Personality Disorder Overview
HISTORICAL CONSTRUCTS OF PERSONALITY DISORDERS
Historically, personality disorders were conceived of as commonly witnessed clusters of traits
While the nomenclature is antiquated, and some find the terms used below stigmatizing, we think it’s important to be aware of these conventions since most seasoned clinicians still think in these terms.
While these are presented as distinct categories, in reality, people usually present with overlapping features from multiple clusters or disorders.
Below we describe the 3 clusters of personality disorders as they’ve historically been represented, including the common diagnoses included within.
Going back to our prior discussion, these conditions are all believed to relate to an underdeveloped sense of self and difficulty in relation to others, leading to clinically relevant deficits in functioning.
Cluster A: “Outliers to the Norm”
Cluster A represents disorders that are often called “odd or eccentric.” These individuals often present as outside the norm and their relationship to reality is difficult for others to understand and relate to.
There are three diagnoses in cluster A:
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These individuals perceive threats in events or interactions that most people would not think are threatening. They are constantly uneasy, skeptical, and may be frustrated that they are the only ones able to see the threats lurking behind every corner. Their fundamental lack of trust makes it difficult to connect with others. It’s important to note that paranoia itself is a symptom of many personality disorders, as well as other conditions (it’s common in neurodegenerative diseases, PTSD, substance use, and more).
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These individuals strongly prefer being alone — showing very little, if any interest or ability to form relationships with others or express a full range of emotions. Their experiences are therefore not tempered or socialized to be relatable to others, and they often pursue solitary hobbies other find hard to relate to (e.g. coin collecting). Importantly — restricted affect and social withdrawal and isolation are symptoms of many conditions, overlapping with autism spectrum disorder, early stages of schizophrenia, and even other mood and personality disorders.
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These individuals often have a disorganized thought process with beliefs that are outside the norm. They may find it hard to manage their distress in social situations, leading to notably awkward movements, behaviors, and speech patterns.
Cluster B: “Interpersonal Disturbances”
Cluster B shares the common thread of disturbed interpersonal relationships. At times presenting with social adeptness and sensitivity to others, they may use interpersonal skill to control and engage others to compensate for an unstable sense of self.
There are four diagnoses in cluster B:
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These individuals experience intense dysphoria with a focus on their relationships: becoming frantic at real or perceived rejection or abandonment and avoiding feelings of loneliness at all costs. These individuals are often - but not always - recognized based on patterns of unstable relationships, unstable identity, uncontrollable anger, and self harming behaviors.
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These individuals have challenges regulating their self esteem, harboring fantasies about themselves that are divorced from reality. They tend to avoid relying on other people and protect their self image by ignoring reality. While the stereotypical narcissist in popular culture is “thick-skinned”, grandiose, and selfish narcissistic, there is also a “thin-skinned” presentation as well (discussed at length later on)
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These individuals crave being the center of attention. They tend to be performative, flirtatious, and all around extra — all in the pursuit to be seen and heard.
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These individuals have difficulty understanding and complying with social conventions, and feel limited guilt for often reckless, careless, and destructive behaviors. They are aim-oriented, justifying that they can do “whatever they want to get what they want” — disregarding the limitations society imposes. They often feel an intense sense of deprivation — they didn’t get what they were owed by the social contract, allowing them to justify disregarding the social contract entirely.
Cluster C: “Controlling Reality”
Cluster C is all about anxiety management. These individuals are so sensitive to becoming anxious that they adopt over-determined coping responses to events that are indeed anxiety invoking in the real world.
There are three diagnoses in cluster C:
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These individuals are highly concerned with their interactions with others, and go through great lengths to protect themselves from judgement and rejection. This often leads to a fear of forming relationships or engaging in social activities.
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These individuals feel helpless without someone to take care of them — finding it difficult to navigate general adult life. They are often perceived as clingy and needy.
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These individuals are perfectionistic, driven by the need for absolute order and completeness. They strive to live up to extreme, self-imposed standards, and tend to exist in rigidly structure, inflexible life patterns.
Reflection Questions
Do you feel like the “clusters” and “labels” provided here are helpful to you?
How would you map these conditions onto the chart here?
Which is your favorite car in the parking lot?
Do any of these diagnoses resonate with your own experiences? How so?