What are personality disorder clusters?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What are personality disorder clusters?
Photo courtesy of Pixabay.

What are the three main groups of personality disorders?

The newest edition of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders divides personality disorders into three categories based on their similarities.  Personality disorders are long-term or enduring patterns of behavior.  The old way of thinking about these issues was that this is just the way someone is and treatment was not likely to be successful.

Recently treatments for many of the personality disorders have become available.  Currently, we think of many of these personality disorders as problems of living which may occur in varying degrees.  Someone who is low in self-esteem might be described as low in narcissism.  If they were high in narcissism they might be lacking in the ability to empathize with others.  Below is a list of the clusters of Personality disorders with brief descriptions of the disorders in that cluster.  For longer discussions of the personality disorders see separate posts on the specific personality disorder.

Cluster A personality disorders.

This group of personality disorders includes people who appear odd or eccentric.  Among the Cluster A personality disorders, are Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder.

Paranoid Personality Disorder involves people who are more fearful of people, life, and events that would be warranted.  They are especially likely to think that other people are out to get them.

Those with Schizoid Personality Disorder are detached from others and seem to have little desire to have close personal relationships. They have less ability to express emotions.

In Schizotypal Personality Disorder, people are very uncomfortable in close relationships, have eccentric behavior and may have thinking or perceptual difficulties.

Cluster B personality disorders.

Cluster B personality disorders include things like Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.

Those with antisocial personality disorder seem to have little regard for others and their rights.  They don’t mind taking advantage of people around them.  This is different from those people who may make a life out of crime and intentionally steal from, or harm other.  Career criminals get a diagnosis of Adult antisocial behavior Z72.811.

People with Borderline Personality Disorder are likely to have a poor self-image, low self-esteem, fluctuating emotions and often are very impulsive in their relationships.  Those with Borderline Personality Disorder may also self-harm.

Histrionic Personality Disorder might be described as the typical “Sarah Bernhardt” actress.  Someone with histrionic personality disorder is excessively emotional and is always looking for more attention.

Cluster C personality disorders.

Cluster C personality disorders include disorders related to relationships with other people.  These personality disorders in Cluster C are thought to begin in early childhood. They include unusual ways of relating to close people in their life. This includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.

People with Avoidant Personality Disorder avoid other people, feel that they’re inadequate, and are often very sensitive to criticism.

Those with Dependent Personality Disorder are the people likely to become co-dependents.   They are often submissive, clingy, with an excessive need to find someone who will take care of them and control their lives.

Obsessive-Compulsive Personality Disorder is different and separate from Obsessive-Compulsive Disorder.  When the pattern of being obsessive-compulsive becomes a preoccupation with orderliness, perfection, control, having everything exactly the way they need it to be at all times, this moves from a single obsessive-compulsive behavior to the level of a continuing personality disorder.

In addition to the three personality disorder clusters, two other personality disorder characteristics are described in the DSM-5.  Sometimes a personality disorder can be the result of medical conditions.  The DSM-5 also allows for other specified personality disorder or other unspecified personality disorder when one exists that does not fit this list.

Each of these personality disorders is described more completely in other “What is” posts about that specific personality disorder.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships your enjoyable activities or cause you personal distress.

Having mild forms of these disorders does not qualify unless it causes you problems.  In that case, you may have the issues, but you will not get the diagnoses. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem these characteristics need to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See also Recommended Books.    “What is.” and Personality Disorders

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Ugly nose and face or Body Dysmorphic Disorder

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Body dysmorphic disorder?
Photo courtesy of Pixabay.com

Can someone be too ugly to get a job or be loved?

There is a group of people in our society who believe very deeply that there is something wrong with their body which makes them so ugly that no employer will hire them and no other person could stand to be in a relationship with them. They often seek medical help to change their appearance but that help rarely results in them feeling acceptable.

There is a range of appearances. Some people are frankly better looking than others. We value celebrities based on their looks. So how far from that ideal level of beauty do you need to fall before you conclude that you are ugly and no one can possibly love or accept you?

Some people believe that they are ugly even when others around them cannot see the “flaw” that makes them believe they are undesirable. This belief that your body is flawed in some way, while others do not see the flaw is called Body Dysmorphic Disorder.

Body Dysmorphic Disorder can center on beliefs that any part of your body is defective but the most common things that are the focus of this belief are the skin, hair, and nose. Stomach, weight, breasts or chest and eyes also cause significant numbers of people to feel badly about themselves.

Researchers believe that the prevalence of Body Dysmorphic Disorder is greatly underestimated. The number of people who suffer from this emotional problem is probably far greater than our statistics are reporting. Estimates of the number of people in the United States with Body Dysmorphic Disorder range from 2 million to in excess of 15 million people. The number of cases you see depends on where you look.

Most people with Body Dysmorphic Disorder do not come to mental health systems because of their excessive focus on their appearance. They often first present at a plastic surgeons office requesting an operation to change that part of them that they feel is making them ugly.

