A quick history of personality disorder
It was back in the fourth century BC when the study of human personality is believed to have begun. This is when Theophrastus separated the people of Athens into 29 personality types. He called these characters such names as boastfulness, irony and arrogance.
The idea of personality disorder is far more recent. In 1801 Philippe Pinel described an ailment which he characterized as outbursts of rage and violence. He called this “manie sans délire,” “Manie” meaning violence.
In 1835, Doctor JC Prichard (1786-1848) came up with the phrase ‘moral insanity’. This referred to individuals characterized by a “morbid perversion of the natural feelings”. Including; habits, affections, temper, inclinations, natural impulses and moral dispositions’. Although this term was considered non-specific and too broad and fell into obsolescence.
60 years later Emil Kraepelin (1856-1926), a psychiatrist, described 7 types of anti-social behavior. These types were classified as ‘psychopathic personality.’ Kurt Schneider (1887-1967) expanded this phrase to feature those that ‘suffer from their abnormality.’
Schneider’s writings of 1923 still forms the basis of modern types of personality disorders. Specifically those contained in the American Diagnostic and Statistical Manual of Mental Disorders 5th Revision (DSM-5).
The different groups of personality disorders
In the DSM-5, a personality disorder may be diagnosed in an individual if there are notable disabilities in personal and social functioning. This along with one or more therapeutic personality traits.
DSM-5 lists 10 personality disorders, and assigns each one to one of the three groups or ‘clusters’: A, B, or C.
- Cluster A (eccentric, bizarre, odd) – Schizotypal PD, Schizoid PD and Paranoid PD
- Cluster B (erratic, dramatic) – Narcissistic PD , Histrionic PD, Borderline PD and Antisocial PD
- Cluster C (fearful, anxious) – Obsessive-compulsive PD, Dependent PD and Avoidant PD
Please note that personality disorders rarely happen in their ‘textbook’ form. Instead, they tend to blur into each other. Eg, in group A, paranoid personality can blur with schizoid PD & schizotypal PD. Their division into three groups in DSM-5 reflects this tendency.
What are the ten types of personality disorder?
Most people with a personality disorder rarely search the help of mental health services. People who often do, do so because they either get help for another mental disorder or they are in crisis. Most often it’s after following breaking the law or self-harming. Even so, personality disorders are relevant to health practitioners. This is because they affect the display and control of existing mental disorders. They additionally lead to considerable distress and impairment. As such might need to treatment within their own right. Whether this should be the mandate of the health professions is subject to controversy. Particularly concerning those people with personality disorders that engage in illegal activity. As such, those who treated with the main goal of preventing crime.
1. Paranoid personality disorder
Cluster A consists of paranoid, schizotypal and schizoid personality disorders. Paranoid PD defines a widespread distrust of others. Including close friends, family members, and partners. Because of this, the person is guarded and suspicious. They look for signs or suggestions to confirm his/her fears. He or she also has a strong sense of personal rights. They are sensitive to setbacks and rejections, feel humiliation and shame. Also bears grievances. Unsurprisingly, he or she tends to seclude themselves from others. They have difficulty building and maintaining close relationships. The main defense in paranoid personality disorder is projection. This involves associating one’s inappropriate thoughts and feelings to other individuals. A significant long-term study concluded that paranoid personality disorder can be hereditary.
2. Schizoid personality disorder
‘Schizoid’ means a bias to direct attention toward a persons inner life and be far from the outside world. An individual with schizoid personality disorder is detached and standoffish. They self-observe and fantasize. They have no wish for sexual or social relationships. They are dispassionate to other people and social norms and conventions. The individual is without any emotional response. One theory about schizoid personality disorder patients is that they are highly sensitive. They experience a deep longing for intimacy. But they find breaking the ice and continuing close intimate relationships too painful or distressing. They then retreat into their inner world. Individuals with schizoid personality disorder seldom make themselves known to medical practitioners. In spite of their reluctance to form intimacies, they are typically well-functioning.
3. Schizotypal disorder
Schizotypal personality disorder identifying features are strange appearance, behavior, and speech. Also, odd perceptual experiences and other symptoms seen in schizophrenia. These may consist of suspiciousness, magical thinking, strange beliefs, and obsessive musings. Individuals with schizotypal personality disorder are often apprehensive with social interaction and communication. They visualize other people as dangerous. This could lead them to establish so-called ideas of reference. This is when beliefs or intuitions are somehow linked to actual events, and in turn, themselves.
So, where people with schizotypal personality disorder and schizoid personality disorder both stay clear of people, with the former it is because they are afraid of others. Whilst with the latter, it’s because they don’t have the desire to engage with other people. Or perhaps find interacting with others too challenging. Individuals with schizotypal personality disorder have an above average likelihood of developing schizophrenia. This condition was called ‘latent schizophrenia.’
4. Antisocial personality disorder
Cluster B comprises of the narcissistic, histrionic, borderline and antisocial personality disorders. Antisocial personality disorder is much more prevalent in men than in women. This illness is defined by a callous indifference for the feelings of others. The individual pays no attention to social standards and obligations. They are irritable and hostile, act impulsively and lack feelings of guilt. They fail to learn from experience. Often, they have no problem finding relationships. They could also appear charming. However, these relationships are often fiery, stormy, and short-lived. Because anti-social personality disorder is the mental disorder most closely associated with criminal activity, he or she is very likely to have a criminal record. Or perhaps even a prison record.
