Ten personality disorders are now recognized by the Diagnostic and Statistical Manual of Mental Disorders. These have been further divided into three groups or “clusters”: A, B, and C. Of the three, arguably the most common fall into cluster C.
The Personality Disorder
Even the dullest, blandest individual has a personality, and even the most healthy and well-balanced have their quirks and failings. Such traits shape thought, feeling and behavior, and yet for some these are so extreme, and so debilitating, that the personality itself becomes a problem.
For example, social anxiety is different to an avoidant personality disorder, though they share much in common. Someone with social anxiety has their particular personality and, on top of that, experiences fear and anxiety in social situations. When possible, they avoid going to parties or meeting new people, but in general their life ticks along normally. For someone with an avoidant personality disorder, however, the fear and avoidance are so fundamental they influence everything the individual does.
The disorders grouped in cluster A are known as “Paranoid,” “Schizoid,” and “Schizotypal,” and those who suffer from them are generally considered odd or eccentric. Under cluster B you find the “antisocial,” “borderline,” “histrionic” and “narcissistic” personality disorders. Though these four differ in specifics, the sufferers tend to be dramatic, emotional, or erratic in their moods and behavior.
Anxiety and fear characterize the group C disorders, which are composed of the “avoidant,” “dependent” and “obsessive-compulsive.” All have fear at their heart. The world appears dark, ugly, threatening and overwhelming. Those with such personalities therefore seek to defend themselves. Some do so through planning and routine, some by clinging to partners or loved ones, some by having as little to do with the world as possible.
Cluster C
All three of the cluster C disorders involve a huge amount of fear. The individual feels intense anxiety; in order to escape, he or she then develops certain patterns of thought and behavior to help minimize the fear and escape the anxiety.
Before looking at the three disorders in more detail, it is important to stress that those who suffer from one usually have traits from all three, and that few have all the symptoms of one personality disorder and none from the other two. The dependent and avoidant are especially close, with over half those who suffer from one suffering from the other.
The “obsessive-compulsive” craves rules, regulations and order. They also like routine. And when any of these are upset or challenged, they react with disproportionate anger. Indeed, friends and work colleagues may be surprised by just how angry and upset they become. For example, someone who moves in with a new partner may be shocked to find his gentle and loving girlfriend transformed into a screaming lunatic just because he sat on a freshly changed bed.
Obsessive compulsives are also rigid and inflexible. They hate change and struggle to adapt to new circumstances, especially new work schedules or working practices. Order and control help them escape fear and anxiety. Unsurprisingly, others find them difficult. Work colleagues complain that they cannot cope with stress, that they lose their temper or start crying when things go wrong.
The dependent personality, as the phrase suggests, depends on other people for love and support. When threatened with its loss, their reaction may be extreme. For example, someone whose relationship falters may threaten suicide if his girlfriend leaves. In general, such people are dismissed as “pathetic,” “weak” or “clingy” by others. And this contempt is only increased by their passivity and submissiveness. In general, they also dislike being alone.
Finally, there is the avoidant personality. Again, the avoider is just trying to cope with fear and anxiety: the obsessive-compulsive deals with it by controlling and ordering the world, making lists and sticking to routines, etc; the dependent escape by clinging to stronger, happier personalities; the avoider, however, simply turns his back on the world altogether and has as little to do with it as possible.
The avoidant personality disorder is sometimes described as a more extreme form of social anxiety, but this is misleading. Avoiders perceive the world as threatening and dangerous and avoid others even when they feel comfortable (in this respect, the avoider resembles the paranoid personality type). If the avoider has a motto, it is “don’t get involved.” When they are with other people, they generally feel small and inadequate. And because they do not form meaningful relationships, they do not grow, either in experience or confidence.
As with the other two disorders in this group, friends and work colleagues generally find them difficult. Avoiders often seem cold, unfriendly and aloof. Others complain that they are obstinate and uncooperative. But, once again, it must be understood why the person is behaving in this way. Quite simply, they find life harder and more stressful, while social interaction is exhausting and unpleasant.
Causes
Those fortunate not to suffer in this way tend to be hard on those who do, dismissing them as cowardly and weak. But such people are simply trying to cope. To someone shallow and insensitive, with a naturally cheerful and upbeat temperament, the world seems a generally pleasant place. They enjoy their lives. Others, however, who are sensitive, socially awkward, and prone to depression, find the world dark and threatening, and so naturally they do what they can to minimize its impact.
The obvious question is why? Why does one person respond to the world with delight and excitement while a second feels nothing but fear and loathing? Genetics may partly explain the problem, though this is controversial. The British psychologist and therapist Oliver James, for example, caused a stir back in 2016 with the publication of Not in your Genes, in which he argued in favor of nurture over nature. Genetics, said James, play a very small part in personality development. It is what happens to you, especially in the early years, that counts.
In general, most disagree with this. The Danish journalist Lone Frank, for example, author of My Beautiful Genome and a lifelong victim of depression, relates these sorts of problems to the individual’s DNA. She knew that her family background was filled with alcoholism, breakdown, and suicide and suspected genetics played a part. And she was right. “It turns out I’m homozygous for all the bad variants,” as she put it, adding that she had inherited a genome that made it hard for her to cope with stress.
Treatment
Treating any personality disorder is tough since you are dealing with the very essence of that individual, something built up over the course of a lifetime. Indeed, many of the thoughts, behaviors and assumptions that form a personality disorder are so ingrained that changing them takes effort and commitment.
First, it would be useful to understand where the problems began. Think back to your childhood. What sort of messages did you receive about the world? If your mother was a depressive, or your father a victim of abuse, they may have instilled the belief that people are out to hurt or exploit you, or that life is a brutal and thankless struggle.
Children are like little sponges, and they absorb more than their parents realize. To put it another way, the mother or father doesn’t have to sit them down and explicitly state that “the world out there is horrible.” Instead, the child observes its parents’ reactions. For example, the mother may flinch when the phone rings, recoiling as if from a blow. The child observes this and associates attempts to contact the home with fear and avoidance.
To overcome such personality disorders, you need to challenge the way you think, both about yourself and others. Second, you need to challenge ingrained patterns of behavior. Cognitive behavioral therapy enables you to do both. The basics are very simple: first, you identify the core, underlying beliefs about yourself and the world; second, you begin to observe and monitor your thought and behavior; third, you challenge anything obsessive, avoidant or dependent. Sticking to this, on the other hand, is much harder.
Finally, is important to realize just how malleable your personality is. The brain is known to be “plastic,” meaning that the wiring or networks constantly change and adapt as we experience new things. Even your genes can be switched on or off. As Frank herself said in an interview, “my genome is not a straitjacket but a soft sweater to fill and shape.”
A cluster C personality disorder is hugely limiting and restricting, holding those involved back in almost every area of life. Relationships are undermined, careers stalled, the list is endless. Above all, it simply means less happiness and more pain.