What is a Personality Disorder?
The Diagnostic and Statistical Manual of the American Psychiatric Association (known as the DSM-5), catalogs all forms of mental illness that is currently recognized by the American Psychiatric Association. These different criteria are what’s used by mental health professionals in the diagnosing and treatment of mental illness. According to the definition of personality disorders in DSM-5, the five key elements of a personality disorder are:
1. A personality disorder is enduring pattern of inner experience and behavior. This pattern manifests in two or more of the following areas:
c. Interpersonal relationships
d. Impulse control
2. This pattern deviates markedly from cultural norms and expectations.
3. This pattern is pervasive and inflexible.
4. It is stable over time.
5. It leads to distress or impairment.
The DSM-5 identifies three different broad brush clusters of behavior, which is then further drilled down to ten specific personality disorders.
The three clusters of behavior are:
Cluster A: Odd, and eccentric.
Cluster B: Dramatic, erratic and emotional.
Cluster C: Anxious and fearful.
Cluster A: Odd and eccentric
Paranoid, Schizoid, and Schizotypal Personality Disorders
The common features of the personality disorders in this cluster are social awkwardness and social withdrawal. These disorders are dominated by distorted thinking.
The Paranoid Personality Disorder* is characterized by a pervasive distrust and suspiciousness of other people. People with this disorder assume that others are out to harm them, take advantage of them, or humiliate them in some way. They put a lot of effort into protecting themselves and keeping their distance from others. They are known to preemptively attack others whom they feel threatened by. They tend to hold grudges, are litigious, and display pathological jealously. Distorted thinking is evident. Their perception of the environment includes reading malevolent intentions into genuinely harmless, innocuous comments or behavior, and dwelling on past slights. For these reasons, they do not confide in others and do not allow themselves to develop close relationships. Their emotional life tends to be dominated by distrust and hostility.
The Schizoid Personality Disorder* is characterized by a pervasive pattern of social detachment and a restricted range of emotional expression. For these reasons, people with this disorder tend to be socially isolated. They don’t seem to seek out or enjoy close relationships. They almost always chose solitary activities, and seem to take little pleasure in life. These “loners” often prefer mechanical or abstract activities that involve little human interaction and appear indifferent to both criticism and praise. Emotionally, they seem aloof, detached, and cold. They may be oblivious to social nuance and social cues causing them to appear socially inept and superficial. Their restricted emotional range and failure to reciprocate gestures or facial expressions (such a smiles or nods of agreement) cause them to appear rather dull, bland, or inattentive. The Schizoid Personality Disorder appears to be rather rare.
Persons with Schizotypal Personality Disorder* are characterized by a pervasive pattern of social and interpersonal limitations. They experience acute discomfort in social settings and have a reduced capacity for close relationships. For these reasons they tend to be socially isolated, reserved, and distant. Unlike the Schizoid Personality Disorder, they also experience perceptual and cognitive distortions and/or eccentric behavior. These perceptual abnormalities may include noticing flashes of light no one else can see, or seeing objects or shadows in the corner of their eyes and then realizing that nothing is there. People with Schizotypal Personality Disorder have odd beliefs, for instance, they may believe they can read other people’s thoughts, or that that their own thoughts have been stolen from their heads. These odd or superstitious beliefs and fantasies are inconsistent with cultural norms. Schizotypal Personality Disorder tends to be found more frequently in families where someone has been diagnosed with Schizophrenia; a severe mental disorder with the defining feature of psychosis (the loss of reality testing). There is some indication that these two distinct disorders share genetic commonalities (Coccaro & Siever, 2005).
Cluster B: Dramatic, erratic and emotional.
Antisocial Personality Disorder (formerly known as Sociopaths and/or Psychopaths). These people are deceitful, manipulative, impulsive, reckless, lack of empathy and remorse, have no value for laws, and have a pervasive pattern of disregard for others, which often manifests as hostility and/or aggression. Many symptoms often appear in childhood, as different types of behavior disorders before the age of 15. Hurting and/or tormenting animals and/or people is common. The level of aggression is a large trait that sets this personality disorder apart from Narcissism.
