Personality Disorders: The Clusters, The Facts, & The Relief

Personality Disorders, as well as Intellectual Disabilities, are considered an Axis II disorder by the DSM-IV, which provides a detailed diagnosis of a host of illnesses, and explains all of the acute symptoms. It is exceedingly important to note that the vast majority of individuals with an Axis I Mood Disorder, such as Major Depressive disorder and Bipolar Disorder. It is incredibly common for people to suffer from both, which greatly exacerbates and complicates both illnesses. Most have at least three.

Cognitive Behavioral Therapy (CBT) is one of several modes of care used to treat personality disorders. Dialectical Behavioral Therapy (DBT) is built upon this model, adding Zen practices (e.g., mindfulness) and the Hegelian principle of dialectical process.

For example, let’s use yours truly, an official nut, as an example. I have Major Depressive disorder (severe, recurrent; Axis I) and (Axis II), as well as Generalized Anxiety disorder with panic and “agoraphobic tendencies,” and PTSD. It is likely, then, that the worst elements of my BPD (I struggled with self-harm addiction, and feel a constant, empty hollow inside) coupled with the more severe class of MDD (which includes an attempt on my life) bolsters the difficultly and pain in managing both—and this hurts me, my family, my friends, my partner, and makes it difficult for my psychiatrist to keep me in a healthy state. I feel in constant recovery rather than full remission, even when I am doing extremely well, which may in fact be directly informed by the BPD state bolstering the MDD condition, and risks causing me additional episodes of great length and unbelievable psychic pain.

So, What Is An Axis II Personality Disorder, really?

The most pervasive symptoms of Personality Disorders include frequent mood swings, unhealthy relationships, a propensity toward isolation, angry outbursts, suspicious and paranoia, difficulty making (and especially in retaining) friendship and romantic attachments, a need for instant gratification, poor impulsive control, and alcohol or substance abuse. This is one of the factors that makes correctly diagnosing an Axis II disorder (or certain Axis II disorders, for that matter), as the traits tend to overlap. Other characteristics frequently seen in people with both Axis I and Axis II conditions is a remarkable class of mental exhaustion and emotionality scorned by precipitous societal stigma; it can make the chronic illnesses seem absolutely unmanageable and even beyond any hope. Many more progressive doctors find the term in and of itself to be problem (I cannot overstate how many times I have heard people who’ve been diagnosed with a Personality Disorder, say, “It’s my illness; my personality is me!”). According to a doctor at the Mayo Foundation for Medical Education and Research (MFMER):

[T]he diagnosis “personality disorder’ should be replaced by the diagnosis “adaptation disorders’. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research—we discuss these aspects in some detail.

The most commonly diagnosed Axis II disorders are as follows:

  • Antisocial
  • Avoidant
  • Borderline
  • Dependent
  • Histrionic
  • Narcissistic
  • Obsessive Compulsive
  • Paranoid
  • Schizoid
  • Schizotypal

These disorders are grouped into three “clusters,” (A, B, and C) based on similarities in the symptoms. Having one does not at all preclude you from having a secondary Axis II disorder; rather, it increases your chances, which is why therapy is essential for anyone with a chronic behavioral health illness, regardless of what it is or how many. Traditional psychotherapy, family therapy, Cognitive Behavioral Therapy (CBT), and Dialectical Behavioral Therapy (DBT), to name four quite popular types, have been proven greatly successful at ameliorating some of the most acute characteristics.

Cluster A personality disorder are grouped by illnesses where odd, eccentric thinking or behavior are central and prominent. This includes Paranoid Personality Disorder (distrust of others, believing others are trying to harm you, emotional detachment, and hostility); Schizoid Personality Disorder (lack of interest in social relationships, limited ranged emotion expression, inability to pick up so-called “normal” societal cues, and appearing indifferent to people, places, and events); Schizotypal Personality Disorder (extremely strange thinking, beliefs, or behavior, sensory perceptual alterations, discomfort in close-knit relationships, flat or inappropriate emotional responses, indifference toward others, believing that messages intended only for you are in plain sight within public forums or even speeches, and engaging in “magical thinking, such as the ability of others to read and/or influence your thoughts).

