Clinical psychology and psychopathology

The most complex mental disorders are personality disorders, as they are very resistant to change and become even more complicated when co-occurring with other personality disorders or when presenting as “mixed types.” In such cases, the symptoms of one disorder may dominate, but features of other personality disorders are also present, making the person a real challenge for psychological assessment and especially for treatment.

Psychological treatment is not impossible, but it requires cooperation from the individual undergoing therapy. Without such cooperation, successful treatment is unlikely—not just for personality disorders, but for any psychological condition.

There are various types of personality disorders, each with different signs and symptoms. Sometimes, similar symptoms appear across multiple disorders, requiring what is known as differential psychodiagnostics to properly distinguish them.

According to diagnostic classifications, the following personality disorders are recognized:

• Paranoid Personality Disorder
• Schizoid Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Narcissistic Personality Disorder
• Histrionic Personality Disorder
• Borderline Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder

Paranoid Personality Disorder

The core characteristic is suspicion and distrust toward others, with a tendency to interpret others’ actions as malevolent—even when there is no evidence to support such beliefs. These individuals unjustifiably suspect others of exploiting, harming, deceiving, or wanting to hurt them.

They are preoccupied with doubts about the loyalty and trustworthiness of friends and associates, and they constantly develop suspicions about the motives of partners, friends, or colleagues. They avoid sharing information about themselves, their feelings, or thoughts, believing it will be used against them.

They misinterpret harmless comments as threats or personal criticism. They often hold grudges for a long time and have difficulty forgiving perceived insults or threats. Their reactions are quick and marked by anger or hostility, and they tend to be overly defensive or aggressive.

They also harbor suspicions of infidelity and may constantly accuse their partners of cheating (sometimes these paranoid accusations actually hide defensive reactions due to the accuser being unfaithful themselves—a neurotic defense mechanism to preemptively accuse their partner in order to conceal their own infidelity). They may also have ideas of persecution, i.e., a belief that others are deliberately trying to undermine or harm them.

Schizoid Personality Disorder

The core characteristic is a restricted range of emotional expression and detachment from social relationships in interpersonal settings. These individuals are introverted, prefer solitary activities, and are indifferent to the opinions or desires of others. They have little interest in forming close relationships—not even strong attachments to family members or romantic partners.

They prefer to spend time alone rather than engage in social activities or hobbies that involve others (e.g., if they enjoy hiking, they prefer to do it alone). Their emotional expression is so limited that others often find it difficult to identify how they feel or what emotion is dominant at any given time.

They lack interest in sexual activities with others, often showing no sexual appetite or desire—they are asexual. They do not respond to praise or criticism and are indifferent to whether others view them positively or negatively.

They may give off an impression of emotional coldness and detachment, generally appearing emotionally distant, indifferent, and cold in their relationships. They have little or no desire to form intimate bonds, which limits their social interactions and often results in having few or no friends. They are socially withdrawn, with minimal social engagement, and often neither value nor seek out such interactions.

They show no desire for group activities (even family gatherings are seen as unimportant) and have a weak emotional response to life events—even significant ones (a new family member, a wedding, someone’s success or failure, the loss of a loved one). They struggle to understand, accept, and adapt to social norms or conventional rules.

Schizotypal Personality Disorder

This disorder involves eccentric behavior, strange beliefs, distorted thinking, and social anxiety. Such individuals experience cognitive or perceptual distortions and feel highly uncomfortable in close relationships. They may believe in things that have no basis in reality, such as telepathy, superstition, or possessing special powers (supernatural abilities). They often have unusual perceptual experiences, such as sensory distortions (e.g., the sensation of being watched), though not full-blown hallucinations.

They wear unconventional clothing and have peculiar speech, body language, and mannerisms. They experience discomfort and tension in the presence of others, especially in close relationships, and often feel different or misunderstood. They are typically suspicious and may have paranoid ideation, with a tendency to be excessively mistrustful or paranoid, believing that others want to harm or deceive them without sufficient evidence—these are personal distortions in thinking.

Their speech can be metaphorical and difficult to follow (especially for less intelligent listeners), and their thoughts may appear disconnected or abstract. They lack close friendships and people they can trust, often having few or no friends outside their family—and they are often emotionally distant even from family members.

They generally show inappropriate emotional responses in certain situations. Their distorted beliefs can negatively affect their ability to understand and accept social norms and rules, as well as to form stable and meaningful relationships. They display strong superstitious thinking, believing in paranormal phenomena such as supernatural experiences, occultism, satanism, and similar topics.

Antisocial Personality Disorder

/Psychopathy/

Commonly known to the general public under the simplified term “psychopathy,” this disorder is characterized by a disregard for and violation of the rights of others, impulsiveness, manipulativeness, shallow emotionality, frequent involvement in various forms of criminal behavior, conduct problems before the age of thirteen, promiscuous sexual behavior, and a tendency toward risky activities that endanger themselves or others. Individuals often live a parasitic lifestyle (exploiting others), show a lack of guilt or remorse, and are incapable of empathizing with others.