Narcissist Personality Disorder. Is described as a huge sense of entitlement, large ego, need to be powerful and admired, status and image oriented. However, several key features are often overlooked, these are: high level of intelligence, lack of remorse and empathy, a fundamental lack of regard for others, and impulsive, reckless behavior.
* Although the subcategories of Narcissism are not in the DSM-5, many victims of Narcissists believe them to be significantly more accurate and helpful in identifying how different forms of Narcissism present.
The two main categories are: Overt/(aka Grandiose) and Covert(aka Vulnerable).
Overt narcissists tend to be more “textbook” example of what a narcissist presents like. These people are larger-than-life, arrogant, often loud and boisterous, love to be the center of attention, and often come across as obnoxious to most people. They are the classic “one-upper”, and people tend to either be very impressed by them or turned off completely. They are often very status driven, and self-centered. These people are the perpetual hero. They generally justify their behavior and they are always right. “Enough about you, lets talk about me” and “Yeah, but still” would be their mantras.
Covert narcissists tend to the opposite of what people think about when they think of a narcissist. Most people don’t know what they are dealing with for years, or even decades. My opinion is that these are the most dangerous types of narcissists, because they often fool everyone–including therapists. They (initially) come across as humble, sincere, charming, caring, and are liked by most people. They are the kind of person that goes above and beyond for others, often making it a point to come across as selfless and giving. People tend to like them, however, they often tend to have a lot of strained relationships with family members–many of which they no longer talk to. These people are the perpetual victim, and they use pity to trap their victims. Threats of suicide, addictions, other women throwing themselves at them–all behaviors where others (including the victim) takes pity on them, and hopes that this time they really will change. “Let me hear more about you” and “Look at what they/it made me do” would be their mantras.
Within those two subcategories four more distinctions are made:
1. Delusional. Delusional narcissists are very grandiose in their beliefs and are often full of stories that are so over-the-top that rarely do other people believe them. (Example: Telling someone that you have $10 million dollars in the bank and a jet plane in your backyard, but that you work as a gardener because you like to be outside–oh, and you own the company too. Their delusions tend to be focused around the Military, success/power, religion, and/or having advanced degrees.)
2. Somatic. Somatic narcissists are very fixated on their body and appearance. They are often very seductive, and are pathological cheaters. To them, sex is a weapon, and a very powerful one at that. They tend to be very status oriented, and are often checking themselves out in the mirror every chance they get. Many of their victims often feel a soul mate connection to them, which is backed up by (amazing) sex. (Example: Arnold Schwarzenegger.)
3. Cerebral. Cerebral narcissists take great pride in their intellect, and are incredibly convincing. They are master manipulators and are often most visibly seen as the high ranking, cut-throat CEOs and politicans of the world. The more extreme cases of this have cult followings. They often have advanced degrees, and come across as elitists. They rarely like to associate with anyone that is below their intellect or educational level. These narcissists are not necessarily focused on status symbols. (Example: The representation of Alan Turing in “The Imitation Game,” Bernie Madoff and a case could be made for Ferris Bueller as well.)
4. Malignant. Malignant narcissists have a blend of character traits found in both Narcissistic and Antisocial Personality Disorders. If there was a spectrum with Narcissism on the “mild” end, and Antisocial on the “extreme” end, Malignant Narcissists would be in the middle.
Histrionic Personality Disorder. Marked by excessive degrees of emotion and attention seeking behaviors. They must always be the center of attention. These people are known as “drama queens”, and are often seductive, and dress in sexually revealing ways. Their behavior can be theatrical, and over-the-top. They often believe that relationships that are in (friendships, or romantic) are much deeper than they are, which often leads to hurt and heartache for them. Ironically, because of their over-the-top emotions, others often feel that their emotional responses are insincere.
Cluster C: Avoidant, dependent, obsessive compulsive.
Avoidant Personality Disorder
Dependent Personality Disorder
Obesessive-Compulsive Personality Disorder
It includes the Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders. These three personality disorders share a high level of anxiety.
