7 Surprisingly Common Personality Disorders That Are Hardest To Spot
Out of the ten personality disorders recognized in the DSM-5, some may seem more obvious and easy to diagnose, while other signs of personality disorders can be more difficult to spot. The latter is usually the case when the symptoms of a personality disorder are similar to those of other mental health issues — such as anxiety or depression. But this can also happen when the milder symptoms of the disorder "pass" as completely typical.
That tends to happen when the personality disorder makes someone seem shy, or depressed, or obsessive — since these are feelings we all experience, to one degree or another. With personality disorders, however, these symptoms are seen in the extreme, and end up being incredibly disruptive to daily life.
They are possible to treat, though, once identified. "If the person is open to the possibility of change, then consistent and long-term psychotherapy can help [them] recognize patterns of interacting and reacting, gain insight into the thought process behind those behaviors and defense mechanisms, increase mindfulness, and practice alternative coping skills to be able to shift those patterns and make a more positive impact that will be more relatable ... to other people," Tiffany Towers, PsyD, a Beverly Hills-based psychologist, tells Bustle. Here are the seven personality disorders experts say can slip under the radar, or blend in with similar disorders, due to the very nature of their symptoms.
1. Avoidant Personality Disorder
"The most difficult personality disorder to identify in others, and in oneself, is Avoidant Personality Disorder (APD)," clinical psychologist Forrest Talley tells Bustle. He says this is a disorder marked by avoidance of social activities due to fear of rejection, as well as pronounced anxiety around the issue of being embarrassed through interaction with others, a lack of friendships, shyness, and a sense of intense loneliness.
The problem is, these symptoms are similar to emotions almost everyone feels and experiences to one degree or another, so it can make the disorder harder to spot. "Keep in mind that every personality disorder occurs along a continuum," Talley says. "They are simply an extreme example of a personality type, which may be perfectly normal in its mild form. As the features of that particular personality type are accentuated, however, it becomes unhealthy and is then labeled as a 'Personality Disorder.'"
It can make pretty much every personality disorder difficult to identify, but "APD is particularly difficult because so many people tend to be introverts," he says. "Consequently it is difficult to distinguish someone who is simply an introvert from one who fits the diagnosis of APD." The main difference, according to Talley, is that someone with APD will likely want to have close relationships, but will not act to try and make friendships, and this can cause them pain.
If APD is diagnosed, keep in mind that it is possible to move past the feelings of loneliness and shyness. As Talley says, "There are effective ways to help such individuals break out of their self-imposed prisons: social skills training, coping skills to deal with the anxiety, group therapy to expose them to safe social interaction, and in some cases a short-term course of medication to take the edge off of their anxiety."
2. Obsessive Compulsive Personality Disorder
Obsessive compulsive personality disorder (OCPD) is said to affect one in 100 people in the US, but it can still be difficult to diagnose — especially since many of us may have some obsessive tendencies.
It's also fairly common to brush off OCPD sufferers as hard workers, since symptoms can affect them on the job. "They typically are seen as being devoted to careers or 'getting things right' but in actuality they struggle to get things 'perfect' or may be reluctant to let other people do things because they wont do it 'right,'" Dr. Kevin Gilliland, PsyD, executive director of Innovation360, tells Bustle.
And therein lies the difference between someone who simply wants to do a task well, or is a bit particular about things, and someone who may have a personality disorder. According to Psychology Today, OCDP is marked by "perfectionism so extreme that it prevents a task from being completed; and devotion to work and productivity at the expense of leisure and relationships." If you or someone you know seems to be suffering from OCPD, seeking help from a therapist can better assist in managing these symptoms.
3. Paranoid Personality Disorder
Another personality disorder that can fly under the radar is Paranoid Personality Disorder (PPD). Having some skepticism of the world is common, "until you see it day in and day out and across relationships where suspicion isn’t warranted," Dr. Gilliland says.
Studies estimate that PPD affects between 2.3 percent and 4.4 percent of the general population, according to the Cleveland Clinic. But it's another one that's easy to sweep under the rug. It's common to have a healthy amount of doubts when it comes to strangers, or certain situations when we have to put ourselves on the line.
