Per the DSM-V-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision), personality disorders “represent an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.” A personality disorder may cause distress and impact an individual’s ability to function in society. In this blog, I will break down the different types of personality disorders. By doing so, the hope is to create greater understanding, compassion and empathy for those that deal with persistent impacts on their mental health. I will also explore ways to cope with personality disorders should you or someone you care about has a diagnosis.
Clusters and types of personality disorders
We organize personality disorders into three different clusters: A, B and C. Cluster A includes paranoid, schizoid, and schizotypal. This cluster encompasses individuals who are often categorized as eccentric and express unconventional behaviors. Cluster B includes antisocial, borderline, histrionic and narcissistic. These four personality disorders encompass dramatic, erratic or emotional behavioral and thought patterns. Cluster C includes avoidant, dependent and obsessive compulsive (not to be confused with OCD, or obsessive compulsive disorder). Anxiety and fear are often at the root of cluster C personality disorders. In order to be diagnosed with any personality disorder, the APA (American Psychological Association) states that the symptoms must impact at least two of the following areas of ones’ life: way of thinking about oneself and others, way of responding emotionally, way of relating to other people and/or way of controlling one’s behavior.
In the United States, approximately 9% of Americans have some sort of a personality disorder. The most common three are borderline personality disorder (BPD) narcissistic personality disorder (NPD) and obsessive compulsive personality disorder (OCPD). So often in today’s culture, we throw diagnoses around casually. People label others as “narcissists,” which can impact others’ mental health who may be struggling. Some people may confuse OCD with OCPD. People may use humor, social media or misinformation when discussing BPD. In order to undo shame for those with personality disorders, we can explore BPD, NPD, and OCPD from a place of awareness, knowledge, and compassion.
Obsessive Compulsive Personality Disorder
An individual is diagnosed with OCPD when they display an overwhelming need for order, an unwillingness to relinquish control, strictness around rules and a superiority around the way things should be done. Some of the symptoms include perfectionism that may interfere with someone’s ability to accomplish tasks, excessive fixation on regulations, a devotion to work that overrides outside obligations, rigidness in multiple areas of their life and potential hoarding behaviors. When these symptoms interfere with interpersonal relationships and a social life, an OCPD diagnosis is often appropriate.
Treatment for OCPD
With hyper fixation around rules, a feeling of superior moral ground and fear of letting others lead, it may be challenging for others to connect with someone with OCPD. Conflict may arise and it could be difficult to negotiate and find common ground. Remember that these behavioral patterns and thoughts can come from genetics or family dynamics. For example, imagine an individual who grew up in an authoritarian household. Consider the implications of what would happen if strictness was alleviated, even if it meant letting go of something small. Treatment for OCPD includes psychotherapy, medication, and meditation. Medication may help shift focus from obsessing over minor details. Through therapy, you can celebrate wins, stay curious about motivation behind actions and create a safe bond with someone who will show up for you every week.
Narcissistic Personality Disorder
NPD can often display contradictions, where one may feel both entitled and insecure. Although someone may feel superior, defenses may arise. Self-importance, fantasies of power, a belief of uniqueness, an intense need of admiration and envy are common symptoms of NPD. These symptoms can impact how one relates with others by either pushing people away or drawing people near in a self-serving way. A person with NPD may be easily hurt by others internally, yet present as infallible externally. An important distinction between NPD and narcissism is that narcissism is a personality trait that may lift someone up in certain situations, where NPD can cause intense distress and impairment over time.
Treatment for NPD
So how does one tackle narcissistic personality disorder? Learning how to navigate strong emotions may create greater balance rather than such a broad swing between entitlement and insecurity. One can explore what it would mean to have a different self-image and how to manage thoughts that are intrusive. By focusing on relationships with family and friends and less on money or success, you may be able to reframe values and shift your priorities. CBT (cognitive behavioral therapy) can help with cognitive restructuring to shift black and white thinking to a more mindful, diverse practice. Psychoeducation can provide an outside perspective that may help ground you. NPD cannot be treated with medication, however, certain medications may help treat comorbidities to NPD like anxiety and depression.
Borderline Personality Disorder
BPD, the most common personality disorder, often displays extreme symptoms that impact interpersonal relationships. Mood swings may appear, lasting from a few hours to a few days, with depressive, anxious or irritable symptoms. Impulsivity is commonly seen with those dealing with BPD, in budgeting, sex, substance use and shifting jobs. Boredom, lack of fulfillment and a persistent sense of emptiness can also occur in those diagnosed with BPD. Suicidality may occur due to the intense nature of these symptoms. While there is no one cause for any personality disorder, BPD is often influenced by dysfunction and instability in the child’s home.
Treatment for BPD
A previous client of mine exhibited multiple symptoms of borderline personality disorder. With a tumultuous romantic relationship, a cycle of quitting jobs, and a fractured dynamic with his parents, we experienced a breakthrough exploring what he thought he deserved, especially when it came to love. Due to a different line of thinking and feeling, those with personality disorders can often experience extreme aloneness. DBT (dialectical behavioral therapy) can help teach coping skills to deal with the symptoms associated with BPD. Additionally, medications may assist in lessening impulsivity and suicidality, while also stabilizing mood swings.
Thriving instead of surviving
Through discovering your own identity, regardless of the diagnosis, this will allow you to take the necessary steps to thrive within your circumstances, rather than solely surviving. Personality disorders sometimes go undiagnosed. However, recognizing symptoms may provide comfort or relief to understand how you interact with others. Additional wellness considerations may include substance use and physical activity. Depending on mental health medications, alcohol and/or drug use may worsen symptoms or skew interactions with others. Exercise of any kind could assist to lessen the chances of comorbidity, or the addition of other diagnoses or disorders.
If you think you may have a personality disorder, you can seek professional help for a diagnosis. Therapy may be a beneficial addition to understanding certain thought patterns, emotional regulation and behaviors. I want to conclude with one note around all diagnoses. Someone may wonder “do I have a personality disorder?” after reading this blog. Historically, diagnoses are through the lens of one cultural view, not taking into account other beliefs, practices and norms.
This is all to say, take the above information and any information on diagnoses (especially with the increase of mental health discussions on social media) and personality disorders with a grain of salt. While some may find them healing and enlightening to a history of distress, others may find them as limiting and a commentary only subscribing to a majority view on how people should act and behave. Remember you are an intersectional human composed of layers of emotions, experiences, environments and everything in between.
Are you interested in seeking treatment for a personality disorder? Reach out to myTherapyNYC to find out which of our therapists would be a good fit for you!
Have you had an experience with personality disorders or any diagnoses that has impacted your life, or that of a loved one? Join the conversation in the comments below!