Personality Disorders

As a group of diverse diagnoses, 'personality disorders' have traditionally been considered a distinct category of mental health problem. Whereas conditions such as anxiety and depression have been conceived as 'episodic' (they afflict an otherwise healthy person for discrete periods of time), personality disorders refer to difficulties that are inherently related to a person's enduring style of thinking, feeling, behaving and relating to other people. 

The concept of personality disorder is controversial. A 'disordered personality' implies inherent dysfunction within the individual, rather than a dysfunction in their social environment or the wider society. Notable people in the field (e.g. Marsha Linehan) have noted this, suggesting that any problem can only reasonably be understood as an interaction between the individual and the environment within which they live. 

Nevertheless, it is clear that for some people, a personality disorder diagnosis captures the problems they have been experiencing more accurately than other mental health labels. For example, the experience of repeated relationship turmoil, self-defeating and self-harming behaviours may be better understood by considering whether aspects of our personality may have contributed to the reoccurrence of these patterns. 

Ten different personality disorders are included in the current Diagnostic and Statistical Manual of the American Psychiatric Association, and these are grouped into three 'clusters' of related disorders. These diagnoses and their associated features are listed below. In my own clinical experience, no client maps neatly or discretely into one category. We can all have various aspects of these features in our psychological makeup, and each area is more accurately thought of as a kind of spectrum than as a binary disorder.

Cluster A (Disorders associated with schizophrenia, but lacking or with less severe psychotic features)

• Paranoid personality disorder: this involves difficulty trusting other people, and potentially perceiving sinister motives in others.
• Schizoid personality disorder: limited interest in interacting with others, an apparently limited range of expressed emotion .
• Schizotypal personality disorder: marked discomfort in social interactions, and disorganised thinking and perceptions.

Cluster B (Disorders associated with intense emotion and/or dramatic or erratic behaviour)

• Antisocial personality disorder: a lack of concern for the feelings of others, a willingness to act impulsively without interest in the repercussions. Can be manipulative, abusive and violent in pursuing goals. 
• Borderline personality disorder (typically termed 'Emotionally Unstable Personality Disorder' (EUPD) in the UK): ability to connect and form relationships with others, but marked instability in these relationships often related to the triggering of intense emotion. Self-harm and suicidal features frequently present.
• Histrionic personality disorder: a pattern of 'attention-seeking behaviours', a desire for stimulation and approval. This may involve heightened, dramatic emotional behaviour that could be perceived as 'for effect'. 
• Narcissistic personality disorder: a highly elevated sense of self with a consequent need to have this view of self validated by other people. Displays of anger (grandiose narcissism) or sensitivity/defensiveness (vulnerable narcissism) when this self-conception cannot be sustained

​Cluster C (anxious or fearful disorders)

• Avoidant personality disorder: an extreme sensitivity to being judged as inadequate by others, deep feelings of social inadequacy and consequent avoidance of social situations.
• Dependent personality disorder: a tendency to become entirely dependent on the support of one (or a limited number) of people to the exclusion of other relationships and associated fear for the ending of this relationship.
• Obsessive-compulsive personality disorder (OCPD aka 'Anankastic personality disorder'): while superficially sharing some features of OCD (such as a concern with rules, perfectionism, and control), OCPD is termed 'ego-syntonic': unlike in OCD, they do not typically have any sense that they are excessive in their high standards or obsessiveness.