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.

So it’s complex. Who and what is not?

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.

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, perhaps join a support group, and, of course, be kind and gentle with yourself.

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

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

  2. 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.

  3. Found what you had to say useful. 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.

  4. 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 ur personality and thoughts are quite refreshing.

  5. 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?

  6. 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 the feelings is disempowerment that can come with panic attacks. It is the cycle of feeling panic, then being afraid one will panic again, then feeling ashamed for being afraid, and so on. A lot of self-blame and loads of unproductive guilt. You can get help to treat your rage issues. Have you looked into CBT or DBT? These types of therapies have been proven VERY helpful in treating certain disorders (namely DBT treating BPD). It can actually CURE it completely, according to a wealth of research. It takes loads of time, dedication and work, but you CAN get better! I greatly recommend checking it out.

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