Annual expenditures for plastic surgery surpassed 10 billion dollars in 2008. This was an almost 900% increase over 1992 and this figure continues to grow. Unfortunately people with Body Dysmorphic Disorder are most likely to feel that their operation was “botched” and as a result sue the doctor or request a second or third operation. One study reported that 44% of plastic surgery patients were repeat clients. Some clearly were happy with the results and having more done but those with Body Dysmorphic Disorder are likely to undergo repeated operations because the problem lies in their thinking that they are ugly rather than in any particular objective problem with their looks.

So how does this Body Dysmorphic Disorder manifest in those who have the disorder? Suffers typically spend 3 to 5 hours per day looking at themselves in the mirror. They are highly sensitive to minor flaws in people and can spot defects in others readily. Many become housebound, afraid to go out and socialize because they believe that they are so ugly no one will like them. A deficit in social skills predisposes them to believe that their lack of friends and romantic partners is the result of their appearance rather than their lack of social skills.

Since those with Body Dysmorphic Disorder blame their lack of friends and jobs on their appearance they are unlikely to present for counseling or therapy. One way they enter treatment with a mental health professional is when their depression, anxiety or other emotional problem brings them to the notice of the mental health system.

Almost half of those with Body Dysmorphic Disorder have been hospitalized in a psychiatric hospital. As many as 82% have had thoughts of suicide and one in four is likely to have attempted suicide. Most are young, single and unemployed. They frequently have eating disorders, Obsessive Compulsive Disorder or another psychiatric problem in addition to the Body Dysmorphic Disorder. Skin picking and religious or sexual preoccupation are also common. Many go on to develop Avoidant Personality Disorder.

They are also at risk to miss many days of work or school and many social events as a result of their feelings that they are physically ugly. Many of those with Body Dysmorphic Disorder drop out of school to avoid being seen by others.

Body Dysmorphic Disorder frequently begins in early teen years and gets progressively worse. The mean age of onset of the Body Dysmorphic Disorder is between 14 and 16. Those with the disorder will cover their faces in various ways, spend excessive amounts on clothing or cosmetics or resort to extreme methods to try to alter their appearance.  Frequently those with Body Dysmorphic Disorder have been teased or bullied.

The mean age of onset of the Body Dysmorphic Disorder is between 14 and 16. The DSM-5 tells us that the most common age for onset of Body Dysmorphic Disorder is 12 to 13 years old.

This disorder is not restricted to females. Many young men develop the notion that they need to have huge bulging muscles to be acceptable and develop a related condition called Muscle Dysmorphic Disorder. Males are also at risk to believe that their genitals are too small resulting in avoiding dating and sexual relationships.

Those with Body Dysmorphic Disorder may also show up in weight loss groups where despite their low to normal body weight they will be focused on changing the shape of one part of their body that they see as defective.

Our understanding of Body Dysmorphic Disorder continues to change. In the DSM-4 Body Dysmorphic Disorder was included in the section on somatoform disorders, those disorders where emotions make you sick or make you illness worse. In the new DSM-5 Body Dysmorphic Disorder is included in the Obsessive Compulsive disorders because of the time people with this disorder spend on concerns about their appearance.

There are effective treatments for Body Dysmorphic Disorder. The difficult part is getting those with the disorder to come for treatment. Since they firmly believe that their problems are the result of some physical defect they do not see how counseling can help them, and will often insist that they are not “crazy” or “mental.”

Treatment of other issues, depression, anxiety and suicidal thoughts and actions are often the first step in engaging those with Body Dysmorphic Disorder in treatment. Cognitive Behavioral Therapy, Antidepressant medications, Narrative therapy and skills training are all thought to be effective in treating Body Dysmorphic Disorder.

So if you or someone you know has no friends, no romantic partner or no job and you think this may be because of looks, consider working with a counselor on your social skills, career counseling and self-esteem before you conclude that the problem is your looks.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What are Personality Disorders?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What are personality disorders.
Photo courtesy of Pixabay.

Update.

In the new DSM-5, the five-axis system was eliminated. Personality disorders are now included in the full list of mental, emotional, and behavioral disorders, just like any other mental health issue. I have left this post here, as originally posted because much of this information remains relevant. Not all of the changes we expected in the DSM-5 took place. For the current status take a look at some of the newer posts.

How many Personality Disorders are there?

Personality Disorders are a special class of mental illnesses that are considered different in kind and nature from other mental health problems. Mental illnesses in all their shades are recorded on Axis I. There are currently over 300 recognized Mental illnesses. Most mental illnesses have several standard treatments and if severe enough are likely to be covered by insurance or public funding. Not so with personality disorders.

Personality Disorders are kept separate. They are recorded on Axis II in a separate and small class of problems that just don’t seem to ever change or get better. They have long been considered like mental retardation, something we need to help with, but something that just won’t change. Personality Disorders are a short list, rarely over a dozen labels, though the list changes over time.