That's why, for paranoid thinking to qualify as a personality disorder, it has to be extreme and ongoing. PPD is marked by intense symptoms such as a pervasive distrust of others — even friends and family — as well as a guarded, suspicious nature, and the desire to constantly hunt for clues to validate these fears, according to Psychology Today. If someone you know is showing these symptoms, therapy may be the best course of action.
4. Narcissistic Personality Disorder
"Narcissistic personality disorder (NPD) is often hard to spot as moderate degrees of narcissism can be seen as normal in our society," Thomas Franklin, MD, medical director for The Retreat at Sheppard Pratt Health System, tells Bustle. "But these people have great difficulty in their relationships and often are significantly impaired."
It's not just about posting photos of themselves online, or talking about themselves too much. As Dr. Gilliland says, "Individuals with a narcissistic personality disorder are oxygen thieves — they walk into a room and take all the space with their high opinion of themselves and low opinion of others. They will burden others with their ideas of wild success and in a not-so-subtle way, expect you to admire them." But again, since many people can act this way from time to time, a true narcissistic personality disorder can easily go undiagnosed.
5. Dependent Personality Disorder
Dependent Personalty Disorder (DPD) can be covert, in that it's common — and totally healthy — to be at least a little bit dependent on others. "Societally, we seem to value a particular balance of mutual dependency/interdependency," Anthony P. DeMaria, PhD, a New York State-licensed clinical psychologist and psychotherapist, tells Bustle. "When an individual with dependent personality disorder feels their needs are being met, others would likely not notice the problem."
It's only when their needs aren't being met, that the disorder may become more obvious. As DeMaria says, "When the third party becomes unavailable, preoccupied, etc., then difficulties with balancing dependency and autonomy emerge. Potentially, this disorder could go unrevealed indefinitely if that individual’s dependency needs are not blocked in some way." So it may take the person with the disorder, and those around them, years to realize there's a problem — if they notice at all. But once they do, they should seek professional help to cope with these symptoms.
6. Antisocial Personality Disorder
Antisocial personality disorder (APD) falls somewhere in the middle, when it comes to whether or not others will pick up on it. "In many ways, this presentation may seem obvious: often, the antisocial individual will have a propensity towards conducting malicious acts without guilt or remorse," DeMaria says. "However, individuals with antisocial personality disorder can often be quite charming and manipulative. If we remember that personality ostensibly means the self, individuals with antisocial traits are likely more practiced at being manipulative than the average person is at spotting manipulation and false charm."
Because they're so nice, "this can make their personality pathology go unnoticed, and even — in some cases — appreciated," DeMaria says. Other symptoms of APD include a disregard for rules, irritability and aggression, impulsivity, a failure to learn from experience, and a lack of remorse, according to Psychology Today.
7. Schizoid Personality Disorder
"Schizoid Personality Disorder (SPD) is a very difficult disorder to spot because the characteristics are odd but not overly pronounced," Joshua Klapow, PhD, clinical psychologist and host of The Web Radio Show, tells Bustle. "Some of the symptoms or characteristics include: disliking close relationships and preferring solitary activities and doing things alone."
They also tend to have little interest in sex, and very few activities bring them pleasure, which is why SPD is "often mistaken for depression," Klapow says. "But the symptoms are not consistent with depression. The person is generally disengaged from activities in life but not completely. So they can appear odd, disconnected, and not engaged but without many overt symptoms. This makes it very hard to put a label or diagnosis."
When symptoms of a personality disorder mimic those of other disorders — such as depression — the person with the disorder may not realize they have it. And those around them might not catch on, either. It can also be tough to spot a personality disorder, since we can all be a bit lonely, or dependent.
That's why these are only considered a disorder when they're pervasive. "A personality disorder is a condition where the person's baseline traits, characteristics, and tendencies are disruptive to their functioning," Klapow says. "Most often the person has little awareness or insight because these are their core characteristics — they tend to see the problems as residing in others because they are simply being 'themselves.'"
But that's where awareness — and sometimes therapy and even medication — can come into play. "Awareness of the concrete behaviors that disrupt and disturb others is critical," Klapow says. From there, anyone with a personality disorder can work to reshape their actions and how they interact with others, so that they can experience less distress, and feel better.