The Spectrum of Personality Disorders: Understanding Types & Traits

We each have our own unique personality, but what happens when one has a personality disorder?

Firstly, personality disorders differ from other psychiatric disorders such as bipolar, schizophrenia and major depressive disorder in that personality disorders are chronic, as opposed to the episodic nature of conditions like depression, meaning their symptoms are enduring over time and situations. Personality disorders are conditions where individuals think and behave in markedly different ways from the culturally accepted norms. In addition, these conditions cause distress and impair functioning of those affected.

According to the existing literature, personality disorders are relatively common, with estimates suggesting that about 1 in 20 people may be affected. These disorders are significant, not only for the individual’s well-being, but also for the impact they have on their relationships and overall functioning.

The DSM-5 identified 10 different personality disorders, organised into 3 clusters:

Cluster A: Paranoid, Schizoid and Schizotypal personality disorders

Paranoid Personality Disorder: Characterised by a pervasive distrust and suspicion of others, often without rational basis. Individuals with this disorder tend to be excessively wary of other people’s intentions and motives, constantly on guard for perceived threats. They are hypervigilant and defensive during social interactions and perceive minor criticisms as attacks on their character or reputation, resulting in hostility towards others with frequent outbursts of anger and aggression.

Schizoid Personality Disorder: Characterised by a pattern of detachment from interpersonal and social relationships, with limited emotional expression and a preference for solitude. People with schizoid personality disorder often lack an interest in close relationships, are emotionally detached and find limited joy in activities. This disorder is estimated to affect around 1.6% of the general population.

Schizotypal Personality Disorder: Characterised by attributing personal meaning to objects or events, even when there is no connection. Much like schizophrenia, people with this disorder believe in magical thinking, telepathy or supernatural phenomena outside those of the cultural norms. They are extremely paranoid and seem to have high levels of unwarranted suspicions about ideas, people and events.

Cluster B: Antisocial, Borderline Personality, Histrionic Personality, Narcissistic Personality disorders

Antisocial Personality Disorder: Characterised by a general disregard for others, with patterns of behaviour that violate societal norms and the rights of others. Individuals with disorder may engage in persistent lying, stealing and manipulation, lack empathy for others, exhibit recklessness and fail to maintain long-term goals and relationships. Antisocial personality disorder is estimated to affect between 0.2 and 3.3% of the global population.

Borderline Personality Disorder: Characterised by unstable interpersonal relationships, a fragile sense of self, emotional dysregulation, and impulsivity. Individuals with BPD often fear abandonment, struggle with intense and unstable relationships and are at high risk of engaging in self-harming behaviours with recurrent suicidal thoughts and gestures. They experience intense mood swings, chronic feelings of emptiness and often have difficulty in controlling anger. BPD impacts an estimated 0.7 and 2.6% of the population.

Histrionic Personality Disorder: Characterised by a constant need for attention and a tendency to be overly dramatic. Individuals with histrionic personality disorder seek approval and display wild mood swings, even in minor situations. They become bored easily and seek novelty, and they also tend to be overly involved in relationships, constantly demanding attention and validation. A diagnosis requires symptoms like discomfort when not the centre of attention, sexually seductive interactions, shallow and insincere emotions, impressionistic speech lacking details and exaggerated emotional expression. This disorder is estimated to impact between 1.6 and 2% of the population.

Narcissistic Personality Disorder: Characterised by an inflated sense of self-importance, a pre-occupation with fantasies of success and a constant need for admiration from others. Individuals with this disorder often lack empathy, believe they are entitled to special treatment, and often exhibit exploitative behaviour in their interactions. Narcissism impacts roughly 6% of the population.

Cluster C: Avoidant, Dependent and Obsessive-Compulsive Personality Disorders

Avoidant Personality Disorder: Characterised by social inhibition, withdrawal and the avoidance of social interactions due to high levels of discomfort and fear of negative judgement. They are extremely shy, sensitive to criticism and have a low self-esteem, desiring acceptance but forming relationships extremely cautiously. People with this disorder are unwilling to engage with others unless they know they will be liked and accepted, and have a pre-occupation with criticism, disapproval or rejection in social situations.

Dependent Personality Disorder: Characterised by a persistent reliance on others to meet their needs, exhibiting submissive behaviour and an intense fear of separation. They often delegate major life responsibilities to others and have trouble expressing disagreement out of fear of losing support and approval. They are excessively pre-occupied with being left to fend for themselves and go to great lengths to obtain nurturance and support from others.

Obsessive-Compulsive Personality Disorder: Characterised by extreme pre-occupation with order, perfectionism and control, often at the expense of their interpersonal relationships. These individuals overly devote themselves to work to their detriment, are rigid in their thinking patterns and spend excessive amounts of time trying to achieve perfection at the expense of other important aspects of their lives, such as their health, well-being and relationships.

How do these personality disorders develop?

Twin studies that investigate the heritability of such disorders suggest that personality disorders have a genetic basis ranging from 27% to 42%, while research focusing on environmental causes suggest that things like childhood emotional abuse, neglect and environmental instability during those early life stages contribute to the development of these disorders.