Personality Disorders

Cluster A (Atypical/odd/eccentric)

Paranoid, schizoid, schizotypal

Cluster B (Big personality/dramatic/emotional/erratic)

Antisocial, borderline, histrionic, narcissistic.

Cluster C (Coward/anxious/fearful)

Avoidant, dependent, obsessive-compulsive personality disorder.

Borderline personality disorder

Unstable relationships, fear of abandonment, self-harm, impulsivity, splitting, emotional dysregulation. Best intervention: DBT.

OT: consistent boundaries, structure, and skills practice.

• focus on the here and now

• provide psychoeducational support and reality testing using a cognitive behavioral approach

• provide calmness and consistency, avoid power struggles

OT approach with borderline personality disorder

Be consistent, set clear limits, keep the same expectations from every staff member, and avoid taking sides. Splitting is a common trap.

Antisocial personality disorder

Disregard for others’ rights, manipulation, lack of remorse. Use clear firm limits and consistent consequences.

Narcissistic personality disorder

Grandiosity, need for admiration, and lack of empathy. Use a matter-of-fact approach and avoid power struggles.

Histrionic personality disorder

Attention seeking, dramatic emotion, and shallow emotional expression.

Obsessive-compulsive personality disorder

Perfectionism, rigidity, control. Different from OCD because there are no true obsessions or compulsions, and the person sees the behavior as correct.

Avoidant personality disorder

Social inhibition, feelings of inadequacy, and hypersensitivity to criticism.

Dependent personality disorder

Excessive need to be cared for, difficulty making decisions, and fear of separation. Build independence through graded decision-making tasks.