Personality Disorders are one of the more interesting types of disorders in mental health.  They attract the most attention and curiosity about why individuals act the way they do.  For the secular mind, it attempts to explain right and wrong, criminality, oddities, and other quirks that step out of bounds within the social structure.   As observed in early psychology, it a disorder but the mind still has the ability to possess rationale in its own self.  From a religious perspective, it constitutes the reality of brokenness of humanity and how individual acts of deviation can become habitual aspects of one’s personality (McRay, 2016).  These disorders distort personality to such an extent to cause inner personal turmoil in one’s feelings towards others and one’s assertion of those feelings outside the norms of one’s cultural context (McRay, 2016).   For this reason, many personality orders are not only odd, eccentric, selfish, rude, and withdrawn, but also violent and terrifying to others.

Personality in itself is an essential feature to a person.  It involves a person’s overall demeanor, it includes how a person reacts internally and externally with others and the person’s overall temperament.   Overall, a personality is one’s unique patterns of thinking, acting and feeling (Myers, 2019).  There are numerous theories of personality ranging from the psycho-analytic schools to the humanistic as well as the behavioral schools of psychotherapy.  All emphasize their targeted areas of study to the development of personality and all add unique elements to understanding personality.  Within personality, exist various traits that are essential to proper functioning within the norms of society.  Traits are  characteristics or behaviors or dispositions of how a person feels or acts in certain ways (Myers, 2019).  Experts list the Big Five Factors of traits that determine personality factors.  Myers lists Conscientiousness, Agreeableness, Neuroticism, Openness and Extraversion (2019).  When one sways from one extreme to the other in these traits, then imbalance occurs.  In addition, the DSM-V-TR also lists these traits in its alternate diagnosis for personality disorder with openness being replaced with lucidity (2022).

When an individual deviates from the cultural norms of his or her culture and society and these extremes manifest against the core basic traits, one will witness odd or deviated social behavior, but isolated acts of misconduct or erratic behavior do not constitute a disorder.  A disorder is far more deeper and its duration long lasting.  In this blog, we will take a closer look at personality disorders and their striking deviations from cultural norms and behavior.

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What is a Personality Disorder?

The DSM-V-TR points out that an enduring pattern of inner experience and behavior that deviates from expectations of one’s culture constitutes a personality disorder.  These disorders manifest in one or two ways, via cognition, affectivity, interpersonal functioning or impulse control.   The DSM-V-TR continues that these enduring patterns are inflexible and pervasive across the range of the person’s personal and social situations and interactions with others (2022).   The DSM-V-TR states that these behaviors cause significant distress and impairment in social and personal relationships and this pattern remains stable and of long duration with origins in adolescence and early adulthood (2022).  Obviously, these issues are not related to substance abuse, medication, or other mental defects.

The DSM-V-TR looks at moderate to severe impairment in traits to affect identity, self-direction, empathy and intimacy.  In addition, these disorders can portray various distortions of personality traits to the extreme.  They can manifest negative affectivity versus emotional stability, detachment versus extraversion, antagonism versus agreeableness, disinhibition versus conscientiousness, and psychoticism versus lucidity (2022).  It is because of this one can witness in personality disorders a wide range of odd, eccentric, emotional, impulsive, egocentric, aggressive, violent, unempathetic, and manipulative traits.

The DSM-V-TR groups personality disorders into three clusters.  Cluster A includes paranoid disorders such as paranoid, schizoid and schizotypal.  Cluster B includes personality disorders such as anti-social (sociopathy/psychopathy), borderline personality disorder, histrionic, and narcissistic disorders.  Finally, Cluster C includes avoidant personality disorders such as avoidant, dependent and obsessive compulsive personality disorders (not to be confused the OCD itself). (2022).

Of particular note, based on different case studies and surveys, the percentage of personality disorders within the general population is 9 to 10 percent suffering from some type of personality disorder in some degree or level (Barlow, et al. 2023).  Ironically, many of the terms associated with these disorders, are used loosely in everyday vernacular towards individuals who may act a certain way in a given situation but not possess the disorder.  Bad behavior, sin, vice, or whatever one wishes to label it is part of the human condition and people are not perfect.  Personality Disorders are merely a persistent form of these behaviors at an extreme and rigid level.  So, when diagnosing, anyone at some time or some point can see at least a couple undesirable traits and feel guilt or shame for exhibiting these actions.  Ultimately guilt and shame and acknowledgement are key signs one does not possess the disorder itself.

