Personality disorders are regarded by mental health scientists as one of the most controversial categories of mental disorders. For decades psychologists argue about the diagnostic criteria of these “problems of character”. Some colleagues go so far as to refrain from diagnosing them at all. However, when a person keeps facing specific difficulties in a given area of life for years, it is likely they suffer from a personality disorder.
Friends and relatives of personality disorder clients frequently make comments, such as: “He is simply like that.” “She has a difficult character.” “He’s been like that since I know him.” “She is odd.” So where do we draw the distinction between individual characteristics and psychopathology?
What constitutes a personality disorder?
Each personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. It is characterized by pervasiveness and inflexibility, stability over time, and an onset during adolescence or early adulthood. It leads to distress or impairment.
There are two approaches to the understanding of personality disorders. The traditional one categorizes them in separate groups (clusters), based on similar features. This is the one described below. The newer one views them as pathological traits that impair personality functioning.
Types of personality disorders
Cluster A: Odd, eccentric
Paranoid Personality Disorder: The suspicious
This is the person, who is always on guard. They constantly suspect hidden motives in others. They view others as enemies, who are about to harm or abuse them somehow. The biggest challenge for paranoid personalities is developing trust and the ability to relax.
Schizoid Personality Disorder: The loner
These are the people who are a sufficient company of themselves. After all, not everyone is social and outgoing. The schizoid personalities feel at their best when they are by themselves. They simply don’t value social contacts as much as the rest of us. Often these people look unemotional. The biggest challenge for them is to achieve a sense of comfort in social interactions.
Schizotypal Personality Disorder: The hermit
Often these people hold an unrealistic image of themselves. They perceive themselves as so exceptional that they become hostile towards others. They find it difficult, even meaningless, to follow social convention. That’s why they prefer to isolate themselves. They are sometimes even prone to believe in supernatural forces.
Cluster B: Dramatic, overly emotional, erratic
Antisocial Personality Disorder: The criminal
Not everyone with ASPD becomes a criminal. However, among criminals, the majority have ASPD. What makes these people violate the rights of others and overlook rules? The lack of empathy – the ability to understand and share the feelings of another.
Borderline Personality Disorder: The drama queen
A person with Borderline Personality Disorder at the low end of the severity scale appears to be overly emotional. This might not cause any major dysfunctions – after all, there are some people, who are more sensitive by nature. Such healthy emotionality is based on overdeveloped empathy. On the other hand, the BPD clients lack emotion regulation skills. That deficit makes it difficult for them to see clearly the boundaries between self, the world, and others.
Histrionic Personality Disorder: The flamboyant
Extravagant outfit, noisy laughter, loud speech, excessive makeup – please turn the spotlight to the center of your attention – the histrionic personality! This is the person with an obvious need for your attention, approval, and admiration. If she doesn’t get them, she will do her best to draw your attention. She might even play ill or faint, or act promiscuous or infantile. There is just no way such a person remains unnoticed wherever they go.
Narcissistic Personality Disorder: The braggart
We all know at least one of those. The person who always points out their success, achievements, or superiority. The one, who frankly believes they are better than the rest of us. You can breathe in self-confidence around them. But the image of the successful, perfect person that the narcissist projects all around them is nothing but a mask. And behind that mask is an underlying inferiority complex. After all, genuine self-confidence never seeks the spotlight.
Cluster C: anxious, fearful
Avoidant Personality Disorder: The shy
Avoiding uncomfortable situations is a natural coping mechanism. However, relying exclusively on that strategy to deal with stress has a long-term detrimental effect. Avoidant personalities cannot meaningfully participate in any social interaction. They are not simply shy. They are terrified by the notion they can make a mistake and be ridiculed about it. These are the people at the party who silently stand to the side. In contrast to the schizoid personalities, who have no desire for social contact, the avoidant want to connect. They can’t do it, however, because of the intense anxiety they feel about others’ judgments.
Dependent Personality Disorder: The child
The dependent personality requires to be taken care of. These people are incapable of taking decisions. They always seek reassurance from others in the form of asking for others’ opinions or directly seeking advice. They are passive, sometimes even naive, and very sensitive to criticism. They place others’ needs before their own. They are able to tolerate negative behavior, even abuse. Often they feeling helpless. Dependent Personality Disorder is widespread among women, victims of domestic violence.
Obsessive-compulsive Personality Disorder: The perfectionist
Order and discipline! Strict adherence to the rules. Making an exception is wrong. These are some of the limiting beliefs of the perfectionist, who thinks there is only one correct way of doing things, and everything else is mediocre. If your partner suffers from OCPD, prepare for constant disapproval and a tsunami of criticism. Making mistakes is a crime! OCPD clients are prone to developing anxiety disorders, especially obsessive-compulsive disorder, but it is not necessarily that those two conditions go hand in hand.
Treatment for personality disorders
Diagnosing a personality disorder should be done by a mental health professional. Most people have some features of more than one PD. This doesn’t mean all of us should be treated.
People with personality disorders usually seek treatment after years of struggling, when they notice a specific problem – a failure to establish a fulfilling intimate relationship, difficulty holding a long-term job position, or other communication problems.
Cognitive-Behavioral Therapy for personality disorders usually takes about six months, up to a year, depending on the client’s level of functioning. Some CBT approaches are specifically tailored to address personality disorders.
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