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.

Are Wiccans Schizoid? Are African-Americans?

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

Who is Schizoid?

These kinds of search questions come up periodically. Sometimes I feel like these questions need to be answered even at the risk of making some people mad. I think we need to look at Schizoid personality disorder and other psychosis and its relationship to religious and racial minorities even at the risk of making a whole lot of people angry.

Wow, religion and race in one post, guaranteed to piss someone off!

Particular religious groups have been connected with various mental illnesses from time to time. In fact, even in professional trainings, Wiccans, members of a particular recognized religion, get connected with mental illness especially Schizoid personality disorder or Schizotypal disorder frequently. There was a time that minority races were mostly considered to suffer from mental illnesses also.

So first let’s look at what is Schizoid personality disorder and then why races and religions get connected to particular disorders.

At this point, before the hate mail starts arriving, I would like to point out, for better or worse, that I do indeed know people; some yes are even friends, of both the Wiccan and the African-American persuasions. As an aside I have also made the acquaintance of a few assorted Muslims, Christians, Atheists, Israelis, Palestinians, an Icelander and one person who might be described as a genetic Republican. Most of whom I consider more or less friends through no fault of theirs. I have left a few others out of this post because I could not spell their race or religion.

This issue of who or what is Schizoid is somewhat clouded by the way in which classification of personality disorders will change when the DSM-5 comes out in May. Some disorders stay, some go and they we reenter the whole question of are any diagnosis real? This is the old Categories versus dimensions controversy. Some people clearly have enough symptoms to get a diagnosis but what about people with only a few symptoms are they normal? Do they have a slight disorder? Or will we need to create a billion or so individual symptom severities to fit each and every one? I will leave that one to the authors of the DSM-5.

DSM-5 update.

Mostly they left the personality disorders alone.

What we currently think of as Schizoid personality characteristics is a person who:

Is detached from social relationships have a restricted range of expressing emotions in interpersonal situations, and this has been going on since they reached adulthood. (I am crudely paraphrasing from the DSM-4-TR here) and they have 4 or 7 characteristics listed below and they do not have another mental illness that explains their symptoms.

You math majors out there will note that 4 of 7 symptoms allows for 840 possible combinations of symptoms. We clinician types also get to interpret whether you have or do not have any one of these symptoms which can result in a lot of disagreement between clinicians.

The seven symptoms to choose from are:

1. Does not enjoy or want close relationships including being part of a family

In addition to schizoid personality disorder this might fit people who have faced abuse or discrimination and as a result, avoid close relationships.

2. Almost always chooses solitary activities

These criteria could also fit gamers and those who are addicted to the internet.

3. Has little interest in having sex.

This could be the result of past aversive experiences.

4. Takes pleasure in few if any activities

This sounds a bit like depression so does the lack of interest in sex above, this will make it harder but not impossible for gamers to get this diagnosis.

5. Lacks friends other than first-degree family members.

Lots of victims of discrimination and immigrants could fit this criterion.

6. Appears indifferent to praise or criticism of others.

This fits lots of people with learned helplessness and those who live in non-affirming environments. Why seek praise or affirmation if when you expose your emotional self you will not be liked for who you are.

7. Shows emotional coldness, detachment or flattened affect.

People who face discrimination may hide their true selves and restrict their emotions in public situations. If you get abused for your differentness you may keep your feelings inside even at home.

Now someone with a true personality disorder has these symptoms, most or all of them all the time and not just when in social settings. But can you see how someone who has faced discrimination or is a member of a religion with unusual beliefs could try to avoid expressing those feelings around others who might attack or punish you for being who you are?

Can you see how mental health could be used to punish people who were different racially or religiously and then when they try to keep who they are a secret to avoid that discrimination they could be labeled withdrawn and uninterested in others?

Sure some people with certain mental illnesses could be attracted to certain religious or political causes, but to move over into thinking that people of any one religion or race are probably suffering from any one mental illness is wrong and potentially dangerous.

Besides, I think the people who wrote these search terms probably had Schizoid personality disorder and Schizotypal personality disorder confused. Schizotypal probably fits some rock and rollers and celebrities better than it fits Wiccan and African-Americans but it also gets thrown on anyone who is different way too often.

Schizotypal people wear funny clothing like straw hats and suspenders – or are those farmers? See how easy it is to think that people who are different from you must be sick in some way?

Before we start thinking that people who are different must somehow be mentally ill, think back to those basic criteria. Does this person’s problem or behavior interfere with their ability to work, have friends and family or does it upset them? If not they shouldn’t get a mental health diagnosis just because they are different.

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.

Morning Question # 8 – Which personality Disorders can’t read other people?

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

personality disorder

Personality Disorder?
Photo courtesy of Pixabay.com

Which Personality Disorders can’t read other people?

None really. The closest would be Schizoid Personality Disorder, they can read people they just don’t care for people, any people. They are the classic hermits and loners.

I think you are asking about the Autism Spectrum. Autism, Asperger’s and Pervasive Developmental Disorder NOS. Next year with the DSM-5 these will all become part of a new label Autism Spectrum Disorders. People with these disorders or varying degrees of this disorder have difficulty reading other people.

When shown pictures of people’s faces they can’t tell the angry person from the calm person. They also have difficulty reading lots of non-verbal clues. So they don’t understand when someone likes them and wants to talk or is bored and wishes they would go away. This creates all sorts of social problems.

One new treatment approach consists of teaching them all about nonverbal clues to behavior. More on this treatment coming up in a future post.

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.

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.