Cluster B personality disorders are often classified due to the individual’s melodramatic and overly emotional thoughts and actions. This includes Antisocial Personality Disorder (which used to be called Sociopathic, and is typified by a frequent disregard for others, incessant lying and/or stealing, recurring difficulties with the law, repeatedly violating the rights of others by using aggressive, often violent behavior, and a prevailing disregard for the safety of themselves and others); Borderline Personality Disorder (impulsive/risky behavior, volatile/extremely unstable relationships, instability with regard to mood, self-injurious acts, and suicidal behavior); Histrionic Personality Disorder (classified as someone who is constantly seeking attention and has a prevailing concern with his/her physical appearance, extreme sensitivity to the approval [or disapproval] of others, and a chronically unstable mood); and Narcissistic Personality Disorder (includes fantasizing about power, success, and attractiveness, exaggerating one’s achievements or talents, the expectation of constant praise and admiration, and continually failing to recognize the emotions and emotional needs of other people).

Cluster C personality disorders are often typified by anxious, fearful thinking/behavior. Avoidant Personality Disorder is comprised of great hypersensitivity toward criticism or rejections, feeling inadequate and timid, and thereby very shy in social settings. A person with this Axis II disorder would most likely have intense social anxiety, but also have a grave dislike for social isolation, making it a very complicated illness to treat); Dependent Personality Disorder (commonly reflected as an excessive dependence on and submissiveness to others, a desire/need to be taken care of, tolerance of poor or even abusive treatment, and the urgent need to begin a new romantic relationship as soon as one concludes); Obsessive Compulsive Personality Disorder (this disorder usually entails a preoccupation with orderliness and rules, extreme and unhealthy perfectionism, the desire to be in control, an inability or great challenge in discarding broken objects, and a general lack of flexibility in toto).

{Please note: Obsessive Compulsive Disorder (OCD) is not the same as Obsessive Compulsive Personality Disorder, which is a class of anxiety disorder.}

Is There Any Hope In Overcoming A Personality Disorder?

In a word: yes! Firstly, getting a correct diagnosis from a knowledge and caring psychiatrist is essential, followed by adherence to your safety plan, which may or may not include medication, but should definitely include therapy. The best class can be sorted out between you and your doctor (and perhaps conversation with allies, including family and friends). You can even engage in several yourself to decide which you feel you will benefit most from, and finding out what type the majority of people with your illness(es) utilize, and why. Additionally, there are now many mood stabilizers, antidepressants, anti-anxiety, and antipsychotic medications that have been proven to greatly aid with helping people recover, so long as they remain dedicated to their therapeutic treatment and live a healthier lifestyle. In instances where individuals are in grave danger of harming themselves or others, or have developed psychotic conditions, relatively brief psychiatric hospitalizations (usually 72 hours to three or four weeks [the latter when receiving, for example, ECT or severe medication adjustments, which mandates hospital stays for safety and monitoring).

You need to want to get better because you know you can (e.g., roughly a decade of participating in DBT will reduce or even eliminate approximately 86% of BPD cases), and give yourself that new life starting with some small steps (and soon!). Try to maintain your medical care, exercise and activity (and less social isolation, as hard as that is!), making healthier food and drink choices, learn all about your illness(es), and pay attention to your triggers and warning signs to better understand when the pain is most profound; that way, you can create a solid safety plan, and get into more intensive treatment right away.

Use your expertise to defeat these diseases. And remember: it is imperative to learn some relaxation techniques and stress management (deep breathing is a great way to begin, and I personally love Ashtanga yoga); perhaps join a support group (contrary to everything I’d assumed, DBT group therapy has always been transformative and empowering); and, of course, be kind and gentle with yourself.

