Examples of Personality Disorders With Distorted Thinking Patterns

Brindusa Vanta, MD, DHMHS
Medical editor

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Personality disorders are an entire class of mental health conditions. They are characterized by patterns of behavior, thinking, and feeling that aren't aligned with the expectations of your culture. These patterns, which are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) by the American Psychiatric Association, are typically inflexible, exist in many contexts for the person, and lead to distress or impairment.


Understanding personality disorders is crucial for the individuals directly affected by these conditions, as well as their families, friends, and colleagues. These disorders can profoundly impact interpersonal relationships, social interactions, and professional life. By gaining insight into the nature of personality disorders, those within the support network of affected individuals can develop more effective communication strategies, foster empathy, and provide better support. This knowledge is also key in breaking down the stigma often associated with these mental health conditions, thereby promoting a more understanding and inclusive society.

Diagnostic Criteria and Clusters

The diagnosis of personality disorders requires a comprehensive evaluation by healthcare professionals. This process includes a detailed clinical interview and often the use of structured or semi-structured diagnostic tools. 

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The criteria outlined in DSM 5 are commonly used as a benchmark for diagnosis. These criteria emphasize specific long-term patterns of behavior and inner experiences that differ significantly from cultural expectations, are pervasive and inflexible, often start in adolescence or early adulthood, and lead to significant distress or impairment.

Healthcare professionals, including psychiatrists, psychologists, and clinical social workers, play a pivotal role in managing personality disorders. Their expertise is crucial in diagnosing conditions and providing comprehensive treatment plans. These plans often include psychotherapy, medication management, and ongoing support that is tailored to each individual's needs.

Personality disorders are grouped into three clusters based on similar characteristics and symptoms:

  • Cluster A: Often described as the "odd, eccentric" cluster, it includes Paranoid, Schizoid, and Schizotypal Personality Disorders. Individuals in this cluster are often perceived as odd or eccentric due to their unusual behavior and thought patterns.
  • Cluster B: This cluster is characterized by dramatic, overly emotional, or unpredictable thinking or behavior. It includes Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders. These disorders are often associated with intense emotional experiences and impulsive actions.
  • Cluster C: Known as the "anxious, fearful" cluster, it encompasses Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders. Individuals with these disorders often display anxious and fearful behavior and thinking patterns.

By understanding these clusters, healthcare professionals can better categorize and treat the wide range of personality disorders.

Dr. Brindusa Vanta, MD, says, ”Distorted thought patterns associated with personality disorders can significantly interfere with various aspects of life, affecting relationships, self-perception, and decision-making. Seeking treatment is very important, as it provides an opportunity to challenge these distortions, cultivate healthier behaviors, and boost overall well-being.”

Examples of Personality Disorders

Considering examples of specific personality disorders helps illustrate these dysfunctional thinking patterns and the types of interpersonal problems that are created as a result.

Paranoid Personality Disorder

Someone with Paranoid Personality Disorders exhibits suspicious thinking and has difficulty trusting other people. They may misinterpret what other people say or do as intentional attempts to attack them, hurt them, or take advantage of them. In turn, they end up holding grudges and may act in ways that are overly defensive, hostile, or even aggressive. This guardedness, defensiveness, and hostility is unpleasant for people in the individual's life and makes close relationships nearly impossible.

Avoidant Personality Disorder

Someone with an Avoidant Personality Disorder tends to think they are completely flawed and inferior to others. They may be unable to recognize their good and bad qualities. Their extremely negative self-image convinces them that other people see them in the same way—as flawed and inferior.

They often believe no one will like them and expect others to ridicule them. This leads them to avoid social situations because they anticipate these encounters will be painful and unpleasant. Professionally, they might avoid social situations or public speaking and miss out on professional and networking opportunities that usually benefit career development and advancement.

Schizotypal Personality Disorder

Someone with Schizotypal Personality Disorders exhibits odd beliefs. They might be extremely superstitious and have unusual beliefs in magic or the supernatural. Other people often find such a person odd and eccentric and may feel uncomfortable being around them. People with Schizotypal Personality Disorder sense they are different from others and are often aware that other people seem uncomfortable around them. As a result, they have chronic feelings of not "fitting in."

Narcissistic Personality Disorder

Someone with Narcissistic Personality Disorder exhibits distorted thinking that involves moving between over-idealizing themselves and completely devaluing themselves. They tend to overestimate the importance or significance of their abilities and talents, frequently experiencing fantasies of having unlimited power, success, or special talents. These over-idealized beliefs about themselves can cause them to behave in ways that are arrogant, ruthless, and entitled.  

Such behavior frequently causes conflict with others. For example, a person with Narcissistic Personality Disorder may ignore the social custom of waiting in line to purchase a ticket. Instead, they might march to the front of the line, believing they are more important than the other people and entitled to special treatment.  

Eventually, a person with this disorder is likely to run into a situation in which they realize they have some normal human limitations. The sudden realization of ordinary human limitations can lead them to completely debase themselves, shifting from the over-idealized fantasy of unlimited success and special powers to a devastating and paralyzing sense of complete worthlessness, shame, and defeat.

Borderline Personality Disorder

For someone with Borderline Personality Disorder, things tend to be "all or nothing," "black or white," or "all good or all bad." This way of viewing the world creates emotional suffering and is particularly devastating in relationships. Other people are seen as either "all good," meaning they are perfectly loving and available to meet the other person's needs at all times, or "all bad," meaning they're malicious and hateful. 

A person with Borderline Personality Disorder can experience fast viewpoint changes. In just a few seconds, their opinion might swing from "that person is completely wonderful" to "that person is horrible." 

This pattern of interpreting relationships creates distress and provokes an intense emotional reaction in people who think like this. Subsequently, their partners may be baffled and distressed by these extreme ways of thinking. In such cases, conflict is likely to be frequent.

Dr. Vanta, MD, says, “Historically deemed challenging, Borderline Personality Disorder treatment shows promise with dialectical behavior therapy and cognitive therapy. Research suggests these approaches can make a difference and improve the condition.”

Distorted Thinking Patterns 

It's important to note that even healthy, well-adjusted people without a personality disorder can also occasionally fall prey to some of the distorted thinking described above. Distorted thinking is common when people are feeling very distressed, depressed, or anxious. Personality disorders are a variant form of normal, healthy personalities—so the difference is in the frequency, degree, and persistence of the distortion.

For people with personality disorders, the degree of distortion is more extreme and occurs with greater frequency than for those without a personality disorder. Additionally, people with personality disorders find it much more difficult to become aware of and challenge their distorted thinking. Personality disorders significantly affect an individual's relationships with family and others, social activities, work or school performance, and overall quality of life.

Distorted thinking patterns influence emotions, thoughts, and behaviors. It's important to note that to qualify for a personality disorder diagnosis, an individual must exhibit persistent, inflexible, pervasive patterns of maladaptive traits involving two or more of the seven characteristics outlined in the DSM 5. Alongside distorted thinking patterns, there must be the presence of additional traits or behaviors, such as patterns of problematic emotional responses.

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