Unpacking Personality Disorders: The Mad, the Bad, and the Sad
A Look at the Three Clusters and a Deep Dive into the Infamous Cluster B
A personality disorder and a personality trait are not the same things. A trait is simply a personality characteristic like generosity or greed. Personality disorders are grouped by the DSM chart into three groups (A, B, C) based on their manifestations. Often internally chaotic disorders that cannot be regulated easily, they are maladaptive patterns of behavior that affect every part of a person’s life. It causes them problems in all areas of their existence and can wreak havoc in the lives of all those around them. When their life is negatively impacted significantly in all aspects and cannot be easily regulated or managed, it can be defined as a personality disorder.
“The Mad” Cluster A
Cluster A disorders include
- schizoid- characterized by a lack of interest in social relationships, a tendency toward a solitary lifestyle, emotional detachment, and apathy.
- paranoid- marked by behavior that may seem strange or unusual to others and demonstrates suspicion of other people.
- schizotypal personalities- are loners who prefer to keep their distance from others and often exhibit odd speech or behavior with a limited or flat range of emotions.
They are sometimes found in psychiatric facilities, residential housing, or homeless camps because they are so often psychotic to the degree they cannot manage their conditions well enough to find their place in regular society. They are termed “mad” because of their disconnect from reality and as a consequence of delusional or psychotic manifestations. They often respond well to a combination of treatments to the point they can be managed effectively thereby restoring functionality.
“The Bad” Cluster B
Disorders Under the Cluster B Umbrella include
- narcissistic personality disorder- a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others.
- anti-social personality disorder- characterized by a lack of empathy and regard for other people and no concept of right or wrong. They are deceptive, manipulative, seductive, often aggressive or violent, and participate in criminal activity. They have no remorse or conscience.
- histrionic personality disorder- characterized by a pattern of excessive attention-seeking behaviors, including inappropriate seduction and an excessive desire for approval.
- bi-polar personality disorder- also known as manic-depression, it causes extreme mood swings that include emotional highs (mania) and lows (depression).
Of all the categories of personality disorders, Cluster B carries the designation as one of the most difficult disorders to treat and many do not respond well to treatment at all. It is the “cluster of chaos” as these disorders wear the badge of “bad” boys(girls). They are interpersonally difficult and can exist on a spectrum from having characteristic tendencies to having full-blown pathological disorders that render them incapable of being high functioning or able to lead a normal life with stable relationships. They do not respond well to therapy, medication, or any treatment modality and are considered the most difficult set of disorders to achieve a positive outcome.
“The Sad” Cluster C
Cluster C is a set of disorders rooted in fear, shame, insecurity and manifests as anxiety and sometimes even panic disorder. They often involve abandonment and attachment issues. There are three major types.
- Dependent- Need to be taken care of and need others to assume responsibility for themselves. It is a
- Avoidant - Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection.
- Compulsive Obsessive- Recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).
Cluster C conditions, also known as the fear and anxiety cluster, often respond well to prescriptions and other treatments. Medications for anxiety can help manage symptoms of dread, and mood stabilizers can level out the feelings of panic.
A Closer Look at the Infamous Cluster B
Public Enemy #1 Narcissistic Personality Disorder (NPD)
Narcissists have infected the minds of people all over the world. They have infiltrated the entertainment industry with shows like Killing Eve, Dirty John, and more recently, The Undoing, as well as movies like Enough and a Promising Young Woman. They have filled the pages of social media with countless posts and groups and pages dedicated to understanding narcissism and recovering from narcissism. Your next-door neighbor can talk about narcissists, folks around the water cooler compare notes on their narcissistic boss, and your best friend probably thinks she is dating one. Narcissists are everywhere and growing like a plague.
There are different ranges and cadres of a person with NPD. The low range has no knowledge of what they are, lacks impulse control, and demonstrates primitive behavior. The mid-range narcissist also lives in a false reality with little awareness of what he is but is more sophisticated in their methods, rarely exhibits rage and replaces it with cold fury, silent treatments, and passive-aggressive behavior, and is more manipulative and seductive. The high-level person with NPD has more awareness of what they are, are more calculating, and share more qualities with the sociopath and psychopath.
Narcissists are either cerebral or somatic. In other words, they either generate their fuel/supply by using their bodies or by using their minds. Furthermore, another distinction happens between the grandiose (overt) and the vulnerable (covert) narcissist. Overt narcissists are grandiose, attention-whores and entitled and possessing an inflated sense of self. They are arrogant and consumed with fantasies about being successful with wealth and power. Covert narcissists are usually fragile, vulnerable and self-pitying. They are sensitive to criticisms and imagine themselves having high status. When they fail, they blame others and claim victimhood.