16 thoughts on “Personality Disorders: The Clusters, The Facts, & The Relief

  1. I’ve had covert SPD my entire life but didn’t know until very recently (closing in on 50 now). This revelation doesn’t bother me a bit and I have no desire whatsoever to change. I became financially independent for one reason: I don’t want to depend on anyone for anything – ever. Financial dependence means social dependence, which I find very unappealing.

    I have one friend/acquaintance and have no desire to have others. My favorite activity is reading and I have the news on the TV 24/7. I work from home in a technical field which requires very little interaction with others. I spend a good deal of my free time reading to further my technical skills. I also enjoy reading blogs like these online (psychology related).

    I used to enjoy sex a great deal, but as I grew older I found masturbation to various sexual fantasies online to be far more erotic and appealing. For me, watching others doing it is better than doing it.

    I had difficulty interacting with others at a young age, but as I grew older, I learned to pantomime how others acted in social situations and can effectively interact with others when the need arises. People at work have no idea that I have covert SPD. I’ve been called great at what I do, quiet, kind, and polite. All of my performance evaluations have been excellent.

    I much prefer the company of dogs to people.

    Career wise and degree wise, I’m successful. Graduated Ivy League, Summa Cum Laude, and my yearly income is around 200k. Own my own home, save my money, and have lots of cool toys.

    I LOVE BEER and I usually only drink alone.

    I don’t really care what others think of me but will work hard to gain the respect of others to maintain my social independence. For me, everything is about social independence. I usually don’t even check my mail until it gets dark outside.

    I don’t feel better than others and I don’t feel worse than others. I’m just different and distance from others is comforting.

    I have zero interaction with family members and prefer to keep it that way.

    It would be great to be in a romantic relationship but someone always leaves. Loss of emotional attachment is too painful, as is divorce, so no more of that.

    I am what I am and have become OK with that. Looking back, my “disorder” has probably saved me from a lot of personal conflicts, betrayals, and disappointments.

  2. Hey Ted,

    What an incredibly brave and honest comment—I really appreciate your willingness to engage in this essential conversation so frankly and without needless self-censorship. It does, too, sound as if you’ve found ways to manage your illness (I take it you are referring to Schizod in this case when you mention SPD, just because of the symptoms you list; correct me if I’m wrong!), but remember: we are constantly learning. Coming to terms with who we are is essential—critical, even—to retaining the desire to keep on, for these illnesses can indeed be exceedingly trying. Following in your stead, I will be forthright and admit that managing Major Depressive Disorder and Borderline Personality Disorder (and those crucial anxiety goodie-package) is exceedingly difficult. I has claimed a lot from me: and yes I am claiming it back. But I want to make sure distractions don’t become avoidance, because that isn’t healthy. Because there is a fuller, more fulfilling life out there, and we must not settle because ultimately we’ll know it was the wrong thing to do; that we should have tried more because we are stronger than we think. I feel as if, to some degree, everyone is.

    I understand what you mean about what your “disorder” has given you. I feel I’ve learned infinitely valuable lessons from what I have been through, largely vis-a-vis others at psychiatric facilities. Talk about solidarity. It might seem odd to say, but sometimes I’ve never felt so free. Scared, yes. But doing something for myself that I knew in the long run might work, and I promised to try everything because giving up. Again.

    You may have reached a place in your life where you are happy and content, but if not, please know you are not resigned to having certain traits in line with your diagnoses forever if you don’t want them. Seriously. You should have a look into DBT—it really helped me. (I blab about it all over this site. I know).

    And again: thank you. I appreciate your taking the time to comment—and the guts.

    Sincerely,
    Alex

    • Is an anger attack siimlar to a panic attack? I always feel like my attacks are down to frustration rather than fear. I’ve never hit or lashed out at anyone but instead if someone is criticizing me I feel useless and I start to internalize the criticism and my thoughts just keep getting worse until I have a full blown anger/panic attack. I feel like I have no control or can’t do anything right. Can anyone tell me if this sounds more like panic or just rage at myself?

