The National Institute of Mental Health estimates more than 9 percent of adults in the United States have at least one personality disorder. But what is a personality disorder? According to the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (2013), a personality disorder represents “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” and is outlined in three distinct subgroups — clusters A, B, and C.
The types of diagnosable personality disorders cover a wide spectrum of thoughts and behaviors. In order to fully understand how one can work with, walk alongside, and support a person who has a personality disorder, we should talk about each cluster individually.
Understanding Cluster A
Cluster A personality disorders are characterized by odd thinking and behavior and include diagnoses such as paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. The brains of these individuals are telling them the reality they are experiencing is far different from the one you and I are in. They may share eccentric stories that are so far-fetched they cannot be reasonably believed. Often, well-intentioned people will try to bring the person experiencing this disconnect into the current real world. However, this will only escalate the problem and further alienate the person.
These individuals may live on the fringes of society and tend to be resistant to medication or will self-medicate. Self-medication can lead to addiction, which camouflages the underlying issue, often leaving a person further undiagnosed. People who take prescribed medicine frequently report it leaves them feeling worse than they do without it and as though they are only living a half-life because it drains their energy. Conversely, the personality disorder itself can feel electrifying. While a person is in a delusional state, he or she feels very alive, which is expressed in exaggerated vocals and gestures.
When walking alongside anyone, that person’s autonomy comes first. He or she gets to choose his or her course of action or no course of action. Trying to pull the person into your world or force the person to take medication will push him or her further away. Instead, keep your end of the conversation in the present. Even when the person becomes irrational, it is not your responsibility to change that speech. In order to not feed into the delusion, however, make a comment to show you are listening, and then bring the conversation back to the present.
Understanding Cluster B
Cluster B personality disorders are characterized by dramatic, emotional, and unpredictable thoughts and behaviors and include such diagnoses as antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Until recently, individuals living with these personality disorders went widely overlooked as people who were just a little more emotional or dramatic than others. Most notably, narcissistic personality disorder has been brought to the forefront of mainstream conversations. As with cluster A, cluster B disorders are marked by a disconnect from reality. However, this person does not have marked eccentric thoughts and behaviors. Rather, these individuals can move about in society largely unnoticed as their thoughts and behaviors do not seem that out of the ordinary — maybe just a little “over the top.”
All of the disorders in cluster B are based around relationships. More accurately, these individuals all have the inability to form healthy relationships. You may first notice they seem to be charming and friendly. However, shortly after that first bond is made, their brains will begin to sabotage it, and they will push the person away. People in this group move in and out of relationships quickly.
In order to truly walk alongside this group, consistency is key. Individuals in this group will push away well-intentioned people with their words and actions — usually very quickly in the relationship. Staying consistent in your words and actions is critical, as they are looking to discredit you and believe you are not there to really help.
Understanding Cluster C
Cluster C personality disorders are characterized by anxious thinking and behaviors and include such diagnoses as avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. People in this cluster have brains that are constantly telling them to worry. With avoidant and dependent personality disorders, the person will struggle to make lasting attachments. It is important to note obsessive-compulsive personality disorder is different from obsessive-compulsive disorder, which is an anxiety disorder. With obsessive-compulsive personality disorder, the person needs to control all areas of his or her life. These individuals find it difficult to form lasting relationships because of their extreme need for control, or they may form a relationship with someone who has a dependent personality disorder so they can easily control him or her.
People in cluster C also benefit greatly from healthy people who are consistent in their words and actions. While people in cluster B will run to relationships only to sabotage them, people in cluster C may be a little more apprehensive about the nature of your involvement in their life. They may question why you are there or how long you will stay.
Understanding Your Role
Though personality disorders range widely in symptoms, some similarities exist about how to walk alongside individuals in any cluster.
First, check to see whether your motivations are for the individual first and foremost. It will be harmful to the individual if you start a relationship but then abruptly leave when you decide it is too much for you.
Second, be consistent. If you say you are going to do something, do it. The word maybe is not an option. If you cannot do what you have promised, then you must give a clear explanation as to why not. Your actions must match your words.
Last, find support. Interacting with individuals who live with personality disorders can drain and emotionally batter you. Make sure you have somewhere to process your thoughts and feelings. That way, you will be able to be a helper for the long term.
Dr. Marianne Thomas is an expert in complex trauma specifically as it relates to childhood abuse. In her work with complex trauma, Dr. Thomas has seen a number of clients who were misdiagnosed with a personality disorder. Dr. Thomas has been uniquely called to minister to those who have been trafficked and is a speaker and consultant for churches, businesses, governmental agencies, and nonprofit organizations that want to be involved in the anti-trafficking movement.
Disclaimer: The information shared on here is not meant to diagnose or treat a mental health condition. We encourage you to follow up with your health-care provider and seek a mental health professional for individual consultation and care.