The Ten Personality Disorders
Human personality has been the subject of many studies in the past. Tyrtamus (371-287 BC), in his book “Characters,” tackled kinds of bad behavior that was seen in the streets of Athens during his time, including the ones displaying arrogance, irony, and boastfulness and other 30 different personalities. This writing has paved more subsequent studies about behavior and human personality. To name a few, Thomas Overbury (1581-1613) of England and Jean de la Bruyere (1654-1696) in France based their studies on this book.
The psychiatrist Philippe Pinel (1801) described the following personalities– manie sans délire as a condition of rage and violent outbursts without any symptom of psychosis. This is one of the significant foundations of how the study of personality disorders developed over time.
Physician JC Prichard’s term (1786-1848) “moral insanity” in 1835 was used to describe a larger group of people who displayed “morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions and natural impulses.” However, the term was too broad. Hence it is now seldom used for diagnosis.
In 1896, psychiatrist Emil Kraepelin (1856-1926) specified seven forms of antisocial behavior related to “psychopathic personality.” This term was later developed further by Kurt Schneider (1887-1967) when he included those who, in his words, “suffer from their abnormality.”
In 1923, Schneider’s seminal volume of DiepsychopathischenPersönlichkeiten (Psychopathic Personalities) is still being used as the basis of personality disorders and their classifications which can be found in the Diagnostic and Statistical Manual of Mental Disorders 5th Revision (DSM-5).
Based on DSM-5, diagnosing personality disorders is possible when impairments in self and interpersonal functions are seen along with one or more pathological personality traits. The following features must also be seen to make the diagnosis:
- Traits are seen consistent across time and situations
- Not normative for one’s developmental stage and socio-cultural environment
- Not a direct effect of substance use nor a general medical condition
Here is the DSM-5 list of 10 personality disorders. They are allocated to one of three clusters A, B, or C.
Cluster A (Odd, bizarre, eccentric)
- Paranoid PD
- Schizoid PD
- Schizotypal PD
Cluster B (Dramatic, erratic)
- Antisocial PD
- Borderline PD
- Histrionic PD
- Narcissistic PD
Cluster C (Anxious, fearful)
- Avoidant PD
- Dependent PD
- Obsessive-compulsive PD
Personality disorders are a product of historical observations, not solely from scientific studies. Therefore, they are vague and imprecise. There are no classic textbook forms for each personality. Clusters intend to show the personality disorders that blur or overlap one another.
- Paranoid personality disorder
Cluster A —paranoid, schizoid, and schizotypal personality disorders
A paranoid personality disorder is defined by a pervasive trust issue with others, regardless of how intimate and close that person can be— friends, family, and partners. Behavior-wise, this person is too guarded, overly suspicious, and constantly looks for clues or suggestions to validate his prejudices. He also exhibits a strong sense of entitlement: He is susceptible to setbacks and rebuffs during arguments, quickly feels disappointments, shame, and humiliation, and persistently holds grudges against people. Socially, he tends to withdraw from others, feels uncomfortable being put on the spot when introduced to a new crowd, and struggles with building close relationships. They resort to projection, meaning they attribute their unacceptable thoughts and feelings to other people.
Paranoid PD can be heritable, and it presents risk factors that are both genetic and environmental with schizoid PD and schizotypal PD.
- Schizoid personality disorder
The term “schizoid” means a natural tendency to focus on one’s inner life and away from the external world. A person with schizoid PD is introverted, detached, and aloof. They are into introspection and fantasy. Social or sexual relationships do not appeal to this person; instead, he is indifferent to others, has no regard for social norms and conventions, and lacks emotional response. Contrary to not having the desire to pursue relationships, people with schizoid PD experience a deep longing for intimacy. However, they will find it hard to initiate and maintain relationships. Instead, their retreat response is to just focus on their inner world. People with schizoid PD find medical attention unnecessary because they are still productive, well-functioning, and unbothered by their oddness.
- Schizotypal disorder
Schizotypal PD is characterized by eccentric behavior—oddities of appearance, behavior, and speech. Thinking of this person may be similar to those seen in schizophrenia. Schizophrenia, on the other hand, may include odd, magical beliefs and thinking. They also have unusual perceptual experiences and anomalies. They do not like social interactions; they are afraid of them and considered them harmful. They have intuitions and misconceptions that events or happenings are because of them. People with schizotypal PD have a high risk of developing schizophrenia.
- Antisocial personality disorder
Cluster B comprises antisocial, borderline, histrionic, and narcissistic personality disorders.
