What is a Personality Disorder?
Though they may vary greatly between clusters, all personality disorders share some key features that are used in diagnosing them. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) is the handbook used by psychiatrists and Psychiatric Nurse Practitioners in the United States to diagnose psychiatric illness in their patients. According to the DSM-5, a personality disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” These disorders are grouped into three clusters (A, B, and C) based on descriptive similarities.
Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include:
- paranoid personality disorder
- schizoid personality disorder
- and schizotypal personality disorder.
The following information has been assembled based on the guidelines of the DSM-5.
Paranoid Personality Disorder
Though paranoia can occur as a symptom of other disorders, those with paranoid personality disorder (PPD) experience it severely and constantly. The disorder is marked by strong distrust and suspicion of others, begins in early adulthood, and is relatively rare, affecting only 2.3% -4.4% of the population. Indicators of paranoid personality disorder are based on the following symptoms, of which 4 or more would warrant a diagnosis:
1. Suspects, without sufficient basis, that others are exploiting, harming or deceiving him/her/them
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
4. Reads hidden demeaning or threatening meanings into benign remarks or events
5. Persistently bears grudges
6. Perceives attacks on his/her/their character or reputation that are not apparent to others and is quick to react angrily or counterattack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Those with paranoid personality disorder do not think of their behavior or way of thinking as problematic, which makes it difficult for them to trust or follow the instructions of their healthcare providers.
Schizoid Personality Disorder
Though the name sounds similar, schizoid personality disorder is not the same as a diagnosis of schizophrenia. Those with schizoid personality disorder will detach from society and relationships, strongly preferring to be alone as much as possible. This disorder often begins in early adulthood, and is indicated by 4 or more of the following:
1. Neither desires nor enjoys close relationships, including being part of a family
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise and criticism of others
7. Shows emotional coldness, detachment, or flattened affectivity
Many people with this personality disorder can live functional lives but suffer from the consequences of their isolation. Schizoid personality disorder is present in approximately 3.1%-4.9% of the population, but can be hard to determine due to the reclusive nature of those affected.
Schizotypal Personality Disorder
Similarly to schizoid personality disorder, schizotypal personality disorder (STPD) is marked by a lack of capacity and intense discomfort for close relationships. This symptom, however, is often due to distorted beliefs and behaviors rather than a complete disinterest in companionship. People with STPD will often have magical beliefs, but they do not experience the same hallucinations as someone diagnosed with schizophrenia. STPD is indicated by 5 or more of the following:
1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking that influences behavior and is consistent with subcultural norms
3. Unusual perceptual experiences, including bodily illusions
4. Odd thinking and speech
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric, or peculiar
8. Lack of close friends or confidants other than first-degree relatives
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
STPD is found in 3.9% – 4.6% of the population and its symptoms can be alleviated with the proper medications and therapy.
Those with personality disorders differ from those with general anxiety or depression in the sense that they do not perceive their way of thinking to be wrong, rather, they often believe that others are thinking or behaving incorrectly. For this reason, it can be difficult to encourage them to seek the help that they need and ensure their commitment to their prescribed treatment.
For Cluster A Personality disorders, therapy is usually first-line treatment, including:
- Dialectical Behavior Therapy (DBT)
- Cognitive Behavior TherapyCBT
- Psychodynamic therapy
- Group therapy
There are no medications that specifically treat cluster A personality disorders. However, medications like antidepressants, antipsychotics, and mood stabilizers can help with some symptoms
Though these Cluster A personality disorders are not incredibly common, they can severely diminish a patient’s ability to lead a full and successful life. If these descriptions seem to apply to you or a close family member, contact me to learn more or schedule an appointment.