Types of Disorders

Paranoid

Paranoid personality disorders are in the realm of psychotic and the schizotypal form can sometimes be the premorbid phase of schizophrenia itself.   One of the key elements is the disorder is persistent before and after any delusional of psychotic episodes.

Paranoid Personality Disorder constitutes a pervasive distrust and suspicion of others.  Without evidence, they feel they are being exploited or harmed.  They discover unfounded evidence of demeaning actions or threatening meanings in other individual’s remarks or cues.  They are preoccupied with doubts of other’s loyalty to them and find it difficult to confide in others.  They feel information can constantly be used against them.  Emotionally, they can become angry and hold grudges due to the perceived threats (DSM-V-TR, 2022).

Schizoid Personality Disorder is a detachment from social relationships beyond intimate family.  They also possess a restricted range of emotions.  These traits continue before and after remission of possible psychotic episodes (DSM-V-TR, 2022).   Schizotypal Personality Disorder is more severe and resembles Schizophrenia and other schizophrenic spectrums.  It can also co-exist with them but also exists outside the psychotic psychotic episodes (2022).

Anti-Social

Anti-Social Personality Disorder is best known a pervasive and consistent pattern of disregard and violation of the rights of others, occurring since age 15  and must be at least 18 (DSM-V-TR, 2022).  With diagnosis, three of the following traits must persist

1. failure to comply with social norms and laws
2. deceitfulness and pathological lying
3. impulsiveness and failure to plan
4. irritability and aggressiveness
5. recklessness and disregard for safety of self or others
6. consistent irresponsible behavior
7. lack of remorse or empathy

The DSM-V-TR continues in alternative diagnosis with emphasis on a distorted identity based on egocentrism and self-esteem deprived via power and gain and pleasure.  Personal gratification is the primary goal and self direction absence of inhibitions that prevent those gratifications.  There is a lack of emotional connection or empathy within the disordered person and intimacy and relationships are meant for exploitation or manipulation to meet one’s own needs.   The DSM-V-TR in addition lists these traits of which 6 must be met

1. manipulation (antagonism)
2. callousness (antagonism)
3. deceitfulness (antagonism)
4. hostility (antagonism)
5. risk taking (disinhibition)
6. impulsivity (disinhibition)
7. irresponsibility (disinhibition)

Horrifying enough, there can be a psychotic specifier as well with psychopathic features which would constitute the differences between a sociopath and a psychopath.  Depending on degree and opportunity, these individuals can be very dangerous in what they are willing or not willing to do to others.  Many criminals possess these traits and those in trouble with the law.  Many can understand something is wrong but fail to care or display empathy or guilt or emotion regarding their actions.

Narcissistic Personality Disorder is commonly comorbid with Anti-Social Personality Disorder.  Narcissists, according to the DSM-V-TR, display a pattern of grandiosity.  They require admiration and lack empathy.  The disorder can manifest in early adulthood (2022).  Five or more of the following are necessary for diagnosis.

1. grandiose self importance
2. fantasies of unlimited success, power and brilliance
3. believes oneself is special
4. requires admiration of others
5. sense of entitlement
6. interpersonally exploitative
7. lacks empathy
8. envious of others
9. severe arrogance

In regards to identity, they require excessive reference of others for self-definition.  Deep down, they have lower self-esteems and without these appraisals, they can suffer emotionally.  In addition, self direction is tied to gaining approval of others.  Relationships and intimacy are more superficial as to the image it portrays.  Empathetically, they are restricted in understanding the needs and emotions of others at the expense of their own (DSM-V-TR, 2022).  Closely related is Histrionic Personality Disorder which faces excessive emotionality and seeking of attention (DSM-V-TR, 2022).

If the other anti-social disorders are more intellectual, then Border Line Personality Disorder (BPD) is the chaos of emotion.  According to the DSM-V-TR, BPD is a pervasive pattern of instability in regards to relationships, self-image and affects which onsets in early adulthood (2022).  Five or more attributes must be present.

