Cluster A Personality Disorders: Types, Symptoms, And Treatment

Everyone has unique personality traits, or patterns of behaving, reacting, and thinking that remain relatively consistent over time. These traits tend to differ from personality disorders, which can be defined as mental health disorders with long-term patterns of rigid behaviors and thoughts that are different from what is considered typical. These inflexible, potentially unhealthy patterns can contribute to serious difficulties in various areas of life. 

In general, there are 10 types of personality disorders, grouped into three different categories or clusters. The conditions in each cluster typically have similar characteristics and symptoms. Cluster A disorders (paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder) usually involve unusual behaviors and thoughts. 

Cluster B disorders (antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder) usually involve dramatic and emotional behaviors and thoughts that change frequently. Finally, cluster C personality disorders (avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder) can be defined by anxious and fearful behaviors and thoughts. Many individuals with personality disorders can benefit from working with a licensed mental health professional.

Paranoid personality disorder

People with paranoid personality disorder may have a deep distrust of others, assuming they intend to hurt or deceive them, even when there is no justification for these beliefs. This pattern of distrust is usually long-term.

Comorbidities can be common with paranoid personality disorder, and it is rarely a sole diagnosis. People with this condition may be more likely to have anxiety disorders, alcohol use disorder, post-traumatic stress disorder, or another personality disorder.

Symptoms of paranoid personality disorder may include the following: 

• Believing that others have greatly injured, exploited, or deceived them
• Being hypervigilant for potential slights, insults, disloyalty, threats, and hidden meanings
• Scrutinizing others to find evidence to support these suspicions
• Being unable to forgive people who have hurt them
• Holding grudges
• Counter-attacking or becoming angry in response to perceived injuries
• Needing to be in control or autonomous
• Being hesitant to confide in people
• Doubting the loyalty of friends
• Questioning the faithfulness of their partner
• Being exceptionally jealous

Schizoid personality disorder

Schizoid personality disorder can be characterized by a pattern of detachment from relationships and a restricted ability to express emotions in interpersonal settings. People with this condition may withdraw socially and could appear eccentric. They may be uncomfortable with any social interaction and use isolation to avoid this discomfort. 

People with schizoid personality disorder may have a limited ability to relate to others and no desire for close relationships with other people. They may have no friends or people in whom to confide and usually prefer being alone. 

A person with schizoid personality disorder usually appears not to be bothered by what people think of them. They may rarely show emotional reactions, including anger, and may seem passive in response to change. Unlike other conditions, symptoms of this personality disorder may remain stable over time. 

Comorbidities can be common. People with schizoid personality disorder may be at greater risk for at least one episode of major depressive disorder and may have other personality disorders as well.

Other symptoms of schizoid personality disorder may include those listed below: 

• Having a detachment from or lack of interest in social relationships
• Having a limited ability to express emotions
• Lacking a desire for close relationships
• Exhibiting a strong preference for solo activities
• Lacking an interest in sex
• Enjoying few, if any, activities
• Being indifferent to the praise or criticism of others
• Experiencing emotional detachment or coldness

Schizotypal personality disorder

Those with schizotypal personality disorder may have deficits in interpersonal skills, including a reduced ability to form close relationships with others, and they may display eccentric behavior and cognitive distortions. They may be perceived as odd and could engage in magical thinking, expressing beliefs in the supernatural or paranormal.

People with this personality disorder may appear paranoid or suspicious and may be concerned with how they appear to others. They may also have greater disorganization of thought and speech than those with other personality disorders. 

Over half of people with schizotypal personality disorder may have at least one episode of major depressive disorder and may be at higher risk for substance use disorder. 

Symptoms of schizotypal personality disorder may include the following:

• Lacking close friendships 
• A sense that they are different and do not belong
• Difficulty relating to others
• Being unhappy due to a lack of relationships
• Experiencing anxiety in social situations
• Interpreting ordinary occurrences as things that have special meaning for them
• Believing they have special abilities, like being able to read someone’s mind or believing they have control over others’ actions
• Believing in magical rituals
• Speaking abstractly or using odd phrases
• Dressing oddly
• Having odd mannerisms
• Ignoring social conventions due to a lack of understanding of social cues
• Experiencing abnormal sensory perceptions, like hearing voices whispering their name
• Being suspicious or paranoid

Diagnosing cluster A personality disorders

Diagnosing personality disorders can be challenging. During the evaluation, a doctor or mental health professional may ask broad, general questions to prevent the person from becoming hostile or defensive. Because the person may be unable or unwilling to provide reliable information, doctors may ask to talk to family members or anyone else who can provide insight into the person’s thoughts and behaviors. 

After a physical exam and mental health evaluation, the mental health professional may compare symptoms to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) guidelines to determine whether they are indicative of any particular disorder.

It can be challenging to determine the type of personality disorder someone has. Personality disorders often resemble other psychiatric illnesses and can coexist with them, and there tends to be a lot of overlap. For example, it can be challenging to determine the distinction between schizotypal personality disorder and schizophrenia. Because of this, taking the time to get the right diagnosis can be key to receiving appropriate treatment.

Treating cluster A personality disorders

Currently, no treatments have been proven effective for paranoid personality disorder. The high levels of mistrust and suspicion that tend to be the hallmarks of the disorder can make it challenging for mental health professionals to build the trust and rapport necessary for effective treatment. 

In some cases, clinicians may be able to form an alliance with patients to enable them to participate in treatment. When the patient is willing to participate, treatment with antidepressants or antipsychotics and cognitive behavioral therapy (CBT) may help. Still, due to the challenges of getting people with paranoid personality disorder to participate in treatment, thorough peer-reviewed studies have not been completed. 

Treatment for schizoid personality disorder can be difficult to research for the same reasons. Clinicians may increase the willingness of people with this condition to engage in treatment by first focusing on impersonal topics, like their hobbies or collections. CBT centered on social skills may be helpful, but because people with this condition usually lack an interest in relationships, they may not be motivated to change.

Personality disorders can lead to challenges in relationships

Working with an online therapist can help

Schizotypal personality disorder is usually treated with medications, specifically atypical antipsychotics for anxiety and psychotic-like symptoms and antidepressants to help with social anxiety. These medications must be prescribed and monitored by a psychiatrist or doctor. CBT may help people with this condition acquire social skills and manage anxiety symptoms. Therapy can also help people with schizotypal personality disorder learn how to develop healthy defense mechanisms.

If you are a caregiver or a therapist working with someone with a cluster A personality disorder, the relationship can be a challenging one. Prioritizing your own mental health can better equip you to help and support the people in your life, whether they are clients or family members. 

Online therapy can be a convenient, flexible way to get support for your mental health. With an online therapy platform like BetterHelp, you can work with a therapist from the comfort of your home at a time that suits your schedule. Plus, you can change providers at any time for no additional fee until you find the right therapist for you.

Although there isn’t yet much research on the effectiveness of online therapy for personality disorders, a 2022 scoping review suggested that online interventions showed promise. Existing research supports the idea that online therapy is usually as effective as in-person therapy.