Personality Disorders are conditions in which the person to be diagnosed “deviates from expectations of their culture.” There are different. But that is not enough for the diagnosis to be imposed.

This pattern of “differentness” is “Pervasive and inflexible.” They stick to their irritating pattern no matter what. This pattern starts in adolescence or early adulthood and they just don’t change, “grow up” or “grow out of it.” So this pattern of differentness is “stable over time.” It is as if people with a personality disorder get stuck in one way of behaving and then can’t change their approach when they are in a different time or place.

This differentness needs to also cause them problems getting along with other people, holding a job or make them unhappy to get the diagnosis. They are not just a little different some of the time but a lot different all the time.

Some people could care less if they have a personality disorder or not. But most people who have a Personality Disorder are suffering, want and need help, no matter how we label or understand their problem.

Currently, there are ten recognized Personality Disorders in three groups or “clusters.” The DSM-5 due out next year probably will reduce that list to six personality disorders and a new “Personality Disorder Trait Specified.” Not sure what will happen to the people who have a disorder now when their diagnosis is abolished. Will they be declared cured? Or maybe we just give them a new mental illness to compensate them for their loss.

When I was in Grad School I though these personality disorders were interesting, did extra research and even wrote some papers on the topic. I considered specializing in treating these disorders. But what I discovered is that most people with a personality disorder come to the therapist for Depression, Anxiety and relationship problems just like anyone else. Also since these are “inflexible” patterns, only two of these disorders end up in treatment with any regularity.

Here are the clusters as they stand now with the included diagnosis. The descriptors are mine with my apologies to the APA. Clusters A and C first as Cluster B is the biggie.

Cluster A: These are the “Weird” people.

Paranoid Personality Disorder – They are scared all the time. Most are NOT Schizophrenic. We don’t see many of these people unless family or police call us as they are so afraid they never leave home. This diagnosis disappears with the DSM-5. Lots of luck on that one.

Schizoid Personality Disorder

Loners. They do not like being around other people even family. They don’t have or want friends. They would make great hermits. When the DSM-5 arrives they are all cured and free to head for a cave in the hills. Just watch out for the zoning enforcement people as those dudes like to talk.

Schizotypal Personality Disorder – Odd, superstitious and believe in signs, spirits and the supernatural. They may not have friends outside the family or only one close partner. If they think about something that needs to be done, say doing the laundry and then you go do it, they will believe that their thought caused you to do it. They often dress in odd ways. This description has been applied to people who look like “witches” etc. The DSM has an exemption here if they belong to a group that agrees with their beliefs. For the record Modern “Witches” who call themselves Wiccan do not wear funny clothes all the time and do not qualify for the diagnosis of Schizotypal. This is more common than the last two Personality Disorders and stays in the new DSM-5.

Group C Scared People

Avoidant Personality Disorder – they would like friends they are just sure no one will like them and so they avoid people. They are also sure people will criticize them or put them down so they don’t try. This one stays.

Dependent Personality Disorder.

Needy, clingy afraid they will be abandoned. They always need help and what to be told and what to do. This diagnosis goes. Find yourself a dominant partner before your diagnosis is repealed or get help and become less needy.

Obsessive Compulsive Personality Disorder.

This goes beyond everyday OCD. They want everyone else to do things just so. They are often stingy with money, needs to control everything and they have the rule book to do it. Often they cannot get anything done because their rules are so complex they can’t follow them. This one stays.

Cluster B personality disorders.

The people who cause others problems. Cluster B diagnoses are the most common diagnosis in prisons.

Antisocial Personality Disorder.

They disregard the rights of others and violate those rights. This is the number one diagnosis of men in prison. This one needs a whole post all by itself.

Borderline Personality Disorder – The main ingredient here is lots of pain. Unstable interpersonal relationships, poor self-image, unstable mood, often impulsive with a chaotic life. Most people who are diagnosed with Borderline Personality Disorder are women. This traditionally is the number one diagnosis of women in prison. Many women with this diagnosis have been victims of one kind or another at an early age. They did what they had to do to cope in a bad situation but now the way they cope is not working. There are some really good treatments for this, especially DBT, but it takes a time to heal.

Histrionic Personality Disorder.

Excessive emotionality and attention seeking sometimes referred to uncomplimentary as “Drama Queens.” Not common in practices and we are doing away with this diagnosis when the DSM-5 comes out. Most of these folks have their own T. V. shows by now so they can pay for therapy even without a diagnosis.

Narcissistic Personality Disorder.

Were keeping this one. Not sure why. First, we treat you for low self-esteem and then we tell you that you are Narcissistic. Most people who come for marriage counseling tell me their partner is Narcissistic.

This should be on a continuum. Is this a political season? How can we tell the Narcissists from the candidates? Don’t you need to be a lot Narcissistic to think you should be running the show? Does the top Narcissist get to run a Bank or Wall Street?

Running out of time and this post is going long. More on Personality Disorders to come. Do any of you have any thoughts on the topic?

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.