Friday Counseling Issues: The Personality Disorders

First, we need to define our terms.  A personality disorder  is a deeply ingrained and maladaptive pattern of behavior of a specified kind, typically manifest by the time one reaches adolescence and causing long-term difficulties in personal relationships or in functioning in society.

By contrast, depression and Bipolar Disorder are categorized as mood disorders.  Other problems fall under the label of anxiety disorders, such as obssessive-compulsive disorder. More serious issues, such as schizophrenia, are true mental illnesses requiring close medical attention.

A personality disorder cannot be “cured” in the sense that it will ever completely disappear.  It can, however, be treated to a certain extent if the person who has the disorder is willing to be treated. Sadly, much of the time there is no recognition by the afflicted person that there is a problem, except with everyone else.

The DSM-5, which is used by clinicians to identify specific conditions, lists ten personality disorders, grouped into three clusters,  as follows:


Cluster A (Odd, bizarre, eccentric)

Paranoid PD, Schizoid PD, Schizotypal PD

Cluster B (Dramatic, erratic)

Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD

Cluster C (Anxious, fearful)

Avoidant PD, Dependent PD, Obsessive-compulsive PD

As I’ve said many times before, it is difficult to diagnose oneself or someone else by looking up symptoms on the internet.  In fact, I beg my clients not to do it.  It generally leads to increased fear and often a strong misunderstanding of what is really going on. So this and the following posts on this subject are not intended to diagnose you or anyone else; rather, they are for general information.  If you or someone close to you seems to be suffering with symptoms you will find here, the best thing to do is to start by going to your primary care physician, who will refer you as necessary for further medical evaluation and then perhaps to a therapist like me.

Cluster A

I’m not going to spend a great deal of time here, because I am not experienced in this set of personality disorders.  I have a standing rule:  If you have been diagnosed with any  of the three conditions in this cluster, you MUST see a psychiatrist for medical treatment before I will accept you as a client.  My experience has been that people  dealing with these conditions are not going to benefit from counseling if they are not staying faithful to their medication.

Some quick definitions:

Paranoia: Characterized by a pervasive distrust of others, including even friends, family, and partner.The true paranoid is constantly on guard, looking for clues that he is being spied upon, followed, harrassed, wrongly accused and/or gossiped against by everyone he knows. He will not hesitate to call law enforcement if he believes the car he just saw passing his house is following him.  He lives caged in fear and suspicion.

Schizoid Personality Disorder: The term ‘schizoid’ designates a natural tendency to direct attention toward one’s inner life and away from the external world. A person with schizoid PD is detached and aloof and prone to introspection and fantasy. They tend to avoid social interaction, seeming to be content with their own life in their own space.

Schizotypal Disorder: Schizotypal PD is characterized by oddities of appearance, behaviour, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia. These latter can include odd beliefs, magical thinking (for instance, thinking that speaking of the devil can make him appear), suspiciousness, and obsessive ruminations.

There is more, much more, to these three disorders in the first cluster. Again, this is not an area of expertise for me and I in no way want you to think that what I have written here is the complete, substantive description of these three disorders.

And again, if you or someone close to you suffers from these symptoms, your medical doctor is the best starting place in your quest to find help.