightening and they will actively avoid it
Obsessive-Compulsive Personality Disorder
Very attached to following rules, regulations, and orders
May sacrifice the ability to think flexibly in the pursuit of efficiency
Very organised but may struggle with change and find it hard to adapt in social situations
May find it very difficult to be satisfied with their own work due to their perfictionistic tendencies
Linked to this they may also be unable to delegate to others
May be very strict with money
Others often view them as strict, controlling or stubborn
If You’d Like to Know More…
The most effective treatment that we know about for personality disorders is DBT (Dialectical Behavioural Therapy). There are other types of psychotherapy and medications which may also be helpful. If you or someone you know may be affected, please speak with your GP or local healthcare professional.
Here are some more online resources for information, support and advice:
If you need immediate assistance, call Lifeline on 13 11 14. For further information about depression, contact beyondblue on 1300 22 4636 or www.beyondblue.org.au or talk to your GP, local health professional or someone you trust.