Public Enemy #2 Anti-Social Personality Disorder (ASPD)
This is where the sociopaths and psychopaths live. It is a pattern where individuals break all codes of conduct both moral, legal, ethical, and have no remorse or guilt for the bad things they do. They lack empathy or compassion for other humans, exhibit ruthless and exploitative behavior, are impulsive and deceitful, and do not care if people are hurt if collateral damage is necessary for them to achieve their goals. They can be quite charismatic and personable, often charming with those around them. This group ends up either in prison or as the CEO of a Fortune 500 company depending on how high functioning they are. Their psychotic traits can even be leveraged for success. For example, their lack of emotions, such as anxiety and fear, helps them to stay calm in frightening situations. This is a great quality that sets them up for success if they are required to perform dangerous high-risk jobs.
The prognosis for Cluster B impaired people has the worst outcomes of them all and the largest representation among all personality disorders. They are manipulative and do not believe they have a problem. They may fool their mental health professional and are often misdiagnosed as a consequence. There is no real treatment or medication. Simply put, their inner mechanisms are non-existent as they are empty and have no identity or true self. They construct a false self and believe their own version of reality which is an illusion. The inner-circle in their lives often participates in a shared fantasy and becomes trauma bonded to them.
As for relationships with the narcissist, the sociopath, or the psychopath, they tend to prey upon empaths, smart principled types, or people with childhood trauma and mental health issues of their own like codependency or attachment issues. Then they exploit them until there is nothing left, only to discard them, rinse, and repeat. In the short-term, they are on a relentless quest for fuel/supply, character traits, and residual benefits like money, sex, or power; however, as they hit middle age and beyond, they seek more compatible couplings. For long-term and golden years, they will seek a fellow narcissist, sociopath, or psychopath. Eventually, birds of a feather, flock together.
The other two Cluster B disorders, Bipolar Personality Disorder (BPD) and Histrionic Personality Disorder (HPD), do not get top billing in this cluster because the amount of destruction they cause is minimal compared to the narcissist, sociopath, and psychopath. The harm is more likely absorbed by themselves as they struggle to regulate their behavior and manage their emotions. Unlike their NPD and ASPD brothers and sisters, they can be treated quite effectively with a combination of cognitive-behavioral therapy, dialectical therapy, journaling, medications, and other healing modalities.
In conclusion, the bad boys of Cluster B — the narcissists, sociopaths, and psychopaths, are the ones to watch out for. While approximately 1 in 5 psychopaths and narcissists are successful leaders in their fields, captains of industry, champions in their communities, their not-so-shiny sparkly murderous counterparts are also cut from the same cloth. There’s no clinical difference between a sociopath and a psychopath, and they are both dangerous. These terms are both used to refer to people with ASPD and are often used interchangeably. Even a narcissist can be dangerous if they are a malignant pathological narcissist with comorbidities. We have observed OJ Simpson, Scott Pederson, Ted Bundy, Charles Manson, and countless others with a charismatic, almost cult-like charm who committed unspeakable atrocities without a shred of remorse or regret. Just remember, they live and walk among us, shrouded in a false persona of courtesy, kindness, and generosity until they plunge in the dagger and serve you up with a side of fries.
This primer on types of personality disorders should equip you to enter the world of predators and dysregulated individuals with some degree of awareness and protection. Most people are not even aware of these maladapted behaviors, thus they become easy targets.
A word of caution. Regardless of how strong or smart or in control you may be, a Cluster B narcissist, sociopath, or psychopath (and many times a combination of all three) can demolish your life before you know what hit you. They destroy, disengage, then burn everything to the ground so that you are completely annihilated. Nothing left but scorched earth. No one standing. No survivors.
And then they erase you and your entire life together as if it never happened. You are destroyed on multiple levels. It is an extinction-level event. An existential crisis. It will take longer than you think to recover.
I know this to be true.
It happened to me.
Prajinta Pesqueda is a veteran of a war against trauma-induced C-PTSD caused by a lengthy marriage to a somatic mid-range narcissistic-psychopath and compounded by a lifetime of dysfunctional patterns and relationships. Most often, long-term partners of disordered people have their own mental health issues beginning in early childhood. Her journey to wholeness and health can guide others to succeed in their own quest to achieve wellness.
Ms. Pesqueda’s writing does not just consist of articles that provide information and experiences with the recovery from disordered partners but also serve as an evocative bit of professional writing in the spirit of authors like Joan Didion, Annie Dillard, and Sylvia Plath. She does more than teach or guide. She writes evocative, hauntingly tragic yet beautiful non-fiction that combines enlightening research and personal examples alongside compelling narratives that bring the reader a compelling snapshot of relationship trauma.
Ms. Pesqueda is a recovery coach and also holds a Master’s degree with an emphasis on guidance and counseling. Check out her podcast channel on all major platforms at https://anchor.fm/pesqueda
Follow her writing at www.pesqueda.medium.com