      • Hey there,

        I am sorry to learn what you are grappling with. In the sense that you “feel like [you] have no control or can’t do anything right,” that is similar to how a panic attack feels for me. Many times, I would then feel shame at myself for having panicked, especially when diminished by others, but the truth is what I experience in these moments is very real indeed, and the internalized repression that causes such shaming truly must be resisted. That’s not to say it’s easy. Perhaps one of the more difficult things I’ve struggled with. It is pointless to blame yourself–and you can get help to treat your rage issues, which is so much more meaningful than what they can be compared to. Have you looked into CBT or DBT? These types of therapies have proven helpful om treating “personality disorders,” and I greatly recommend checking it out. You can get better.

  3. That was really well done. A lot has been said on these issues of late, nonetheless I prefer this enlightened point of view.

    • Thanks Penny. I think personal struggles have helped make me a daily student…hopefully soon a real one…in behavioral health studies. I appreciate it so much that you took your time to comment so positively. I hope the rest of the blog is helpful as well! I will certainly be writing more all the time, so be sure to check back.

      Take care and be well over there!

  4. Alex,

    I found your site after you left a comment on one of my own blog articles about SPAM comments. I’ve read you posts a couple of times now and think you are truly an excellent writer. You also seem to be developing quite a nuanced understanding of professional mental health literature.

    One comment I wanted to add on this particular post is that I think a better name for Axis II disorders would be “Integration Disorders.” Despite what my esteemed colleagues down at Mayo may suggest, I frequently find that individuals with Axis II disorders are sometimes quite good at adapting to new situations, but they frequently struggle with finding ways to get the different parts of themselves to get along and work together.

    In fact, if you’re ever looking for a dissertation idea some day, my personal thesis is that the main reason psychiatric medications have such a poor track record for helping people with Axis II disorders is that medications can only increase or decrease the connectivity between neurons. When it comes to integrating neurological connections, however, and synchronizing them so they function together in harmony, medications cannot provide any assistance. Skills training, on the other hand, like you find in DBT and to a more limited degree in CBT, does an excellent job of helping people build new connections between parts of their brains that previously refused to talk to each other.

    • Thank you for generous and helpful comment. I in fact embarking on the great process of choosing the proper PhD program, of which what you’ve discussed in your area of expertise. I agree with your remarks, and actually have found what seem to me major flaws in the current medical language, especially regarding “axis II” diagnoses, and of course, Borderline Personality Disorder. I will certainly be sending you a longer, more detailed message, but wanted to thank you immediatly for your work; and to state that I’d be honored to continue the conversation. Thanks again! It means a lot.

  5. Hi,
    Found what you had to say usefull. I don’t have anyone to speak to about my BPD and struggle a lot with it. Alot of what you wrote i found to mirror image myself. What a painful life it is with BPD, should be groups like AA etc for it.
    Thanks for putting yourself out there for others to relate too.

    • The struggle of living with BPD is indeed profound, and I feel very strongly that it is imperative for behavioral health issues not to contonue to receive stigmatization or remain silenced. The more folks know, the more sympathetic true allies will be; people like you, who are brave enough to stand up and speak out as well. Living with the illness CAN get better; look @ the 86% decline in symptoms of BPD through years of engaging in DBT! There is so much more that can be done with proper therapeutic care. Don’t give up. We’ll get there!

  6. Hello Alex, I really enjoy reading your blog. Having recently been diagnosed with bpd, OCD (primarily ordering and symmetry in response to my scattered emotions and unstable moods), generalized anxiety and suffering from chronic procrastination (can’t seem to ever get things done because I never feel emotionally ready to “confront” take or situations, life is so tough!!!! My life is a living he’ll, for the most part, having a newborn and intense, yet unstable w my would’ve been husband, thanks bpd, boyfriend makes things so much worse. I’m currently seeking dbt therapy in NYC, however, through research I’ve come across another form of therapy designed specifically or bpd, “schema therapy,” which I strongly suspect will be more effective. It’s designed to target the several modes individuals w the disorder manifest. I was curious to know what were you’re thoughts and feelings on schema therapy, your blog is very insightful and like many of us bpd -at a good moment- ur personality and thoughts are quite refreshing.

