What are personality disorders?
Personality disorders are characterized by the predominance or deficiency of certain personality traits that cause disturbances in a person's daily functioning. The personality traits associated with these disorders are present in all individuals to varying extents since childhood, but they tend to be firmly established only during adulthood.
Personality disorders are classified into different types, depending on the kind of trait that is more dominant in the individual. There are three broad clusters or groups of personality disorders found in the Diagnostic and Statistical Manual of Mental Disorders ( DSM 5 ) , within which there are several specific disorders. Personality disorders in each cluster have similar characteristics and symptoms, along with certain specific personality traits.
For a person to be diagnosed with a personality disorder, there has to be an observable pattern of behavior that causes distress at a personal, interpersonal, or occupational level. The pattern can be seen in two or more of the following areas:
Perception of self, others, and the surroundings
Remember that the trait becomes a personality disorder only when:
a) The traits are present to an extreme, and influences the person’s view of themselves, others, and their environment. The person exhibits these traits across a sustained period, and they are evident in different situations.
b) The traits cause significant distress to the individual and those around them.
These descriptions are meant to be guidelines for identifying a problem and do not indicate or confirm the presence of a disorder. The diagnosis must be made by a mental health professional.
Types of personality disorders
The first cluster of personality disorders includes paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. These disorders are dominated by distorted patterns of thinking and behavior that others may not be able to understand. People with these disorders have trouble trusting others and tend to isolate themselves. They often come across as eccentric. This has a significant impact on their relationships and daily functioning.
Paranoid personality disorder
Paranoid personality disorder is characterized by inevitable distrust and suspicion of others. A person with paranoid personality disorder does not keep their mistrust to themselves but shows it through their actions and behavior. Their doubt of others often comes without adequate reasons to be suspicious. They are reluctant to confide or share information as they feel that it can be used against them.
People with paranoid personality disorder tend to bear grudges frequently and tend to look for hidden meanings into remarks made by others. This constant feeling of being attacked or hurt by others makes them keep to themselves and thus come across as ‘cold.’ Their strong sense of autonomy also makes them have a high degree of control. This can have severe repercussions on their interpersonal relationships often impact their ability to be collaborative in workplaces or other social situations.
Schizoid personality disorder
Schizoid personality disorder is seen as a pervasive pattern of detachment from social relationships. Persons with this disorder come across as being cold and aloof. They don’t enjoy close relationships with friends or family. As a result, they lack a close network of support and appear to have a lack of desire for intimacy.
Another characteristic of schizoid personality disorder is a restricted range of emotions. People diagnosed with this disorder seem indifferent to praise or criticism. They can tend to feel uncomfortable or lost if they are compelled to spend time in a social situation. This makes them avoid situations in which they may be forced to interact with others and almost always choose solitary activities.
Schizotypal personality disorder
Schizotypal personality disorder is a combination of some of the traits exhibited by those with schizoid and paranoid personality disorder. It is characterized by social and interpersonal deficits along with cognitive distortions. A person diagnosed with it is generally distrustful of others and avoids establishing close relationships. This comes from paranoia without much evidence that they might be taken advantage of by others.
They may also display behavior that might be considered eccentric to those around them. A significant feature of schizotypal personality disorder is having magical beliefs and a conviction that it has an impact on behavior. People with this disorder can be invested in superstitions or paranormal beliefs as well. This puts them in a position where they have trouble distinguishing real events from those they might have imagined.
The second cluster of personality disorders includes four personality disorders — antisocial, borderline, histrionic, and narcissistic personality disorders. These disorders are marked by behavior that can be seen as dramatic or overly emotional by others. A common feature seen among people diagnosed with these disorders is that they are unable to see beyond the immediate outcome of their actions. They can also have problems with impulse control and managing emotions.
Antisocial personality disorder
The one trait that identifies a person with antisocial personality disorder is their failure to conform to norms or follow lawful behaviors, often warranting arrests. The person is unable to see the future impact of his actions on others or self, even if they are counterproductive. They also tend to display reckless and dangerous behavior.
A person with antisocial personality disorder displays destructive behavior — being emotionally and physically violent, breaking the rules, disregard for others’ property (for example breaking things that belong to others). People with antisocial personality disorder may have had persistent behavioral difficulties as children, often expressed through bullying, intimidation, and physical violence towards more vulnerable groups, such as weaker children and small animals. They often lack remorse and see nothing wrong with their behavior, or the harm they cause to themselves or others. Another characteristic feature of this personality disorder is aggression and manipulative behavior.
Borderline personality disorder (BPD) is a disorder that affects the way a person manages their emotions, self-image, and behavior. BPD is characterized by maladaptive patterns of thoughts, emotions, and behaviors. The person may not have a fixed idea of their identity, and go through a constant struggle of trying to ‘fit in'. Some of the presenting symptoms that characterize BPD are instability – in relationships (how they interact with others), in identity and self-image (how the person sees themselves or others), and mood (which tends to fluctuate often).
A person with BPD does not have a fixed identity of self and attempts to define themselves by their current situation or environment. People with BPD are highly emotionally sensitive to events happening around them; this causes them a great deal of distress as they struggle to cope with everyday life.
