Different Personality Disorders Cause Different Types of Harm

Many of my clients seek therapy due to chronic relationship problems—whether it be with their parents, co-workers, family members, and/or partners.

“They're driving me crazy!”

“Is it them or me?"

“Am I doing something wrong?”

While these are good questions to ask when evaluating relationships, what my clients sometimes don’t realize is that they may be dealing with people with undiagnosed mental health issues, sometimes even personality disorders. When this is the case, relationship strain is usually chronic and difficult to resolve.

Mature, emotionally healthy people generally take responsibility for their behavior and try to repair ruptures in their relationships. However, this is rarely the case for those with personality disorders, who are much more likely to be emotionally immature. Due to inherent limitations in their coping skills and personality, relationship repair and close relationships are often extremely challenging if not altogether impossible.

While other mental health diagnoses can overlap with emotional immaturity—and many people who are emotionally immature or frustrating to deal with have no mental health diagnoses at all—for the purposes of this article, my focus will be on people who likely have a clinical personality disturbance, which, while still generally rare, may be more common in the population than previously thought (Lester & Godwin, 2021).

Someone with a personality disorder who is emotionally immature is likely to blame others for their poor behavior instead of taking responsibility, refuse to apologize, or struggle to see another's point of view because of their limited self-awareness and tendency to be self-absorbed. Over time, dealing with such people can be emotionally taxing and detrimental to your mental health because of the frustration and pain they cause.

Conflict, emotional drama, and erratic and unpredictable behavior are common in these relationships. However, some high-conflict personalities can cause harm in other ways that may not be as combative.

Some types of personality disorders, for example, may not lead to overt aggression or over-the-top emotional expression. Instead, the person may withdraw, avoid, or dismiss their loved ones' feelings and reality—a tendency that, while often less obvious, can be just as hurtful in relationships as outright aggression.

When there are problems to work out in a relationship, such individuals may quickly resort to cutting others off—i.e. “I am not speaking to you for a long time”—or ghost them completely. They may return to the relationship when it suits them or when they feel like it. This typically causes more problems and long-term damage to the relationship.

Personality-Disordered Relationships Aren't Always Narcissistic

In our culture, the ever-present term “narcissist” is often misused—including, often, by my therapy clients trying to understand the frustrating people in their lives.

For example, let's say a client has a parent who seems to behave in a self-absorbed manner and causes frequent conflict. They tend to do this by behaving coldly and indifferently toward others, avoiding contact whenever possible, sabotaging the client's attempts at a close relationship, or refusing to address interpersonal issues.

The client may tell me their parent is a "narcissist." But the evidence suggests otherwise. I would likely argue instead that, if a personality disorder is indeed present, it is more likely to be a schizoid or avoidant personality disorder (Cluster A or C). Such relationship problems may not be due to manipulation or aggression but instead could be the result of being too disinterested in personal relationships (schizoid personality disorder) or extreme social anxiety and fear of conflict (avoidant personality disorder).

Different Personality Disorders and the Harm They Can Cause

The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5 TR) outlines 10 types of personality disorders. Common components of all the disorders listed below are (a) the general inability to be genuinely emotionally available and (b) a limited capability for true interpersonal reciprocity (Gibson, 2019). While no one should ever diagnose someone unless they are a professional evaluating them, it can be helpful to know the common interactional patterns of people with personality disorders, so you know how to recognize and approach these relationships differently—if you choose to approach them at all.

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Cluster A: Paranoid, Schizoid, Schizotypal Personality Disorders

How they present: The hallmark of this cluster of personality disorders is eccentric and odd thinking or behavior. People with these disorders may be paranoid, distant, cold, or behave in strange or off-putting ways. For example, someone with schizoid personality disorder may not engage in almost any type of conflict—or indeed, much social interaction at all—because they tend to lack interest in social interaction and have limited capacity for emotional expression.

Possible relational harm: Harm and conflict may be caused by avoidance and long-term emotional neglectful behavior. Those with schizoid personality disorder, for example, typically have no desire to have close relationships. A parent with this disorder might therefore cause tension, misunderstanding, and harm through their apparent disinterest in an emotional connection.

The parent may, for example, not check in with their adult child on a regular basis, or fail to reach out after major adverse life events such as surgeries, natural disasters, deaths, etc. As they have limited relationship repair skills (or interest in maintaining relationships in the first place), they may choose to withdraw or disappear after a disagreement, whether periodically or permanently. Over time, this may irrevocably rupture a relationship.

Cluster B: Antisocial, Borderline, Histrionic, Narcissistic Personality Disorders

How they present: This cluster gets the most headlines because the characteristic behavior is overly dramatic, emotional, and erratic and is known for its ability to cause serious psychological and physical harm. Such individuals frequently violate the boundaries of others.

Possible relational harm: Harm and conflict are usually caused by drama, over-emotional states, manipulativeness, and deceit. One example would be a romantic partner who consistently cheats, lies, steals, or engages in other patterns of behavior that disregard the feelings and rights of others. Another would be a family member who lies on a near-constant basis (usually due to their own distorted perception of reality). They may attempt to turn family members against one another through smear campaigns or try to ruin someone's reputation or career.

Cluster C: Avoidant, Dependent, Obsessive-Compulsive Personality Disorder

How they present: This cluster is characterized by anxious and fearful thinking/behavior.

Possible relational harm: Those with avoidant personality disorder, for example, may cause relational harm through extreme avoidance, hypersensitivity, and social anxiety. They may deal with conflict by distancing themselves and refusing to engage, which tends to exacerbate relationship tension.

Conversely, being overly passive and needy can also cause harm, as seen in dependent personality disorder. A parent with this disorder, for example, may tolerate severe abuse or mistreatment from the other parent because they fear being alone—and, as a result, they may turn a blind eye to the harm it caused their children, or attempt to reconstruct reality with statements like “it really wasn’t that bad” and “just don’t upset your father and it won’t happen.”

Similarly, they might ignore emotional violence between siblings or not stand up for or protect a bullied child. This leaves the child to question their own reality; they may come to believe that their feelings don't matter or resort to fending for themselves in violent family interactions.

How to Manage Personality-Disordered Relationships

Experts in the field of personality disturbance argue that it is vital to understand different personality disorder traits in order to recognize and approach relationships with these individuals in more effective, self-protective ways (Gibson, 2019, Lester, 2021; Godwin, 2021, Simon, 2011)—by, for example, recognizing and accepting that communication may be difficult if not impossible with a personality-disordered, emotionally immature parent. "Fixing" the relationship may be an unrealistic expectation; often, it's better to manage it, or, if possible, simply disengage.

Part 2 of this series will explore how individuals can heal from relational harm caused, often unintentionally, by other people's personality limitations.

A version of this article also appears on www.drtracyhutchinson.com