About 15% of the general population has at least one personality disorder. This post discusses the personality disorders in Cluster A: paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. The topic of personality disorders is fascinating but also incredibly important, as personality disorders deeply affect the daily functioning, interpersonal relationships, and mindset of affected individuals. Unfortunately, personality disorders are often misunderstood, but it is my goal to provide more information that is easily accessible. You or someone in your life likely has a personality disorder. In most cases, they do not receive professional help through therapy because they are unaware of their personality traits. If they are aware, they may not see their maladaptive traits as a problem, even if it causes them distress or leads to impairment in their life.
Personality disorders are persistent but can still wax and wane in severity due to life circumstances, phases of life, social support, and various stressors. About half of people who meet the criteria for a personality disorder will meet the requirements for at least two personality disorders. People with personality disorders also are more likely to have other diagnoses, including depression, anxiety, eating disorders, and substance use. Personality disorder development has both genetic and environmental components, so there is likely an underlying genetic predisposition combined with childhood stressors and trauma.
Cluster A is known as the odd or eccentric cluster. People with a personality disorder in cluster A have problems with interpersonal relationships, usually due to mistrust or lack of interest in others. People who are affected also have profound functional impairment across their lifespan and all domains of life. They tend to live isolated lives and appear introverted to others. Professional functioning often limits them to a job they can hold with limited interaction with others.
Paranoid personality disorder involves distrust, unjustified suspicion, hypervigilance to potential threats, and disproportionate reactions to perceived attacks. About 3% of the general population has paranoid personality disorder, which is also more common in men. People with paranoid personality disorder try to be very self-sufficient and may even perceive an offer of help as criticism that they cannot do something themselves. They are more likely to have coexisting alcohol and substance use disorders.
Schizoid personality disorder involves social isolation, voluntary detachment from relationships, and a preference for solitary activities. People with this personality disorder may have little interest in sexual relationships, indifference to praise and criticism, and restricted emotional expression. About 4% of the general population has schizoid personality disorder. It is also more common (and more severe) in men. Many people with this personality disorder have fantasy worlds they access (such as through video games) that replace reality.
Schizotypal personality disorder involves eccentric behavior and appearance, magical thinking, social anxiety, paranoia, social isolation, speech that is difficult to follow, and inattention to usual social conventions (like eye contact). About 1% of the general population has schizotypal personality disorder. It may be slightly more common in men. More than half of people with schizotypal personality disorder will have at least one episode of major depressive disorder.
For more information on these personality disorders, listen to my related episode.