Cluster A Personality Disorders: Types And Treatment
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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.
Understanding mental health and personality disorders
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.
The three clusters of personality disorders, including obsessive compulsive personality disorder
There are three different clusters of personality disorders.
Cluster A personality disorders
Cluster A disorders (paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder) usually involve unusual behaviors and thoughts.
Cluster B personality disorders
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.
Cluster C personality disorders: Avoidant, dependent, and obsessive compulsive
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
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.
Symptoms of schizoid personality disorder
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
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.
Diagnostic challenges in mental health and personality disorders
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
Treatment options
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.
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.
Takeaway
Frequently asked questions
What is a personality disorder?
Personality disorders are mental health conditions characterized by pathological personality traits—that is, personality traits which “become so pervasive they go against cultural norms, causing significant social and functional impairment.” It’s generally posited that personality disorders originate mainly from an interaction between genetic and environmental factors, especially subjective distress related to family dysfunction in youth.
Several conditions share some descriptive similarities but are distinguished by other characteristics, such as narcissistic personality disorder being driven primarily by self-grandiosity and antisocial personality disorder by a disregard for others.
For example, most people experience low self-worth now and then—most often, these individuals are able to rebuild their self-value with everyday strategies. Individuals with avoidant personality disorder (AvPD), however, have such intensely negative self-evaluation that they avoid interacting with others, and this negative self-evaluation is resistant to techniques that might help others without AvPD.
There are ten specific personality disorders currently accepted as diagnoses in the DSM-V, although ongoing research may amend these categories. In order to make an accurate diagnosis of a personality disorder, other mental health conditions, such as mood disorders or posttraumatic stress disorder, must be ruled out by reviewing one’s medical history.
What personality disorders are in cluster A?
Cluster A personality disorders consist of paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster A describes the set of personality disorders characterized by “odd or eccentric traits,” including unusual beliefs, social isolation or emotional coldness, and pervasive patterns of acting overly suspicious.
Paranoid personality disorder is driven by a pervasive distrust of others, and a consequent unwillingness to self-disclose out of fear of persecution. Schizoid personality disorder appears as disinterest in others, such as few or no emotional responses to social engagement.
People with schizotypal personality disorder have strange beliefs, often related to the supernatural, and tend to be suspicious of others; unlike schizophrenia, however, these individuals do not experience hallucinations, disorganized speech, or other symptoms of psychosis.
What are cluster A vs B personality disorders?
Cluster A personality disorders are characterized by oddness and social suspicion or disinterest, while cluster B personality disorders are characterized by interpersonal conflict and difficulty maintaining stable relationships, as well as inhibited self-regulation like intense mood shifts, erratic behaviors, inhibited self-awareness, or exaggerated sense of self. Cluster B encompasses:
- Antisocial personality disorder, which involves prioritizing personal gain at the expense of social norms or the well-being of others
- Borderline personality disorder (BPD), in which an individual struggles with intense shifts in emotional expression, stability of interpersonal relationships, and sense of self—impulsive behaviors, intense fear of abandonment, and self-harm are common
- Histrionic personality disorder—this condition is underresearched, but is characterized by exaggerated, at times seemingly theatrical displays of self-destructive behaviors with the goal of receiving some form of attention
- Narcissistic personality disorder, in which individuals have an outsized sense of self-importance, trouble empathizing with others, and a notion of entitlement to special treatment
Note that antisocial personality disorder (ASPD) is often associated with the concepts of “sociopathy” and “psychopathy,” where sociopathy describes the disorder and psychopathy describes a cluster of traits that may or may not be related to ASPD. The terms “sociopath” and “psychopath” are typically not used in clinical settings.
Additionally, “narcissist” can refer to a person with the mental illness of narcissistic personality disorder (NPD) or suspected NPD, but it is also common vernacular for individuals who are generally considered self-serving or inconsiderate of others, or are perceived to have inflated egos.
What is a Cluster C personality disorder?
Cluster C personality disorders are characterized by anxious thinking, typically centered around relationships with other people. This cluster includes:
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
People with avoidant personality disorder (AvPD) engage in persistent avoidance of social interaction, leading to a substantial inhibition in social functioning. However, as opposed to cluster A personality disorders like paranoid personality disorder, this avoidance stems from a pervasive feeling of inadequacy to other people. People with AvPD want to connect with others but are self-inhibited from doing so because of persistently low self-confidence and self-evaluation.
Those with dependent personality disorder don’t believe they can care for themselves on their own, which leads to dysfunctional patterns of seeking excessive support and care from others.
Unlike people with obsessive-compulsive disorder (OCD), those with obsessive-compulsive personality disorder (OCPD) don’t see a problem with their compulsions. Anxiety around perfectionism drives people with OCPD to engage in rigid behaviors and thought patterns even when there are clear downsides.
What is the #1 diagnosed personality disorder?
The three most commonly diagnosed personality disorders, at least in the United States, are obsessive-compulsive personality disorder, narcissistic personality disorder, and borderline personality disorder.
What is the rarest personality disorder?
One meta-analysis suggests that, globally, cluster B personality disorders are the least common and cluster C personality disorders the most common—however, these figures may be less reliable due to variances in cultural factors, such as divergences in diagnostic criteria used in different regions.
Another meta-analysis and systematic review suggests that dependent personality disorder is the least common personality disorder in Western countries.
What is the hardest personality disorder to deal with?
What is type A personality disorder?
What is a cluster A?
Which cluster is bipolar?
Is ADHD a cluster A?
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