They tend to engage in behaviors that may lead to arrest, including criminal acts. They lie, assume false identities, or deceive others for pleasure or personal gain. Their executive functions are often weaker due to under-functioning of the prefrontal cortex, resulting in poor planning and impulsive actions without consideration of consequences.

Some frequently get into physical altercations or fights and easily express anger, unleashing rage and aggression toward others, often becoming violent. They may engage in dangerous behaviors such as reckless driving, substance use (typically stimulants or combinations), and violence, without concern for the effects on others.

They show irresponsibility in work-related matters (school in childhood, later jobs), in financial matters (evading taxes, alimony, or other obligations), and in family responsibilities (forgetting important dates, showing a lack of care or love for family members, often skipping family events despite claiming “family comes first”).

They justify their harmful behavior—physical or emotional—by showing only indifference. They easily abandon partners who love them and manipulate relationships by pretending to reciprocate those feelings. Their self-image is deeply distorted, and they lack self-awareness, despite high intelligence.

Highly intelligent individuals with antisocial traits may be more suitable for psychotherapy, as they possess stronger cognitive skills than less intellectually equipped individuals, which increases the chance of achieving self-awareness. For those with cognitive deficits, however, this is rarely possible.

Many antisocial individuals can appear charming or charismatic, but these are superficial traits used to manipulate others. There are also people particularly vulnerable to becoming victims of such manipulation.

Narcissistic Personality Disorder

Just like individuals with antisocial personality disorder, those with narcissistic personality disorder also exhibit a lack of empathy, a grandiose self-concept, and an excessive need for admiration from others (all of these symptoms are also present in antisocial personalities). Narcissistic and antisocial traits often appear in combination, forming one of the most treatment-resistant categories, often with long-lasting consequences. Many of these individuals also show signs of “enduring personality changes following catastrophic events,” known as complex PTSD, as deeper analysis frequently reveals childhood abuse in various forms.

These individuals tend to avoid treatment and find it difficult to face themselves, preferring instead to hurt others. Narcissistic personalities exploit others for personal gain, have an inflated sense of self-importance, and struggle immensely with criticism (a trait also seen in psychopathic personalities). They expect to be recognized as superior without having achieved anything to warrant such status. They exaggerate their accomplishments and talents, fantasizing about unlimited power, success, beauty, brilliance, or ideal love—constantly preoccupied with how others admire them, how to reach the top, or how to find the perfect partner.

They believe they are special and unique, and that only high-status individuals or institutions can truly understand them. They demand constant validation, recognition, or admiration to maintain their self-esteem and self-confidence. They feel entitled to special treatment or expect others to comply automatically with their desires.

Others are exploited to achieve personal goals, often without guilt or remorse. These individuals have difficulty recognizing or caring about the feelings and needs of others. They are envious of others or believe that others are envious of them. When others succeed, they may become resentful and act vindictively. Their behavior is marked by arrogance and haughtiness.

Histrionic Personality Disorder

This disorder is characterized by attention-seeking behavior, typically through exhibitionistic patterns and exaggerated emotionality. Individuals constantly seek validation and recognition, often displaying dramatic, theatrical, or seductive behaviors to draw attention to themselves. They feel uncomfortable when they are not the center of attention or the focus of social interactions.

They may exhibit inappropriate sexually provocative or flirtatious behaviors, including seduction or provocative interactions with others—even when these behaviors are contextually inappropriate (e.g., seducing a therapist instead of focusing on treatment, or using flirtation to secure business deals).

Their emotions shift rapidly and tend to be shallow. Because their emotional expressions change so quickly, they often appear superficial or insincere. They use physical appearance to attract attention, placing excessive focus on their looks, dressing provocatively, or engaging in attention-seeking behaviors (e.g., loud laughter, flashy makeup, bold or clashing colors, dramatic vocal expression, theatrical behavior).

They tend to express emotions in a theatrical, dramatic, and exaggerated manner, which is particularly noticeable in their speech. As a result, they may come across as artificial or unnatural, reacting emotionally more than what is appropriate for the situation.

They are highly suggestible and easily influenced by others or circumstances, often changing their beliefs and opinions based on external input, due to a lack of a strong personal identity. They may misinterpret the depth of relationships, believing them to be more intimate than they actually are.

Their speech is often impressionistic and lacking in detail—dramatic, vague, or excessive, without depth or substance, as if “there’s no point.” When they are not the focus of attention, they become easily frustrated. Their sense of self-worth depends on external validation rather than inner self-confidence, which tends to be unstable.