1. frantic efforts to avoid real and imagined abandonment
2. pattern of unstable and intense interpersonal relationships
3. identity disturbance and unstable self-image
4. impulsivity with spending, sex, substance abuse, reckless driving or binge eating
5. recurrent suicidal behavior, gestures, threats or self mutilation
6. affective instability due to marked reactivity
7. chronic emptiness
8. inappropriate anger or controlling anger
9. transient stress related paranoid ideation

In regards to identity, BPD is marked by poorly developed and unstable self-image.  Self direction consists of instability with goals and plans.  Empathetically, individuals have a difficult time recognizing the feelings and needs of others.  In regards to intimacy and relationships, there is a consistent intense, unstable and constant conflict with others (DSM-V-TR, 2022).  They experience intense emotional lability, anxiousness, separation insecurity, depression, impulsiveness, risks and hostility (DSM-V-TR, 2022).

Avoidant

Avoidant personality disorders include Avoidant Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder.

Avoidant Personality Disorder involves more than an introvert life style or bouts with anxiety but a pervasive pattern of social inhibition, inadequacy,  and hypersensitivity to negative evaluations of self (DSM-V-TR, 2022).   Four or more of the following are need in diagnosis.

1. avoids occupational activities
2. unwilling to get involved with others unless certain of being liked
3. restraint with intimiate relationships
4. preoccupied with fear of rejection
5. feelings of inadequacy
6. views oneself as unappealing, inferior or inept
7. avoids risks of engagement or new activities

Avoidant personalities are associated with low self esteem identity wise.  Their self direction is distorted due to reluctance to pursue goals.  Their empathy for others is distracted by their own internal fears and their intimacy is restricted due to shame and fear of rejection.  Their traits include anxiousness, withdrawal, anhedonia and intimacy avoidance (DSM-V-TR, 2022).

Dependent Personality Disorder involves a pervasive or excessive need to be taken care of by others which leads to submission and clinging behaviors marked by separation anxiety which manifests in early adulthood (DSM-V-TR, 2022). Five or more of the following symptoms are required for diagnosis.

1. difficulty making everyday decisions without excessive advice and reassurance
2. needs other to assume responsibility in life
3. difficulty expressing disagreement
4. difficulty initiating projects
5. goes to excessive lengths for reassurance
6. feels helpless when alone
7. seeks relationships for security
8. fearful of abandonment

Finally, Obsessive Compulsive Personality Disorder concludes the avoidant disorders.  This disorder is not to be confused with OCD which can be comorbid but unlike OCD which reacts to stressors and anxiety, OCPD exists in all situational relationships.  According to the DSM-V-TR, it is represented by a pervasive pattern of preoccupation with order, perfection and mental and interpersonal control at the expense of flexibility which begins in early adulthood (2022).  Four or more of the following symptoms are necessary for diagnosis

1. preoccupation with details, rules, lists, order, schedules, organization
2. perfectionism derails task completion
3. focused on work before any types of leisure
4. overconscientious, scrupulous and inflexible in matters of morals, ethics or values (not when accounted to religious or cultural identification)
5. unable to discard worthless objects
6. reluctant to delegate tasks to others
7. adopts miserly spending habits
8. rigid and stubborn

Those with OCPD compose their identity as correlated with work or productivity.  Their self direction is complicated due to rigidity in completing tasks and meeting standards.  They lack difficulty in empathy to understand the feelings and standards of others.  Finally, their intimacy is restricted in relationships since they put relationships secondary to work and maintain a rigid and stubborn life with others (DSM-V-TR, 2022).  They adhere to rigid perfectionism, perseveration in tasks, intimacy avoidance, and possess restricted affectivity (DSM-V-TR, 2022).

Etiology and Treatment

Personality Disorders like all mental pathologies cannot be originated from one aspect of life but is a culmination of biological, genetic, psychological, behavioral and social factors.  In addition, many possess comorbid mood disorders or maladaptive coping strategies involving substances.  In the cases of Anti-Social Personality, it is obvious that there are genetic dispositions as well as biological deformities within the brain that restrict empathy and impulsivity (Barlow, et al., 2023).   In addition, early childhood mistreatment, abuse, trauma, poverty and malnutrition can play roles in the development of life views and emotional affectivity (McRay, 2016).   None of these things guarantee a disorder, but they collectively can contribute to disorders that later develop in early adulthood.

