LINK 1, 2, 3, 4
Personality disorders are characterized by four criteria:
1. Distorted thinking patterns: People with PDs have distorted thought patterns about themselves and the world around them. These extreme and strange ways of thinking are generally most evident when interacting with non-disordered personalities. Distorted thinking can often be sorted into five categories:
- Black-and-white thinking: For the person, everything is all-or-nothing. They either always get their way, or never. In an argument, the person is absolutely right and the other person is absolutely wrong, there is no room for nuance or both parties to be correct/incorrect.
- Idealization and devaluation: Similar to black and white thinking, the person fluctuates between seeing others as flawless and perfect, or hopelessly incompetent and flawed, even malicious or evil. These fluctuations can be triggered by even minor-seeming events.
- Suspiciousness and distrust: The person has a heightened sense of suspicion of others. They may believe that humans are inherently manipulative or harmful, and constantly search for these motives in others’ actions. For example, a small gift may seem to them like an act of manipulation or bribery.
- Odd and unusual beliefs: The person believes in strange things, contrary to the person’s culture.
- Perceptual distortions: The person experiences brief “glitches,” such as hearing their name called in an empty building or seeing another’s face change before their eyes. These distortions are not considered hallucinations or delusions because the sufferer can often distinguish them from reality.
2. Problematic emotional responses: People with PDs often have emotional reactions, contrary to their culture, that are either too modulated or too exteme. For example, people with schizoid PD are very over-regulated and consequently cold and indifferent, while people with histrionic PD are very under-regulated and thus prone to extreme mood swings and reactions.
3. Over/under-regulated impulse control: Similar to the above, people with PDs are either over- or under- constrained in controlling impulses. For example, people with avoidant and obsessive-compulsive PD are over-regulated and consequently extremely controlling over their environment, while people with antisocial or borderline PD are under-regulated and prone to risky, reckless behavior.
4. Interpersonal difficulties: As a result of the above characteristics, a person with a PD often experiences considerable difficulty in relationships of all types. For example, a person with borderline PD may often frustrate their partner by starting arguments, acting on their distorted thoughts and under-controlling their impulses.
Cluster A: The Odd, Eccentric
Cluster A disorders are characterized by social awkwardness and withdrawal. Disorders within the same cluster have a high comorbidity; if you have one PD, it is very likely that you have some symptoms, or even another fully-developed PD from the same group. Note that these symptoms are not checklists; every case is unique and not everyone will experience the same symptoms.
Primary features: detachment, flat affect, disconnection
- Little to no social drive, urges.
- Does not develop attachment; it’s debated whether this is an inability or a choice not to, most likely varies with the individual
- Emotions are shallower, more fleeting - default state is virtually emotionlessness
- May have trouble identifying emotions and/or putting them into words
- Apathetic, listless, detached
- Anhedonia (lit. lack of pleasure) , avolition (lit. lack of want, desire)
- Lacks affective empathy, the ability to “walk a mile in one’s shoes” and feel as someone else does. However, most schizoid people still posses cognitive empathy, or the ability to recognize, categorize, and name emotions in others.
- Indifferent towards praise and criticism
- May have a rich, detailed inner world OR be somewhat unimaginative, prefer mechanical and scientific pursuits [citation needed - contributions welcome]
- Overt schizoids do not disguise their personality and often appear cold, aloof, indifferent, callous, dull, uninterested, boring. Often speaks tersely and/or in a monotone.
- Covert or “secret schizoids” present themselves through a persona that is sociable, friendly, and engaged.
- Few/no friends or confidants - if any, they’re probably first-degree relatives
- Seem listless, directionless, without goals
- May avoid things like seeking a job or higher education due to avolition, a desire to avoid engaging with society
- Will probably not seek out professional help on their own or for being schizoid per se - most see a psychologist only at the urgings of a family member and for an unrelated illness, such as depression
- Due to these factors, SzPD appears to be among the rarest PDs but is probably underdiagnosed
Primary features: odd beliefs, unusual thought patterns/speech, social discomfort
- Holds suspiciousness and paranoid ideations about other people or the human species in general, especially based on fears of physical/verbal/sexual violence - contrast to social anxiety, which is based on fears of embarrassment and misreading social cues
- Feels acute discomfort in social situations and interpersonal relationships that does not diminish with familiarity - usually due to paranoid ideations, but a certain level of / comorbidity with social anxiety is not uncommon
- Experiences minor cognitive and perceptual distortions such as movement in the corner of the eye, a sensation of weightlessness/melting limbs, hearing their called name in a crowd - as stated in the introduction, these are generally not considered to be delusions or hallucinations.
- Experiences magical thinking, or the belief that their thoughts influence reality - a development of Obsessive-Compulsive Disorder may result, as the schizotypal person struggles to control certain malicious or frightening thoughts and develops rituals to pacify or neutralize them
- Experiences ideas of reference; believes that other people notice them, notes passing events (ex. a popular advertisement) as having a hidden message or meaning
- Holds odd beliefs and superstition (that are unusual for the patient’s culture and upbringing) . An American example would be a person that believes they can read minds, that their thoughts are being stolen, or that they are targeted for alien abductions.
- May experience psychotic episodes (e.g delusions, hallucinations) when under extreme duress - frequent, non-stress related psychosis is indicative that the schizotypal person has progressed to schizophrenia.
- Dresses oddly and inappropriately; may be mismatched, ill-fitting, dirty, or inappropriate for the occasion/setting
- Odd thinking and speech patterns - may be overly abstract, metaphorical, vague, elaborate, ornate, or focus on the “wrong things” in conveying a message - schizotypal people can be hard to understand or follow in a conversation
- Inappropriate or flat affect, an inability to express conventional emotions or depths thereof
Primary features: pervasive distrust and suspiciousness
Paranoid Personality Disorder is generally not diagnosed if the person has already been diagnosed with a psychotic disorder, such as schizophrenia.
- Strong, constant assumption that others are out to hurt, manipulate, and/or humiliate them
- Puts tremendous effort in maintaining safety, distance
- Tends to ruminate over past slights
- Tends to hold grudges, jealousy, envy - includes romantic/erotic jealousy and suspicions of infidelity
- Constantly worries over and/or questions the loyalty of others
- Reluctance to confide in others - fears that the confidant may use that information against the paranoid person
- Constantly searching for malicious intent in others - to the paranoid person, a simple apology can be an attempt to re-earn their trust and manipulate/hurt them again and again in the long run
- Emotional state dominated by suspicion, distrust, and hostility
- Places importance on self-reliance, autonomy
- May pre-emptively attack someone they feel threatened by
- Expresses psychic distress through: complaining/criticism, argumentativeness, aloofness, stubbornness, sarcasm, a desire to control their environment
- Keeps self guarded, secretive - may appear devious, cold, callous, even cruel
- Combative and suspicious nature provokes others ► reinforces the original belief that other people are out to hurt them ► becomes more combative and suspicious, provoking others ► reinforces the original belief… and so on and so on, creating a feedback loop of hostility