The DSM-5 recognizes 10 personality disorders, organized into 3 different clusters (A, B, and C). People with cluster A personality disorders display a personality style that is odd or eccentric; they are often described as having a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.
Cluster A disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
Paranoid Personality Disorder
Defining Paranoid Personality Disorder
Paranoid personality disorder (PPD) is a mental disorder characterized by paranoia and a pervasive, long-standing suspicion and general mistrust of others. Individuals with this personality disorder may be hypersensitive, easily feel slighted, and habitually relate to the world by vigilantly scanning the environment for clues or suggestions that might validate their fears or biases.
DSM-5 Diagnostic Criteria for Paranoid Personality Disorder
According to the DSM-5, to qualify for a diagnosis of paranoid personality disorder, at least 4 of 7 criteria must be met. These 7 criteria include that the person:
- suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her;
- is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates;
- is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her;
- reads hidden demeaning or threatening meanings into benign remarks or events;
- persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights;
- perceives attacks on their character or reputation that are not apparent to others, and is quick to react angrily or to counterattack;
- has recurrent suspicions, without justification, regarding the fidelity of their spouse or sexual partner.
In addition, the person's symptoms must not be due to schizophrenia or any other psychotic disorder.
Paranoid personality disorder
People with paranoid personality disorder are characterized by a pervasive, long-standing suspicion and general mistrust of others.
Etiology of Paranoid Personality Disorder
Brain researchers have found a possible genetic predisposition to paranoid traits as well as a possible genetic link between paranoid personality disorder and schizophrenia.
Psychosocial theorists implicate the projection of negative internal feelings and parental modeling into fears of other people and/or situations.
Cognitive theorists believe the disorder to be a combination of both an underlying belief that other people are deceptive or malevolent as well as a lack of self-confidence.
Treatment of Paranoid Personality Disorder
Because of their reduced levels of trust, individuals with paranoid personality disorder can be challenging to treat. However, psychotherapy—in combination with antidepressants, antipsychotics, and anti-anxiety medications—can be useful if an individual is receptive to intervention.
Schizoid Personality Disorder
Defining Schizoid Personality Disorder
Schizoid personality disorder (SPD) is characterized by a lack of interest in social relationships as well as a tendency toward a solitary lifestyle, secrecy, emotional coldness, and apathy. At the same time, however, individuals with SPD may demonstrate a rich and elaborate internal fantasy world.
DSM-5 Diagnostic Criteria for Schizoid Personality Disorder
In order to be diagnosed with SPD, a person must lack the desire to form relationships with others, be aloof and show emotional coldness and detachment, be indifferent to others' approval or criticism, and/or lack close friends and confidants. These symptoms must not be attributable to an autism spectrum disorder or to schizophrenia or another psychotic disorder.
Etiology of Schizoid Personality Disorder
Research has found that an individual is more likely to meet the criteria for SPD if they have a relative with schizophrenia or schizotypal personality disorder; this suggests that genetics play a partial role in heritability of this disorder. Twin studies also support this hypothesis.
Researchers hypothesize that the environment also plays a role—that unloving, neglectful, or excessively perfectionistic parenting might contribute to the development of this disorder.
Treatment of Schizoid Personality Disorder
Schizoid personality disorder has negative symptoms similar to those of schizophrenia (e.g., anhedonia, blunted affect, and low energy), and medications such as atypical antipsychotics may alleviate these symptoms. Those who seek treatment have the option of medication and/or therapy, and therapeutic interventions can be either short-term or long-term. Socialization groups may also help some people with schizoid personality disorder.
Schizotypal Personality Disorder
Defining Schizotypal Personality Disorder
Schizotypal personality disorder (STPD) is a personality disorder characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and unconventional beliefs. People with this disorder feel extreme discomfort maintaining close relationships with people, so they generally avoid forming them altogether. Peculiar speech mannerisms and odd modes of dress are also diagnostic signs of this disorder. In some cases, people with STPD may react oddly in conversations, not respond, or talk to themselves. They also experience what are called "ideas of reference"—that is to say, they frequently misinterpret insignificant or coincidental events or situations as being highly and personally significant. Paranormal and superstitious beliefs are not uncommon. People with STPD frequently seek medical attention for anxiety or depression, but the underlying personality disorder often goes undiagnosed.
DSM-5 Diagnostic Criteria for Schizotypal Personality Disorder
To be diagnosed with STPD, at least five of the following symptoms must be present:
- ideas of reference;
- strange beliefs or magical thinking;
- abnormal perceptual experiences;
- strange thinking and speech;
- paranoia;
- inappropriate or constricted affect;
- strange behavior or appearance;
- lack of close friends; and
- excessive social anxiety that does not abate and stems from paranoia rather than negative judgments about the self.
These symptoms must not be attributable to an autism spectrum disorder or to schizophrenia or another psychotic disorder.
Etiology of Schizotypal Personality Disorder
Rates of STPD are disproportionately higher among people who have a relative with schizophrenia than among those who have a relative with no or a different mental illness. This suggests that there is a genetic component to STPD and that it is also genetically linked to schizophrenia.
There is also evidence to suggest that parenting styles, early separation, and history of trauma or maltreatment. In particular, neglect, abuse, trauma, or family dysfunction during childhood can increase the risk of developing STPD. The exact nature of this relationship is unclear, but the impact is that people with STPD struggle with the childhood process of learning to interpret and respond appropriately to social cues.
Treatment of Schizotypal Personality Disorder
STPD is rarely seen as a primary reason for treatment in a clinical setting, but it has high rates of comorbidity with other mental disorders (i.e., it is often part of a dual diagnosis of STPD and a second disorder). When patients with STPD are prescribed medication, they are most often prescribed the same drugs used to treat patients suffering from schizophrenia.
According to personality psychologist Theodore Millon, schizotypal personality disorder is one of the easiest to identify but one of the most difficult to treat with psychotherapy. People with STPD usually underestimate the maladaptiveness of their social isolation and perceptual distortions; they tend to consider themselves to be simply eccentric, creative, or nonconformist. In addition, it is difficult to develop rapport with people who experience closeness and intimacy as more uncomfortable and anxiety-inducing. In most cases people with STPD do not respond to informality and humor.
Group therapy is recommended for people with STPD only if the group is well structured and supportive.