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.

How to scare an anxious person.

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

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

How many of these things scare you?

People who are high in anxiety are easily frightened. A great many things can scare someone with high anxiety.

Unfortunately, it is often the person who is high in anxiety who is scaring themselves. How many of these thoughts do you entertain that result in feeding your anxiety monster until he is out of control?

Threaten them. 50% chance of an earthquake in the next few years.

Lots of bad things MAY happen. Particularly in the realm of nature and the environment. That earthquakes, hurricanes, tornadoes, and other weather phenomena may happen, does not guarantee they will.

Even in those places where these catastrophic events take place the chances that you and yours will get through unharmed are better than the chances you will be injured. Don’t waste a lot of effort considering low probability events when there are high probability events around the corner.

Does the chance something may happen, justify your using up space in your brain worrying about what may happen at some point off in the future. Eventually we humans all die but happy people live their life based on positive beliefs.

Asking “what if” questions will scare you.

Putting doubt in your head is a proven method to increase anxiety. Ruminating about the future is a sure-fire way to crank up your anxiety. Ask repeatedly “what if” questions about the future and you will discover plenty of possibilities to go wrong.

Attitude towards waiting, traffic jams, lines, being late, can increase anxiety.

For people high in anxiety any waiting is anxiety provoking. Where someone with less anxiety might interpret the wait is a chance to relax and de-stress the anxious person will use the time to worry about what might happen, how this is not the way things are “supposed” to go. Anxious people can catastrophize about any delay in plans.

Remind yourself everyone is watching. Public speaking, presentations, inspections.

There are lots of situations in life where people might be watching you. Giving a bad talk or presentation might get you noticed in an unfavorable light.

The best remedy for that kind of unfavorable attention is to know what you are talking about and to thoroughly prepare that talk. Most of the time you will find that people are paying far less attention to you than you might wish. Even worse than doing a poor presentation, for the person who speaks a lot, is giving a good one and having no one notice.

One thing you will discover if you investigate what others think about you is that most of the time, those other people are far too preoccupied with their own lives to notice what you did or did not do.

Tell them to “dress appropriately.”

Fuzzy directions can create immense anxiety. Planning to be on time only works if you know what is “on time” for the particular function you will be attending. What is appropriate for one situation and a group of people can be very inappropriate for another.

The best way to quiet this fear is to do your homework or ask what is the proper time or attire.

Ask if they noticed that mole, rash, lump, itch.

You can spend countless hours of frantic involvement with your worries as you go over every inch of your body looking for imperfections to diagnose. Stop stressing and head to the doctor. They should be able to tell you what that mark is and put your mind to rest.

You are not wrong to ask a friend about some new mark you see on their body, just do it in a gentle way knowing that the high anxiety person may anxious themselves beyond belief at your question.

Have them work in a place with sudden unexplained noises.

Someone with high anxiety is always on the lookout for sudden unexplained events, noises, and movement. Put that person on a work site that has random unexplained sights and sounds and by the end of the day, they are ready to become the proverbial basket case.

Worse than ending up in that sort of environment by chance is the person with high anxiety who ignores their mental health needs and takes on an unsuitable job or those anxious people who are living in a situation with those random, sight and sound triggers.

Wait till the last minute, for appointments, gas or essentials.

If you are a high anxiety person you know how unnerving last-minute changes of plans can be. You have planned things out in advance to prevent unexpected occurrences and suddenly plans get changed with possible “catastrophic” results.

If you have to live or work with an anxious person, plan ahead to avoid these last-minute emergencies. Stopping for gas on the way to the appointment may be no problem for you but the high anxiety person will come unglued at the thought that you may run out of gas or that you might be late for that appointment and then they would not be seen by the doctor and their cancer would go undiagnosed and they might die as a result —- See how that anxiety train picks up speed as they ruminate about unforeseen plan changes?

Take them for a drive along the cliff when the river floods.

There are a number of things that trigger anxiety so commonly these items made it into the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in the section on specific phobias. While people can be specifically afraid of these things they can also be triggers for high anxiety even when the person with the fear attack is unaware of the phobia.

The list of Specific Phobias includes animals, nature, blood and surgery, close or confined places, choking, vomiting and even costumed creatures.

If you have a person with anxiety in your life, try to avoid doing these things and triggering that person’s anxiety. If you are the anxious person, how many of these things are you creating for yourself and are you willing to try some counseling to get past those anxiety triggers?

For more on this topic see:   Anxiety

Staying connected with David Joel Miller

Two 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.

