Cluster A personality disorders
If you were asked to describe a friend’s personality, you might describe them as generally being a creative type, or easy-going but nervous in groups.
Basically, you’re trying to summarize the personal traits that make them who they are—either how they think or how they act.
Sometimes these thought patterns or behaviors which make up a person’s personality can actually be harmful in the sense that they interfere with their day-to-day functioning in their personal life, at work, or in social settings.
If this were the case, we would say that the individual has a personality disorder. The DSM5, or the diagnostic and statistical manual for mental disorders, the 5th edition, lists ten personality disorders that are split into three different ‘clusters’- referred to as clusters A, B, and C.
These used to be under the category “Axis 2” but that way of organizing isn’t used anymore. Alright so cluster A personality disorders are the “weird” personality disorders, and they include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder, sometimes described as “Accusatory”, “Aloof”, and “Awkward” to help remember.
Each one is defined by specific thought patterns and behaviors. Paranoid personality disorder describes someone who is accusatory or generally distrustful and suspiciousness of other people, and assumes that others will disappoint them, manipulate them, or talk about them behind their back.
Because of this, they think excessively about making sure that they have the loyalty of their friends and family. These beliefs are so strong that they wind up having a strong impact on an individual’s behaviors.
These people react severely if they feel that they have been lied to, or slighted in any way, which can result in their holding grudges for long periods of time.
In many ways, this behavior can lead to a self-fulfilling prophecy, as these strong reactions to minor events might lead others to talk about them behind their back.
Unsurprisingly, these people tend to have superficial relationships and be in a state of isolation, because it’s hard to have ‘real’ friends when you are so suspicious of everyone.
Schizoid personality disorder describes people that are aloof and avoid social interaction because they simply aren’t interested in getting to know others.
And this is distinct from being isolated due to paranoia, like in paranoid personality disorder, or due to social anxiety like in avoidant personality disorder (which is a cluster C personality disorder).
These people even find physical contact in all forms to be less pleasurable, from sexual activity to holding hands, leading these people to be far less motivated to seek them out compared to the average individual.
In addition to generally preferring to be alone, they might also have a flat affect and emotional blunting, meaning that they tend not to show positive or negative emotions.
Finally there’s schizotypal personality disorder, which is where an individual comes across as being awkward. These people engage in excessive magical thinking, which is where they might think that two completely random events are causally linked.
For example, "I got up on the left side of the bed today; therefore it’s gonna rain, because that’s what happened last time around."
Related to this would be ideas of reference, which is a belief that everything, including innocuous events or coincidences that happens in the world, directly relate to one’s own destiny.
These people believing that they are particularly in-tune with the events around them, leads to overconfidence and a self-centered way of speaking that is socially inappropriate and can turn people off.
At the same time, they are also pretty poor at gauging how others perceive them. Like those with schizoid personality disorder, individuals with schizotypal personality disorder tend to have few social relationships, but unlike schizoid, they usually have a strong desire to have them, but are often unable to maintain them.
A way to remember this is that those with schizoid are distant with a “D”, and those with schizotypal have magical thinking with a “T”.
There’s actually considerable overlap in diagnoses between personality disorders. In fact, individuals with paranoid personality disorder often meet diagnostic criteria for schizotypal personality disorder and avoidant personality disorder, and those with schizotypal personality disorder often meet the diagnostic criteria for borderline personality disorder.
Also, all of the Cluster A personality disorders are linked to higher rates of schizophrenia, and the opposite as well, individuals who have a relative with schizophrenia are more likely to have a Cluster A personality disorder, which suggests a genetic link.
That being said, there are important differences between the personality disorders and schizophrenia itself. For example, with paranoid schizophrenia, the paranoia is generally more intense than with paranoid personality disorder, also, people with paranoid schizophrenia may suffer from psychotic delusions, whereas those with paranoid personality disorder don’t.
There are also none of the ‘positive’ symptoms of schizophrenia, like having hallucinations or racing thoughts. There is though, some overlap between schizoid personality disorder and some of the ‘negative’ symptoms of schizophrenia, like having a flat affect and blunted emotions.
Treatment for Cluster A disorders can be varied and difficult. Traditional psychoanalytic treatments tend to be ineffective and might even be counter-productive, since asking these individuals to examine and confront their own contributions to their situations might cause a lot of strain.
For example, traditional talk therapies are ineffective for individuals with paranoid personality disorder because challenging the legitimacy of their beliefs is often met with even more distrust.
More effective forms of therapy seek to try to support the individual instead of challenging them, for example, by helping them to improve their understanding of social activities.
Alright! As a quick recap, cluster A personality disorders are split into paranoid personality disorder, or “accusatory”, schizoid personality disorder, or “aloof”, and schizotypal personality disorder, or “awkward”.
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