Personality disorders, previously listed as Axis-II disorders, are divided into three clusters. The three clusters (A,B, and C) contain the ten personality disorders included in of the latest release of Diagnostic And Statistical Manual Of Mental Disorders (DSM-V-TR). The clusters divide the personality orders according to similar features with the intent to simplify diagnosis of personality disorders. Cluster ‘A’ personality disorders are marked by “odd eccentric behaviors, and are grouped together because of common patterns of symptomology as well as shared genetic and environmental risk factors” (Esterberg, et al., 2010).
Cluster Groupings for Personality Diorders
The grouping of the ten personality disorders into three clusters has led to severe criticism by a number of researchers. For example, one of chief criticisms is the ill defined validity of many of the personality disorders. Accordingly, researchers find it difficult to find empirical support for any particular personality disorder.
Thomas Wigner explains, “due to the less than perfect reliability (and validity) of personality disorder assessment, minor shifts in the assessment will occur over time, resulting in major shifts in categorical diagnoses” (2010).
Besteiro-González, et al. admits that the cluster designation may be useful in “some clinical situations, although with serious limitations and without consistent validation” (2004). They cite several studies to support this opinion. “A number of studies have attempted to identify dimensions underlying the personality disorders, to assess their comorbidity, and to examine their demographic and clinical features, but failed to support the validity of the three cluster taxonomy” included in DSM” (2004).
Cluster ‘A’ Disorders
There are three personality disorders included in the cluster ‘A’ grouping. They are schizoid personality disorder, schizotypal personality disorder, and paranoid personality disorder.
Cluster ‘A’ personality disorders are considered to be the more severe disorders and “assumed by many to be more resistant to treatment.” Often those diagnosed with a cluster ‘A’ diagnoses don’t see themselves as divergent from the world around them, and, therefore, not in need of treatment. The cluster ‘A’ personalities aloofness lead to significant difficulties in initiating and maintaining relationships (2010).
While these three personality disorders share “odd and eccentric” behaviors, they also have fundamental differences. For instance, schizotypal personality disorder has “a unique combination of both cognitive-perceptual (i.e., positive-like) experiences and social and interpersonal (i.e., negative-like) deficits” (Esterberg, et al., 2010).
T. Franklin Murphy wrote “When extreme personality peculiarity co-occur with social and interpersonal deficits, perceptual disturbances and magical thinking the eccentric behavior may indicate the presence of schizotypal personality disorder” (2022).
Paranoid personality disorder is characterized more by “paranoia- and suspicious-related ‘positive’ symptoms”
(Esterberg, et al., 2010). Schizoid personality disorder is characterized more by the “social isolation and emotional detachment” (Murphy, 2022a).
Esterberg explains that Schizoid and Schizotypal personality disorders both share the negative symptoms of interpersonal deficits, however, schizotypal personality disorders interpersonal deficits stem from the paranoid fear of others, while schizoid personality disorder simply lacks a desire for close relationships (2010).
Schizophrenia and Cluster ‘A’ Disorders
The symptomology of Cluster ‘A’ disorders resembles many of the characteristics associated with the onset of schizophrenia. In fact, a diagnosis of schizotypal personality disorder in adolescents is considered a risk factor for later development of schizophrenia. Research has found that “nearly 30% of adolescents with this personality disorder go on to develop a psychotic disorder” (Esterberg, et al., 2010).
Carlo Perris, a Swedish psychiatrist, found that “a series of cognitive deficiencies which have been identified in schizophrenic patients and that could be common, although less pronounced, in patients with cluster A personality disorders.” He described these cognitive deficiencies as “diminished capacity for abstract thinking and a diminished performance in short-term memory” (Scrimali & Grimaldi, 1996).
Cluster ‘A’ Disorders, Schizophrenia, and The Diathesis Stress Model
Perris suggested that schizophrenia (and presumably cluster ‘A’ disorders) contained both a cognitive and environmental component, leading to the eventual development of the disease (1996).
According to the diathesis stress model “disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences” (Murphy, 2021). While stress may occur in a wide variety of circumstances, Perris specifically refers to negative parenting.
”The malfunctioning operative models in patients suffering from cluster A personality disorders may be similar to those of schizophrenic patients.” Parris argues that “this might be traced back to a personality development characterized by negative parenting” (1996). While not specifically referring to John Bowlby’s attachment theory, it is apparent that Bowlby’s theory influenced Perris’s concepts of childhood stress.
The Three Personality Disorders in the Cluster ‘A’ grouping
Paranoid Personality Disorder (PPD)
Paranoid personality disorder exhibits a pattern of suspicion of others, expecting others to act in mean or spiteful ways. Those suffering from this order are haunted by paranoid ideations, always assuming people will harm or deceive them. They also often devise means to create barriers for protection to limit vulnerability.
Diagnosis of Paranoid Personality Disorder requires possession of four or more of these characteristics:
- Suspicions of others intent to harm
- unjustifiable doubts of loyalty
- reluctance to confide in others
- bears grudges
- recurrent suspicions
- gives meaning to benign remarks (Wright & Carbajal, 2021).
Schizoid Personality Disorder (PD)
Those suffering from the schizoid personality disorder emotionally detach from social relationships, expressing little emotion, often sharing similar qualities as the condition known as alexithymia. Another characteristic is that a person with schizoid personality disorder typically chooses to be alone and seems impervious to the praise or criticism.
Diagnosis of Schizoid Personality Disorder requires four or more of these characteristics:
- neither enjoys or seeks relationships
- prefers solitary activities
- minimal interest in sexual activity
- few close friends outside of first degree relatives
- indifference to praise or criticism
- emotional detachment
- little pleasure in activities (Wright & Carbajal, 2021).
Schizotypal Personality Disorder (PPD)
Those suffering from schizotypal personality disorder exhibits a pattern of discomfort in close relationships, distorted thinking and eccentric behavior. In addition, a person with schizotypal personality disorder may hold odd beliefs and have peculiar behavior. they often have excessive social anxiety.
Diagnosis of schizotypal personality disorder requires five or more of these characteristics:
- ideas of reference without delusions
- odd beliefs
- odd perceptions
- odd thoughts and speech
- paranoid ideation
- inappropriate affect
- few friends
- excessive social anxiety (Wright & Carbajal, 2021).
References:
Besteiro-González, J., Lemos-Giráldez, S., & Muñiz, J. (2004). Neuropsychological, Psychophysiological, and Personality Assessment of DSM-IV Clusters of Personality Disorders. European Journal of Psychological Assessment, 20(2), 99-105.
Esterberg, M., Goulding, S., & Walker, E. (2010). Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. Journal of Psychopathology and Behavioral Assessment, 32(4), 515-528.
Murphy, T. Franklin (2022). Schizotypal Personality Disorder. Psychology Fanatic. Published 5-17-2022. Accessed 9-9-2022.
Murphy, T. Franklin (2022a). Schizoid Personality Disorder. Psychology Fanatic. Published 8-29-2022. Accessed 9-9-2022.
Murphy, T. Franklin (2021). Diathesis Stress Model. Psychology Fanatic. Published 9-7-2021. Accessed 9-9-2022.
Scrimali, T., & Grimaldi, L. (1996). Schizophrenia and Cluster A Personality Disorders. Journal of Cognitive Psychotherapy, 10(4), 291-304.
Widiger, T. (2010). Cluster A Personality Symptomatology in Youth. Journal of Psychopathology and Behavioral Assessment, 32(4), 551-556.
Wright, M., & Carbajal, A. (2021). Personality disorders. Journal of the American Academy of Physician Assistants,34(10), 49-50.
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