Narcissistic personality disorder
The most significant feature of narcissistic personality disorder is a constant need for admiration and a pervasive pattern of grandiosity. A person with narcissistic personality disorder has an extremely high sense of self-importance. They are also preoccupied with fantasies of power, beauty, self-importance, or greatness. They believe that they are entitled to special treatment, power, riches, and success.
Their preoccupation with power and success does not translate into measurable personal outcomes. A person with narcissistic personality disorder often uses the limitations of others to demonstrate their superior status, and are willing to undermine others to achieve their superiority. This also makes them exploitative in their interpersonal relationships.
Others see their behavior as haughty, snobbish, or arrogant. While they seem distant and proud, they are very sensitive to criticism. They are always envious of others or believe others are envious of them. They tend to be impulsive and always crave attention from others. The sense of feeling special, along with having a self-centered attitude, makes it difficult for a person with this disorder to have fulfilling relationships with others.
Histrionic personality disorder
As the name suggests, histrionic personality disorder is characterized by intense displays of emotion and attention-seeking behavior. A person with this disorder always wants to be the center of attention in any gathering. They tend to display all emotions, happy or sad, exaggeratedly. They continuously seek others’ attention and approval. This may reflect in the way they dress, their behavior (dramatic display of emotion, flattering, or flirting to get attention) and tendency to take impulsive decisions without evaluating the risks (trying to kill themselves).
In their relationships, they imagine a higher level of intimacy than what exists – someone may see them as just an acquaintance, but they treat the other like a very dear friend. The exaggeration in their emotions makes their behavior look superficial or fake. They are seen as fickle and easily influenced by others. They have short attention spans and may not be able to stick with a single project for a long time.
The third cluster of personality disorders includes three disorders — avoidant, dependent, and obsessive/compulsive personality disorders. These disorders are characterized by anxious and fearful behavior. These feelings of anxiety and fear often disrupt the daily functioning of a person.
Avoidant personality disorder
The main characteristic feature of avoidant personality disorder is a hypersensitivity to other people’s opinion and severe social inhibition. People with avoidant personality disorder are extremely fearful that others will judge them negatively, identify their flaws, or think of them as useless or unworthy. This puts them in a state of heightened anxiety, unable to relax in social situations.
People with avoidant personality disorder have a low sense of self-esteem. They often believe that they are not intelligent enough, not good enough, not rich enough, or not worthy enough, all this without sufficient evidence. They fear interacting with people who consider superior or better than them. They often intensely feel the need for interaction and connection, but at the same time, are afraid of criticism and rejection. Others may view their behavior as being shy, stiff, and emotionally distant. This not only disrupts their daily functioning but also has a significant impact on their interpersonal relationships.
Dependent personality disorder
Dependent personality disorder is characterized by a person’s excessive need to be taken care of, which leads to clingy behavior. A person with this disorder has exaggerated notions of their inability to care for themselves and require others to assume responsibilities. This makes them stay on in situations where they might be physically, emotionally or sexually abused. This leads them to take great lengths to ensure they keep the other person satisfied in a relationship. Their submissive nature restricts them from voicing their disagreement with others as they fear they might lose the person as a result.
A person with dependent personality disorder feels uncomfortable with being alone. They are prepared to be submissive and obedient to get support, to the extent of doing things they don’t want to do. They feel helpless when they have to do anything on their own. Others may see them as needy and clingy. Dependent personality disorder often occurs with other personality disorders like borderline, histrionic, and avoidant personality disorders.
Obsessive-compulsive personality disorder (also known as anankastic personality disorder)
Obsessive-compulsive personality disorder is also referred to as anankastic personality disorder. A preoccupation with perfection and orderliness characterizes this disorder. A person with obsessive-compulsive personality disorder is rigid in their ideas of how things should be done. Their need for perfection is so high; it often disrupts their ability to complete the task in hand. This is also because they are often rigid in their approach: a job cannot just be done; it has to meet their exact standards, and anything below the standard they expect may fill them with extreme anxiety. They are willing to forego fun, rest or even neglect their physical wellbeing to make sure that something is done just the way they like it. This makes them unwilling to delegate tasks and take on more than they can manage. As a result, work is always given priority while personal lives are negated.
A person with obsessive-compulsive personality disorder may have a strong affinity for rules and regulations. They try to control how things are done by laying down rules, making lists, and creating schedules that have to be strictly followed. They are also inflexible in many matters, including morality. Money is often hoarded for the future, and as a result, people with obsessive-compulsive personality disorders may be seen by others as miserly. These factors disrupt their interpersonal relationships as friends and family often struggle to adjust to their ways.
Difference between OCD and OCPD
Obsessive-compulsive personality disorder (OCPD) is sometimes confused with obsessive-compulsive disorder (OCD) due to the similarity of symptoms and behavior.
A person with OCD repeats the same behavior to avoid the distress caused by the compulsions. A person with OCPD, on the other hand, has no compulsions of this sort. They display certain behaviors because of the fear of losing control or being perceived as imperfect. They may get panic attacks when faced with a situation where they cannot control the outcome. In both cases, the behavior is caused by anxiety. While the anxiety in a person with OCD is caused by the compulsion to perform specific tasks, a person with OCPD experiences anxiety due to their personality traits. In most cases, it is the trait of doing things to perfection or rigid thinking about how things should be done causes anxiety.