In children, values and morality are also essential to enforce in life.  In early development of a children, egocentrism is important to survival but children are exposed to empathy, love and the needs of others.  Children that are not properly guided can develop vices that later can lead to habitual life styles (McRay, 2016).   Children with natural inclinations to pride, or selfishness, or other vices, without the proper guidance can fall victim to these inclinations as adolescence continues.  These maladaptive behaviors manifest as the person is permitted without consequence to perform these actions.  Obviously from a religious perspective, morality and restrictions are essential guardrails in anti-social personality development (McRay, 2016).   Even without proper social norms and concepts such as the Golden Rule, individuals can develop into habitual disordered individuals in mind, thought, emotion and behavior.

Unfortunately, many individuals with personality disorders do not seek treatment.  Avoidant groups are the most likely to seek help but anti-social and paranoid seek assistance less.  Those who do find help require extensive and consistent counseling that focuses on emotional regulation, identifying distorted thinking, and understanding the needs of others.  This involves comprehensive psychotherapy that includes CBT, DBT and other cognitive therapies.  Humanistic therapies can attempt to at least encourage acknowledgement of the needs of others.  Medication is rarely helpful but only to alleviate secondary symptoms of anxiety or depression, especially in BPD (Barlow, et al., 2023).

Pastoral and Christian Counseling care has existed well before modern psychology.  In these practices, the proposed opposite virtue of the habitual vice was emphasized such as humility over pride or temperance over anger.  In these cases, the spiritual treatment of the sinful condition was considered in addition to the mental pathology.  Moral virtues, spiritual discipline, submission to God and constant regulation over viceful responses were considered critical.  For many, faith left the change to the grace of God  due to the sinful nature of humanity(McRay, 2016).Too many times, pastoral leaders or even counselors and mental healthcare professionals can become over involved in personality disorder cases looking to rescue and save these clients.  Many of these clients unfortunately are sometimes beyond saving and will attempt to manipulate helpers.

In regards to loved ones, family is encouraged to never withdraw love but to always protect themselves from manipulation or abuse.  In addition, they are to set strong boundaries with those facing personality disorders.  Boundaries are essential and must be made clear and definitive of expectations but also demands for treatment.  Family needs to become psycho-educated on the disorders and be able to identify manipulations or emotional states to better protect themselves but also help the person.

Conclusion

Personality Disorders are habitual, persistent, and impairing traits that affect an individual’s ability to show empathy, regulate emotion, or interact with other people in a fair and just way.  The disorders affect their ability to properly assert themselves in positive or negative ways.  They manifest in types or paranoid, anti-social or avoidant.  All individuals to some extent sometimes deviate from the norm or do something wrong, but personality disorders deviate from the cultural norm on a consistent basis and at disproportionate extreme. While those who suffer from these disorders, especially BPD and Sociopathy must be held accountable for bad actions, one still must understand the unnatural impulse that has habitually sidetracked their ability to operate as normal individuals.  This leads to erratic, odd, distant, dysregulated, manipulative, rigid, emotional, or dangerous behaviors.  These disorders have multiple origins from genetics, biology, as well as past trauma, and behavioral upbringing.  It is difficult to predict what factors will lead to a true disorder but roughly 10 percent of the population suffers from a personality disorder.  In regards to treatment, psychopathology and some medications can help alleviate anxiety and depression, but overall, a person must commit to life long therapy and continually identify their issues.  Ironically, the inability to acknowledge this is the biggest issue for adjustment.  Finally, it is important to form healthy boundaries with loved ones who suffer from these disorders.  While many are hard to understand or even tolerate, it is important to remember they are broken.  This does not mean one surrenders oneself to their desires, nor does it mean one justifies their actions or does not hold one accountable, but it does demand an empathetic condition for their brokenness.

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Additional AIHCP Blogs

Anti-Social Disorders – Access here

Narcissism Video- Access here

Borderline Personality Disorder- Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Personality Disorders. Cleveland Clinic.  Access here

Burton, A. (2024). “The 10 Personality Disorders”. Psychology Today.  Access here

Personality Disorders.  Mayo Clinic.  Access here

Pugle, M. (2026). “10 Types of Personality Disorders”. Very Well Health.  Access here