  7. What’s up E?

    Your comment was really endearing: I greatly admire your sincerity and forthrightness, and naturally am deeply moved by learning that you enjoy reading my writing–and find my “personality and thoughts […] quite refreshing.” How can’t that mean a lot to someone, you know? Well, it truly does.

    I am sorry that you too have suffered with mood disorders. It is probably one of the more difficult things in the world, sometimes, to not only survive with, but to live with, and even more, to WANT to live with, and then to just live: to be you, without it there, not even as a chronically menacing threat. For it to be gone. I realize my conditions may not be going anywhere, let alone tout de suite, and thus I better do something serious about it, lest I have yet another complete nervous breakdown and another North Eastern Psychiatric Hospital circuit tour. And I don’t want to be so ashamed anymore. This is a illness, and it is challenging in its originality; at our complex selves living in complex worlds. My dad’s cancer may very well come from exposure to nuclear radiation. I’d find that no great surprise. Another chronic disease that is, thankfully, under control. Why not look at each as a chronic illness that can and is being treated? There’s something about this timing of my hospitalizations and his (his proceeded mine) that really affected that. Sometimes it’s a thing we don’t expect that makes us, and hopefully our loved ones, understand more. After all, it’s not exactly the easiest of matters to fully comprehend. But we try. You try. That matters. And you are thoughtful, and can show your child beauty, because you notice it, even if least than other. When you do, you really, really notice. I think mental illness can do that as well.

    I have not professionally practiced in schema therapy, but think any cognitive therapy (this, CBT, DBT) will be effective with mood disorders and “personality disorders,” particularly those like Borderline Personality and Bipolar Disorder. DBT has been absolutely critical for me, and yet I can scarcely get care. I am talking WEEKS out of YEARS; and this is ONLY because of insurance companies. Disgusting. But I am still struggling because DBT is worth it for me. I am glad Schema is for you, and will definitely look into it more! Thank you for everything.

    Most sincerely,
    Alex

    • Dear Alex

      Thank you for responding to my comment. Mood fluctuations are extremely difficult to live with. Especially when you “snap out” of a mood and dive back into a more stable and healthy self and find yourself alone, having driven away your loved ones, afraid to establish new relationships and too ashamed to reconnect and rebuild. That last clause hurts the most!

      The guilt drives me insane and unfortunately for me, even if I want to reconnect, I procrastinate and doubt, all of which makes the other individual feel a greater sense of betrayal. It’s a vicious cycle. I don’t know about everyone else, but I experience them simultaneously and they are in constant rotation. I’m very predictable.

      Lol, sometimes I just sit back and laugh. If I reject my own thoughts and feelings at any moment, ESP. the destructive and paranoid ones, they
      haunt me and matters always end up worse. Nothing seems to help.

      Unlike you, I have yet been hospitalized. I cannot imagine having a season pass to the local psych ward. However, these past weeks i have really begun to question if i should be. I’m never in danger of hurting myself or others but i do panic: the room starts to spin, my chest tightens, i feel as though I have to faint, sometimes vomit and my blood pressure zooms… But as with all things its end soo suddenly- I fear the aftermath (the stigmatization, the stains it’ll leave on medical record and how it’ll hurt my career) and can’t afford such frequent trips to the ER. Lol. Lately what I feel has remained just as intense but much shorter in time (minutes rather than the 3-day schedule I used to have). Sometimes the only way to avoid conflict is to lie about the shifts.

      So sorry about your father, having a loved one battle cancer is tough, my mother-in-law is undergoing chemotherapy and it’s heart breaking but her strength and attitude is amazing to behold. It gives me loads of hope. I wish your family the very best.

      Awww… My poor boyfriend. I make life soo tough. How inconvenient and unnecessary.