5. Borderline personality disorder
In borderline personality disorder, the individual lacks a sense of self. So, the individual experiences sensations of desolation and fears abandonment. Intense and unstable relationships, emotional instability, eruptions of anger and violence are common. There is a trend of impulsive behavior also. Suicidal threats and acts of self-harm are common. Borderline personality disorder was so-called because it was ‘borderline’ between anxiety disorders and psychotic disorders. For example, bipolar, and schizophrenia. Borderline personality disorder (BPD) is often thought to result from childhood sexual abuse. This is more typical in women partly since women are more likely to experience sexual assault. But, feminists argue BPD is more common in women because women with promiscuous behavior are classified with it. While men with similar behavior have a tendency instead to be labeled with antisocial personality disorder.
6. Histrionic personality disorder
Individuals with histrionic personality disorder lack self-respect. They depend their well-being on getting the attention and acceptance of other people. These people often look to be dramatising or acting in a bid to get noticed by others. ‘Histrionic’ comes from the Latin histrionicus meaning “of the actor’. People with histrionic personality disorder may take very good care of their looks. They behave in a manner which is excessively charming or improperly seductive. Because they yearn for excitement and act upon impulses or suggestions, they put themselves in danger. Danger of accidents and of being exploited by other people. Their relations with people seem false or shallow. In the long-term this can adversely affect their romantic and social relations. This is very upsetting to these people. Because they are susceptible to criticism and feeling rejected. They respond poorly to failure or loss. A vicious circle can happen where the more rejection they feel, the more histrionic these individuals become. And then the more histrionic they end up being, the more rejection they feel. It is often thought that a vicious circle is at the center of all personality disorders, as well as all mental disorders.
7. Narcissistic personality disorder
With narcissistic personality disorder the individual feels an intense feeling of self-importance. They feel a sense of privilege and authority, as well as admiration. He or she envies others and expects others to be the same way. He or she is shows no compassion. They will lie and exploit others to achieve their goals. To other people, he or she may appear egotistical. They might also be intolerant, controlling, insensitive or selfish. If the person feels blocked or mocked, he or she can rush into a fit of harmful rage and revenge. This type of reaction is often known as ‘narcissistic rage.’ This reaction might have disastrous repercussions for all those involved.
8. Avoidant personality disorder
Persons with avoidant personality disorder completely believe they are inept in social situations. They feel inferior or unappealing, and fear humiliation, rejection and being criticized. These individuals avoid meeting other people unless they know for definite they will be liked. They are suppressed in their intimate relationships. Avoidant personality disorder is strongly connected with anxiety disorders. These could also be associated with rejection in childhood by parents or peers. Research recommends that individuals with avoidant personality disorder excessively track internal reactions. Their own reactions and the reactions of other people. This stops them from interacting fluently or naturally in social circumstances. Again, a vicious circle takes over where the more they track internal reactions the more incompetent they feel. And so the more incompetent they feel, the more they observe internal reactions.
9. Dependent personality disorder
Dependent personality disorder is defined by lack of self-confidence as well and a strong need to be cared for. The individual needs lots of help even in making day-to-day decisions. The sufferer surrenders important lifestyle choices to the attention of others. They fear those close to them will desert them. Because of this they might go to great lengths to secure and hold onto relationships. A person with dependent personality disorder identifies themselves as incompetent and helpless. So, they give up personal responsibility and submit themselves to their guardians. He/she imagines that they are one and the same with these protective people. They idealize these guardians as powerful and competent. He or she behaves towards them in a way that is servile and humble. Individuals with dependent personality disorder frequently end up with individuals with a cluster B personality disorder. These cluster B people feed on the unmitigated high regard in which they are kept. In general, persons with DPD maintain a childlike and naïve perspective. They have minimal insight into themselves and other people. This strengthens their dependence and leaves them very vulnerable to exploitation and abuse.
10. Anankastic personality disorder
Anankastic personality disorder is defined by extreme obsession with rules, details, organization, or schedules. Perfectionism so severe that it actually prevents a task being completed. A perfection and devotion to productivity and work. Usually at the expense of leisure time and relationships. A man or woman with anankastic personality disorder is usually disbelieving and cautious. The individual is mentally stubborn and controlling, humorless, and ungenerous. Their underlying anxiousness develops from a lack of control over the world which eludes their understanding. The more they try to apply control, the more out of control they feel. Because of this, they have little toleration towards complexity or subtlety. They simplify the world around them by seeing things as either all fantastic or all terrible. His/her relations with family & friends become tense due to the unrealistic and stringent demands they make.
Whilst personality disorders might differ from a mental illness such as bipolar or schizophrenia, they do lead to significant disability. These individuals are believed to affect about 10 per cent of people. Although this number ultimately depends where physicians draw the line comparing a’ regular’ personality and one that results in notable disability. Defining the 10 different personality disorders is tough. But diagnosing them reliably is even tougher. For example, how far from “normal” must personality traits deviate before they are counted as disordered? How significant is ‘significant impairment’? And also how is ‘impairment’ to be characterised?
Whatever the answers to these types of questions, there will be a large amount of subjectivity. A clash of personal values or personal dislike or prejudice may play a part in coming to a medical diagnosis of a personality disorder. Also, it has been debated that the diagnosis amounts to no more than a handy label for undesirables and social deviants.