The Avoidant Personality Disorder* is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and a hypersensitivity to negative evaluation. People with this disorder are intensely afraid that others will ridicule them, reject them, or criticize them. This leads them to avoid social situations and to avoid interactions with others. This further limits their ability to develop social skills. People with Avoidant Personality Disorders often have a very limited social world with a small circle of confidants. Their social life is otherwise rather limited..
Their way of thinking about and interpreting the world revolves around the thought that they are not good enough, and that others don’t like them. They think of themselves as unappealing and socially inept. These types of thoughts create feelings of intense anxiety in social situations, along with a fear of being ridiculed, criticized, and rejected. The intensity of this fearful anxiety, and the discomfort it creates, compels them to avoid interpersonal situations. They might avoid parties or social events, and may have difficulty giving presentations at work or speaking up in meetings. Others might perceive them as distant or shy. They likely come across as stiff and restricted. All this will likely interfere with their ability to make friends, or to move ahead professionally.
The core feature of the Dependent Personality Disorder* is a strong need to be taken care of by other people. This need to be taken care of, and the associated fear of losing the support of others, often leads people with Dependent Personality Disorder to behave in a “clingy” manner; to submit to the desires of other people. In order to avoid conflict, they may have great difficulty standing up for themselves. The intense fear of losing a relationship makes them vulnerable to manipulation and abuse. They find it difficult to express disagreement or make independent decisions, and are challenged to begin a task when nobody is available to assist them. Being alone is extremely hard for them. When someone with Dependent Personality Disorder finds that a relationship they depend on has ended, they will immediately seek another source of support.
Persons with Obsessive-Compulsive Personality Disorder* are preoccupied with rules, regulations, and orderliness. This preoccupation with perfectionism and control is at the expense of flexibility, openness, and efficiency. They are great makers of lists and schedules, and are often devoted to work to such an extent that they often neglect social relationships. They have perfectionist tendencies, and are so driven in their work to “get it right” that they become unable to complete projects or specific tasks because they get lost in the details, and fail to see the “forest for the trees.” Persons with Obsessive-Compulsive Personality Disorder tend to be rigid and inflexible in their approach to things. It simply isn’t an option for them to do a “sub-standard” job just to get something done. Often, they are unable to delegate tasks for fear that another person will not “get it right.” Sometimes people with this disorder adopt a miserly style with both themselves and others. Money is regarded as something that must be rigidly controlled in order to ward off future catastrophe. People with this disorder are often experienced as rigid, controlling, and stubborn.
These ten diagnoses represent ten specific enduring patterns of thoughts, feelings, and behavior. However, each of these ten patterns can be distilled down to four core features of personality disorders:
1. Rigid, extreme and distorted thinking patterns (thoughts)
2. Problematic emotional response patterns (feelings)
3. Impulse control problems (behavior)
4. Significant interpersonal problems (behavior)
In fact, in order to diagnose a personality disorder a person must exhibit at least two of these four core features.
*It is important to remember that everyone can exhibit some of these personality traits from time to time. To meet the diagnostic requirement of a personality disorder, these traits must be inflexible; i.e., they can be repeatedly observed without regard to time, place, or circumstance. Furthermore, these traits must cause functional impairment and/or subjective distress.
* Many Narcissists are hard to diagnose, as they are often incredibly charming, intelligent, and highly manipulative. If you have concerns that a person you are in a relationship with is a Narcissist, and are looking for a formal diagnosis, it’s fine to tell the therapist ahead of time about your concerns, so they can be on the look out for Narcissistic character traits.
My goal is to educate, empower, and inspire other abuse victims in understanding more about what happened to them (and how to prevent it from happening again), as well as how to go on and rebuild an amazing life.
Even though I have had a lot of "in the trenches" experience with highly manipulative people of all kinds, I consider myself to be a student of Narcissism, mindset, motivation, healing, and life in general, and am by no means an expert on any of these topics.
It's for these reasons, that when you are reading my information that I encourage you to hold to what helps, and let the rest go.
Latest posts by Dana (see all)
- Episode 55: How Do I Stop My Addiction to the Narcissist? - August 23, 2017
- Episode 53: Strategies to Help Prevent Your Child from Being Manipulated by a Narcissistic Parent - August 21, 2017
- Episode 54: How can we handle victim blaming and revictimization? - August 18, 2017