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

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. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Meth, Cocaine and Ecstasy really do cook your brain

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

egg cooking

Drugs can fry your brain.
Photo courtesy of Pixabay.com

Stimulant drugs cause overheating of the brain.

Your brains temperature does vary. The temperature in your brain can fluctuate a whole lot. Some things cause your brain to heat way up and other things cause it to cool down a lot.

Most of what we know about brain temperatures come from studies of rats but it looks like the human brain runs at a temperature very close to the rat’s brain.

When Mr. Rat is sleeping his brains temperature cools down to about 95 (35C.) During the day Rat’s brain will mostly be around 98.6 (37C) which is what we expect the human brain and body to be.

When drugs are introduced into a mammals system, as they are metabolized, the brains temperature will shift to reflect that metabolism. Physical exercise and emotions alter this brain temperature also.

The way that a drug affects the brain’s temperature is, as are many other effects of drugs, very dependent on the dose of drugs and the route of administration.

Mr. Rats max brain temperature reaches an extreme high of 103 (39.5) during extremely vigorous rat sex.

That was his top brain temp without drugs. But let Mr. Rat, and presumably, humans, start tweaking on Meth and his brain temp cranks up to an over-the-top level of 104 (40C.)

At that point, the brain temp has begun to damage Mr. Rat and his larger human cousin’s brain. From here on as the brain temperature rises, the blood-brain barrier, the thing that protects your brain from infection and other damage, begins to leak. At this temperature, the very structure of the brain begins to “cook” as in there are structural changes.

I am not making this stuff up. I found this is in Kiyatkin’s article “The hidden side of drug action: brain temperature changes induced by neuroactive drugs,” from Psychopharmacology (2013) 225:765–780

Kiyatkin also points out that while the human brain only contains 2% of your body weight it uses up to 20% of the energy you use every day. This may explain why since T. V. came on the scene humans are thinking less and weighing more, but that is a topic for another blog post. (The T. V. part is my theory, not Kiyatkin’s.)

He does point out that the brain holds heat and the temperature there is likely to run hotter than the body temp, the center of the brain runs hotter yet as it takes a lot of blood flow to cool that part of your brain down. So if someone is doing (abusing) a drug like meth, ecstasy or molly, the temperature in their brain center is likely to be higher than the rest of them.

The hotter the temperature of the brain the more severe any brain injury is likely to be.

This same study looked at rats trained to press a lever to get Cocaine and those rats who just had to wait around for an injection. The rats who self-injected or were drug seeking – guess what? The temperature in the brains of addicted rats goes up when they are looking for the cocaine. This suggests, at least the way I read this study, that the stimulant drug had changed the way the brain utilizes neurotransmitters and regulates temperature.

Both Meth and MDMA (Ecstasy or Molly) induce strong peripheral vasoconstriction. So while they increase the temperature in the brain they reduce the ability of the body to get rid of this heat.

In male rats when the room temperature went up to 29C (84.4) and they had social interactions with female rats, something that would normally raise the temperature of their brain slightly, Meth raised their brain temperature to dangerous levels (42C, 107.6F.) and within 6 hours 5 out of 6 rats died.

This brain cooking phenomenon may well explain the reports of deaths at human social events from dehydration despite efforts to drink water and stay cool.

Humans can tolerate Meth and other stimulant drug doses better than rates and we humans are better at regulating temperature. Still, above 104F (40C) high brain temperatures are implicated in permanent damage to the brain. (See (Chen et al. 2003; Iwagami1996; Oifa and Kleshchnov 1985; Lepock 2003; Sharma and Hoopes 2003; Yamamoto and Zhu 1998) quoted by Kiyatkin,)

So when people tell you that Meth, Ecstasy or Molly is cooking your brain, they are telling it right.

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 does “an expectation not an exception” mean when applied to co-occurring disorders?

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

Mental illness and addiction go together.
Photo courtesy of Pixabay.com

Are Co-occurring disorders to be expected? – Morning Question #24

Most substance abusers also have some form of mental illness. The two are seen together so often we need to begin by assuming the client could have both and then assess as if both disorders were present. Many substance users had the mental illness before they began using drugs or alcohol. Depression, Bipolar Disorder, and Anxiety are all common among those with an addiction.

People who use and abuse substances are at risk of developing mental health issues as a result of the using experience.

Substances can also alter the brain, resulting in mental illnesses while under the influence, while withdrawing or after use. Mental illnesses that are the result of drug or alcohol use are called drug-induced illnesses.

Anyone who works with the mentally ill or substance abusers should expect that they will see both of these problems and others on a frequent basis.

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.