According to studies, Antisocial PD is seen more daily in men than in women. It is defined by a lack of concern for the feelings of others. For them, social rules and obligations are irritating. They tend to be aggressive, act impulsively, lack guilt and empathy, and fail to learn from experiences. In many cases, they can charm others, making it easy for them to find relationships. The term “charming psychopath” refers to their ability to be charming superficially. These relationships, however, are usually toxic, turbulent, and short-lived. Often, antisocial PD is a mental disorder seen in people involved in crime; hence, this person may have criminal records because of his condition.
- Borderline personality disorder
A borderline PD (or emotionally unstable PD) person exhibits a lack of sense of self. They feel empty and have a fear of abandonment. Their relationships are intense but unstable, and patterns of emotional instability, anger outbursts, and violent reactions, especially regarding criticism. They are also prone to impulsive behavior. They also resort to suicidal threats and self-harm. This is why they need medical attention. Borderline PD is a disorder that is on the borderline between neurotic (anxiety) disorders and psychotic disorders. It has been said that borderline PD is caused by sexual abuse during childhood. This is common in women because they are more prone to suffer sexual abuse. However, there is also a feminist perspective stating that borderline PD is more common in women because women who exhibit angry and promiscuous behavior are being labeled with it. In contrast, men who present similar behavior are marked with antisocial PD.
- Histrionic personality disorder
People with histrionic PD seek approval from others through behaviors that will attract others’ attention. They lack a sense of self-worth. To do so, they often seem to exaggerate or ” play a part” to be heard and seen. People with histrionic PD may bank on their appearance and behave in an overly charming manner or inappropriately seductive. They are after the excitement and are impulsive, so they are prone to accidents or exploitation. Since they are just after the attention, their interactions are superficial. Their relationships, therefore, can be unstable and short-lived. Approval is critical, so they are sensitive to criticism and rejection. Loss or failure is distressing and hard to handle. A vicious circle may become continuously persisting. Hence, they become more historic because of the series of rejections they experience.
- Narcissistic personality disorder
In narcissistic PD, the person possesses an extreme feeling of self-importance and a great sense of entitlement. They constantly need to be admired. He tends to feel envious of others and wants them to be jealous of him too. He lacks empathy and gaslights and exploits others to feed his needs. To others, he tends to be self-absorbed, controlling, intolerant, insensitive, and selfish with his interactions. He can become angry and revengeful when obstructed or ridiculed, coined as “narcissistic rage.” Disastrous consequences may fall on those involved.
- Avoidant personality disorder
Cluster C consists of avoidant, dependent, and anankastic personality disorders.
People with avoidant PD perceive themselves as socially inept and unappealing. They feel inferior and fear being criticized, embarrassed, or rejected. To avoid that, they dodge meeting others unless they are sure they are liked. They also feel restrained even in their intimate relationships. Avoidant PD is strongly related to anxiety disorders and may also be associated with their experiences of rejection from parents or peers during childhood. Research suggests they excessively monitor internal reactions, both their own and those of others, which hinders them from being natural or fluent in social situations. A vicious circle occurs when they constantly monitor their internal reactions. They would find themselves more inept than again monitoring their internal reactions.
- Dependent personality disorder
Dependent PD is defined by a lack of self-confidence and an excessive need to be guided. This person needs a lot of assistance in making even the simplest decisions and relies on others to make important life decisions for him. He fears being abandoned and may go to lengths just to ensure that his relationships are secure. A person with dependent PD perceives himself as helpless and inadequate. He, in turn, surrenders to his responsibility, submits himself and idealizes others as competent and powerful. People with dependent PD would end up with people with a cluster B personality disorder. They respond to the unconditional high regard of the person they are dependent on. Overall, people with dependent PD act in a naïve and child-like manner. They do not see themselves as adequate. They are vulnerable to abuse and exploitation.
- Anankastic (obsessive-compulsive) personality disorder
Anankastic PD is characterized by an excessive dependence on details, rules, lists, order, organization, or schedules. They are perfectionists so extreme that they would prevent tasks from getting done; and devotes all energy to work and productivity, sacrificing leisure and relationships. A person with anankastic PD is typically in doubt, cautious, rigid and controlling, lacks humor, and is stingy. He is anxious about the perceived lack of control over a world that eludes his understanding. As he tries to gain power, he feels more out of control.
Consequently, his tolerance for complexity or nuance is very short. He sees the world as either all good or all evil. He also has unreasonable demands from his colleagues, friends, and family, which result in strains and conflicts.
Personality disorders differ from mental disorders. However, by definition, they can cause significant impairment in a person. They affect about 10 percent of people, although this figure would depend on where clinicians draw the line. Characterizing the 10 personality disorders is a challenge, as well as diagnosing them. Analyzing the norm to classify the personality trait as disordered plus how impairment is defined is not easy to determine. Findings can be subjective in every clinician because personal dislike, prejudice, or a clash of values can influence the diagnosis of personality disorder.