      Time. It’s an interesting thing. Thanks for highlighting that. I often feel unusually lucky as far as time goes, in fact everyone around me notices as well and when I was able to better function, I was able to use time to my advantage; even if I procrastinated, I was ok. Right before I learned I was expecting, the conflict (my bpd) btw my bf and I hit a peak, we settled on separating bc whenever I say “I’ll fix things” I find my self confused, frustrated, and intolerable – I don’t understand grey areas. During the pregnancy things were getting worse but feelings weren’t always projected in efforts to preserve my baby’s health.. Now there’s no “net” (no reason for him to stay because my thoughts and feelings just lead to dysfunction, we aren’t always a family) and I’ve pushed him so far out he wonders how in the world I could even want I’m to stay and breaking up wasn’t the intention. Ughhhh. Kill me now. If I could drown myself and wake up a new person I would. How do we achieve normalcy? Will it ever come our way? My only normal moments are lies. :’ (

      I would like to thank you Alex. I viewed my illnesses as a chain, however, I appreciate your thoughts and will try my best to view each as a separate illness. I think thats great. Although its difficult for me to grasp, and hold, because i do view them in order, i’ll try my best. Maybe I’ll better my chances that way.

      Best,
      Edmee

      Sorry for the rambles.

      • My goodness! Not only are not apologies due, but conversely, I feel privileged to have such a meaningful correspondence emerge. Honestly, when I started writing on here, I thought it would be cool if even one person wrote back that something, somewhere one here, meant something, mattered, made that person feel less alone or have a bit of a positive, empowering reaction, then it would be fabulous. I have had several people of this sort, much to my continual amazement, which only goes to show how exceedingly exhausted we all are with being told to remain in yet another form of metaphorical closet, if you will. (I think my bisexuality allows me to make slightly inappropriate jokes of this nature? Yes? Like how we can call ourselves “bananas” but others shouldn’t Or really: who cares!).

        I really have learned that there is not normalcy. What would that look like? To me, it would be frightening indeed to do certain jobs and live certain lifestyles others would call the so-called “American Dream.” Eras of stigmatization, a la Foucault, have made us abnormal. Surely we do have an illness—but I find we have an introspection and a way of looking at the world too that is unique, and with proper therapy and medication, if applicable, will allow us what I dare say is something of an advantage, even if it is sometimes painful.

        Each day is a step. For everyone. Some periods are harder. Some are not. Remember the ones that were not when you’re in the ones that are as best you can. I know how incredibly rough that is, how sometimes seemingly impossible. But we have to try, daily. It’s all slow. It’s all about improving what we want. No conclusion. Learning, always. I hope.

        Sorry if that sounds too existential or like pompous philosophical mush. I blame DBT. :)

        Sincerely yours,
        Alex

  8. Well I guess “normal” wasn’t the right word. Lol. Like “perfect,” and, the “American dream,” normal just describes a collection of ideologies and set standards of behaving, thinking, looking, living … It’s difficult to put into to words but by normal I guess I just meant stable, having a personality or center that is more or less set in stone. Although I love my many “sides” (as I like to refer to “it”) and am well aware that even “normal” folks &/or those free of mental illness, experience these feelings and such variability from time to time, my feelings and thoughts deviate greater distances and more frequently. Add spontaneous bouts of anger and depression, severe indecisiveness and compulsive avoidance to the mix, it can sometimes make life dreadful for all those involved.

    I love my complexities and myself very much, some days. However, I’d love myself much more and would live more comfortably if my unconventional-ness didn’t affect the ones I love. I guess that’s where I was headed with “normal:” stable, comfortable.. In addition, I couldn’t agree with you more, “we have an introspection and a way of looking at the world too that is unique” and provides us with considerable leverage. I LOVEE ITT!!! :) Many, many, many times I have felt as though I’ve been given a gift. So far, from the few I’ve been blessed to interact with, we are quite intuitive, articulate well and … idk something about feeling and thinking as we do – although we may feel scattered, we’re like a complete being, it all melts together and eliminates the exclusion of “any.”

    Similarly, bisexuality carries the same advantage and fun. According to Cixous, it serves as the ultimate representative of a worldwide unconsciousness. THAT’S pretty amazing. = D

    … Steps and learning always, thanks!

    Wishing us all wellness and creativity,
    Edmee

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