They engage in manipulative behaviors, using seduction, charm, or excessive emotionality to get what they want. They struggle to form deep relationships and find it difficult to maintain stable and meaningful connections due to their constant need for attention, which can become exhausting for partners.

Borderline Personality Disorder

This disorder is often also referred to as Emotionally Unstable Personality Disorder due to its hallmark feature: instability in relationships, emotions, self-image, and behavior. Individuals with this disorder typically have a strong fear of being abandoned or left alone and often go to great lengths to avoid real or imagined abandonment. A dominant defense mechanism is splitting—viewing others as either all good or all bad—which leads to unstable and intense relationships where people are alternately idealized or devalued.

Their self-image is unstable, leading to frequent changes in their sense of self, identity, goals, and values. Impulsive behaviors are common and can include excessive spending, binge eating (particularly in adolescence), substance abuse, and risky sexual activity. Recurrent suicidal behaviors may be present, such as threats or attempts, farewell letters, or dramatization of suicidality, as well as self-harming behaviors like cutting, burning, pulling out hair, or scratching.

They experience intense mood swings that may last from hours to days and can range from extreme happiness and euphoria to deep sadness, anger, or anxiety. A chronic sense of emptiness often manifests as feelings of inner void, boredom, or emotional numbness. They struggle with controlling anger, often experiencing sudden outbursts of rage. Under stress, they may become paranoid or experience dissociative symptoms. In close relationships, they may fluctuate between seeking intimacy and fearing closeness.

Avoidant Personality Disorder

This disorder is marked by social inhibition, feelings of inadequacy, and extreme sensitivity to negative evaluation. Individuals avoid social contact, including work and social activities that require interpersonal interactions, due to fears of being criticized, rejected, or embarrassed in such settings.

They are reluctant to get involved with others unless they are certain of being liked, which leads them to avoid forming friendships or relationships unless unconditional acceptance is guaranteed. In intimate relationships, they avoid emotional closeness out of fear or shame of being ridiculed.

They are preoccupied with the idea of being criticized or rejected and constantly worry about how others perceive them, which leads to social withdrawal. They are inhibited in new social situations because of feelings of inadequacy, and they have low self-esteem, finding it difficult to adapt to unfamiliar environments.

They see themselves as socially inept, unappealing, or inferior to others and often feel “not good enough.” They are reluctant to take risks or try new activities because of fears of failure or embarrassment, and therefore avoid unfamiliar situations altogether.

Dependent Personality Disorder

This disorder is characterized by an excessive need to be taken care of, which leads to submissive and clingy behaviors. Individuals with this disorder have an intense fear of separation and struggle with making decisions, maintaining self-confidence, and being independent. They frequently rely on others for emotional and physical support. They require detailed advice and reassurance from others even for simple decisions. They depend on friends, family, or partners to manage essential aspects of life, such as finances, work, or daily responsibilities.

They have difficulty expressing disagreement due to fear of losing support, avoiding conflict or contradicting others even when they disagree. They find it hard to initiate projects or work independently because they lack confidence in their abilities and depend on others to start or manage activities.

They may tolerate inadequate or abusive relationships just to maintain support and validation. They experience intense fear of being alone and believe they cannot function independently. As soon as one relationship ends, they urgently seek another. These fears of abandonment are often unrealistic, and they constantly worry about having to care for themselves without help.

Their behavior is often passive and submissive. They have low self-esteem and confidence, placing them at high risk of entering emotionally abusive relationships, as they are vulnerable to manipulation due to their fear of independence.

Obsessive-Compulsive Personality Disorder (OCPD)

This is not the same as Obsessive-Compulsive Disorder (OCD), which involves intrusive thoughts and compulsive behaviors. Rather, it is a personality variant in which the person believes their way is the “right” way. It involves excessive concern for order, perfectionism, and control, making such individuals extremely rigid. They are preoccupied with details, rules, lists, order, and organization, placing exaggerated importance on structure and unnecessarily complicating tasks.

Their perfectionism interferes with completing tasks; they set excessively high standards, which can lead to failure to finish projects or procrastination (working only under pressure). They may become excessively devoted to work and productivity, prioritizing work over leisure time and relationships—even when unnecessary.

They are overly rigid about moral and ethical values, maintaining a strict sense of right and wrong and showing inflexibility in beliefs. They struggle to discard worthless items, even when they lack sentimental value, because they believe those items might be useful someday. They prefer to do everything themselves, believing others can’t meet their standards. They view money as something to be saved for future misfortunes rather than spent for enjoyment.

They show extreme stubbornness and rigidity, insisting that things be done in exactly their envisioned way, and they struggle significantly with adapting to change. They exhibit high levels of self-criticism and guilt. Fear of making mistakes often leads to indecisiveness. They have difficulty expressing emotions, which may make them appear cold or emotionally distant. In intimate relationships, they are often perceived as controlling and demanding.