Personality Disorders

🧠 Personality Disorders — According to DSM-5-TR and ICD-11

Personality Disorders are long-term, deeply ingrained patterns of thinking, feeling, and behaving that deviate significantly from cultural expectations.
They affect how individuals perceive themselves, relate to others, and respond to stress or conflict.
Unlike temporary mood changes, these patterns are persistent and inflexible, often beginning in adolescence or early adulthood.

People with personality disorders may struggle with empathy, impulse control, emotional regulation, or self-image, leading to difficulties in relationships and work.
The disorders are categorized into three clusters: Cluster A (odd/eccentric), Cluster B (dramatic/emotional), and Cluster C (anxious/fearful).

Examples include Borderline, Narcissistic, Antisocial, Avoidant, and Obsessive-Compulsive Personality Disorders.

Neuroscientific studies suggest abnormalities in brain circuits related to emotion, decision-making, and social cognition.

While personality disorders are challenging to treat, psychotherapy—particularly Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT)—can help manage symptoms and improve functioning.

Ultimately, understanding these conditions requires compassion and nuance, recognizing that they are not simply “flaws,” but complex patterns of human adaptation and survival.

The category of Personality Disorders (PDs) is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) — a standard issued by the American Psychiatric Association (APA).

According to DSM-5-TR, personality disorders are grouped into three main clusters, totaling 10 distinct types 👇

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🧩 Cluster A — Odd / Eccentric Personalities

Common features: Unusual thoughts or behaviors that deviate from social norms.
Often linked with paranoia or eccentric beliefs.

• Paranoid Personality Disorder — Deep distrust and suspicion of others; constant belief that others intend harm or betrayal.
• Schizoid Personality Disorder — Social detachment; prefers isolation; shows limited emotional expression.
• Schizotypal Personality Disorder — Strange beliefs (e.g., magical thinking), odd speech or dress; resembles schizophrenia but less severe.

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🔥 Cluster B — Dramatic / Emotional / Erratic Personalities

Common features: Emotional instability, impulsivity, and difficulty regulating behavior or relationships.

4️⃣ Antisocial Personality Disorder — Disregard for social norms; deceitful, manipulative, exploitative; lack of remorse (common among criminals).
5️⃣ Borderline Personality Disorder (BPD) — Intense mood swings, fear of abandonment, chronic emptiness, and unstable self-image.
6️⃣ Histrionic Personality Disorder — Seeks attention excessively; dramatic, flirtatious, or overly emotional behavior.
7️⃣ Narcissistic Personality Disorder (NPD) — Inflated self-importance, craving admiration, and lack of empathy for others.

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🌫 Cluster C — Anxious / Fearful Personalities

Common features: Chronic fear, insecurity, and avoidance.

8️⃣ Avoidant Personality Disorder — Avoids social contact due to fear of rejection; desires relationships but feels unworthy.
9️⃣ Dependent Personality Disorder — Excessive reliance on others; fear of separation or making independent decisions.
🔟 Obsessive-Compulsive Personality Disorder (OCPD) — Preoccupation with order, perfectionism, and control (different from OCD, which is an anxiety disorder).

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📘 Additional Notes

Personality disorders are not simply “bad behavior”, but deeply ingrained patterns of thinking, feeling, and behaving that develop from adolescence and cause long-term distress or dysfunction.

Treatment often requires long-term psychotherapy, such as Dialectical Behavior Therapy (DBT) for BPD.
Many patients exhibit overlapping traits from multiple disorders.

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🧠 1️⃣ DSM-5-TR System (APA, 2022)

Used primarily in the United States and medical settings worldwide.
Categorized into three clusters (A, B, C) with 10 major types, as listed above.

• Cluster A: Paranoid, Schizoid, Schizotypal
• Cluster B: Antisocial, Borderline, Histrionic, Narcissistic
• Cluster C: Avoidant, Dependent, Obsessive-Compulsive

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🧩 2️⃣ ICD-11 System (World Health Organization, 2022)

Used across Europe and countries following WHO health frameworks.

ICD-11 (2022) abolished the “10 fixed types” model and replaced it with a dimensional system that evaluates severity and trait domains instead.

Main Diagnosis:

“Personality Disorder” (single category)

Severity Levels:

• Mild
• Moderate
• Severe

Trait Qualifiers (Dominant Personality Features):

• Negative Affectivity — Strong negative emotions (similar to BPD)
• Detachment — Social withdrawal (similar to Schizoid)
• Dissociality — Coldness, lack of empathy (similar to Antisocial/Narcissistic)
• Disinhibition — Impulsivity, poor self-control (similar to Histrionic)
• Anankastia — Perfectionism and over-control (similar to OCPD)

ICD-11 also includes a “Borderline pattern qualifier” to specify BPD-like traits.

👉 In simple terms:
The WHO’s new model views personality disorders as highly individualized, with hundreds of possible combinations depending on severity and dominant traits — rather than just 10 fixed types.

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💡 3️⃣ Emerging Perspectives in Modern Psychology

Some proposed disorders are not officially recognized in DSM or ICD but are found in research and clinical discussions, such as:

Emerging Concept	Key Characteristics	Closely Related To
Passive-Aggressive Personality	Indirect resistance, sarcasm, intentional inefficiency	Dependent / Avoidant
Sadistic Personality	Pleasure from harming others	Antisocial
Depressive Personality	Persistent pessimism, self-criticism	Mood-related
Self-Defeating Personality	Self-sabotaging behaviors	Borderline
Psychopathic Personality	Cold, manipulative, intelligent but amoral	Antisocial / Narcissistic

Some of these types appeared in DSM-IV (before 2013) but were removed due to insufficient scientific evidence.

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📚 Summary

Classification System	Number of Types	Conceptual Model
DSM-5-TR (APA, 2022)	10 types (3 clusters)	Categorical “box-type” model
ICD-11 (WHO, 2022)	1 main disorder + 5 trait domains	Dimensional model
Modern Research Approaches	15–20+ potential variants	Flexible, trait-based hybrid model

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📖 References

• American Psychiatric Association. (2022). DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Revision).
• World Health Organization. (2022). ICD-11: Personality Disorders and Related Traits.
• Widiger, T. A., & Costa, P. T. (2013). Personality Disorders and the Five-Factor Model of Personality.
• Krueger, R. F., & Hobbs, K. A. (2020). Dimensional Models of Personality Pathology.
• Mayo Clinic. (2023). Personality Disorders — Symptoms and Causes.
• National Institute of Mental Health (NIMH).

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