When the world feels distant, unusual, and hard to read

We all have moments when we feel awkward, withdraw, become cautious, or misinterpret things. We can also notice others acting a bit unusual, distant, or occasionally overly suspicious in ways that don’t quite fit the situation, time to time. But for some people, this is not a temporary reflection of a mood; it becomes a stable, long-term way of perceiving the world, reading relationships, and approaching others. In moments like these, it might simply feel like part of they are, like a way their personality organizes itself. But when that pattern sticks around for years, becomes harder to shift, and starts shaping what they can or can’t do in their daily lives, that’s when we begin to move closer to what we call a personality disorder.

Personality disorder is defined as enduring patterns that differ clearly from the cultural context of the individual and that shape their thoughts, emotions, impulses, and interpersonal relationships over time. These patterns influence many areas, from how a person views themselves and their environment, to the intensity and variability of their emotions, to how they approach relationships and regulate their behavior (DSM-5-TR, 2022). Therefore, personality disorders represent a structure far broader than “does this symptom exist or not?” They reflect the overall organization of how a person relates to the world.

Within years, mental health professionals found a way to organize personality disorders like they do for other mental health issues. They divided them into different diagnoses and categorized them under three clusters, labeled A, B, and C. Cluster A involves personality patterns that many people perceive as “odd,” “socially distant,” or “hard to understand.” (Millon, 1996). In this therapy sketch, we will explore Cluster A personality disorder and examine how this cluster emerged and how it has taken shape over the years.

How did personality disorders become divided into clusters?

To understand why this kind of categorization was adopted, it’s helpful to look briefly at the history of the DSM. Even though you can easily access DSM criteria by searching for personality disorders, the formation of these criteria and their categorization into clusters were actually the result of decades of work and empirical research. So let’s take a brief trip back to the 1950s, to the moment when personality disorders first entered the DSM system (Coolidge et al. 1998).

Personality disorders first appeared in the DSM in 1952 under the term “Personality Pattern Disturbance.” They were divided into patterns such as “emotionally unstable personality,” “passive-aggressive personality,” “compulsive personality,” and “personality trait disturbance, others.” In other words, they were viewed more as deviations within personality patterns. Although this kind of categorization may feel less pathologizing than the current terminology, diagnostic systems were revised as the theoretical background of the time was insufficient (Coolidge et al. 1998).

In 1968, with DSM-II, the term “Personality Disorders” was officially adopted as we use it today. However, even in this version, most of the ten personality disorders we define today did not yet exist. Even diagnoses that are widely popular today, such as borderline and narcissistic personality disorder, have not been identified in the DSM-II version. At that time, personality disorders were still approached more broadly through a psychoanalytic lens, and therefore, the categories were quite expansive (Coolidge et al. 1998).

With the third update in 1980, measurable diagnostic criteria were introduced. This period also coincided with the gradual evolution of the psychoanalytic framework and the rise of behavioral and evidence-based approaches. So just as the 1980s were revolutionary for mood disorders, they were similarly transformative for personality disorders, because for the first time, DSM-III introduced tangible descriptions and diagnostic criteria. The number and type of symptoms required for a diagnosis were clearly defined during this period (Coolidge et al. 1998).

The division of personality disorders into three clusters, A, B, and C, was not a decision made at a desk; it emerged because the same three patterns repeatedly appeared across independent studies conducted by different researchers over many years. In the 1970s, Paul Tyrer ran factor analyses on the personality features of hundreds of patients. He found that the traits naturally grouped into three clusters: “odd–eccentric,” “dramatic–impulsive,” and “anxious–fearful.” Around the same time, John Gunderson and DSM committee member Robert Spitzer observed the same three groupings in clinical cases. Widiger and Trull later confirmed that these three clusters reappeared across nearly all datasets (Widiger & Trull, 2012). As a result, the DSM committee formalized these three groups. Thus, personality disorders were grouped into three clusters:

psychotic-like/odd–eccentric (A),
dramatic–impulsive (B),
anxious–fearful (C)

The ABC cluster system has mostly remained the same since the 1980s, but it’s not quite as strong as it used to be. The primary reason is that the DSM has always approached personality disorders, like all mental disorders, through a categorical lens (present/absent). Meanwhile, most research has relied on dimensional models that include anywhere between 3 and 16 personality factors (Coolidge et al. 1998). As mentioned in the previous therapy sketch, there are dozens of personality theories. The questionable relevance of these theories today and the system’s resemblance to an “all-or-nothing” cognitive distortion, with its present/absent structure, have drawn substantial criticism regarding reliability and validity, despite the classification remaining useful in some contexts.

What does Cluster A focus on?

Cluster A includes personality patterns that may appear “odd,” “distant,” or “hard to understand” to most people. Individuals in this group often struggle to get close to others; they may be overly suspicious, keep their emotional world private, or hold beliefs and perceptions that seem unusual to others. They do not experience complete detachment from reality (psychosis), but they may interpret reality from a different angle at times. Therefore, from the outside they may appear “distant,” “cold,” “closed off,” or “a bit unusual.” Cluster A includes three diagnostic groups: Paranoid, Schizoid, and Schizotypal personality disorders (DSM-5-TR, 2022). Without going into the DSM diagnostic criteria, we can summarize them as follows:

Paranoid: For these individuals, the world often feels like a place that must be observed carefully. They have a high tendency to search for hidden meanings behind others’ words or actions. They may struggle to fully trust others, even in close relationships. They may perceive criticism as a personal attack and question whether there is a hidden intention behind ordinary events. This caution can make them seem guarded, easily offended, sensitive, and sometimes tense. They may frequently doubt the loyalty and sincerity of others(Morrison, 2023).
Schizoid: Individuals with this personality disorder often prefer being alone, and this state does not feel uncomfortable to them. They do not have a strong need for social relationships; forming close friendships, sharing emotions, or engaging in intense social interaction does not feel natural. They show little outward emotional expression and may appear emotionally neutral toward both praise and criticism. They often live their daily lives at their own pace, in their own world, with a calm, introverted, and distant style (Morrison, 2023).
Schizotypal: Individuals with schizotypal disorder perceive the workings of the world in a way that is somewhat unique to them. This is less about “weirdness” and more about a tendency to make symbolic or intuitive connections between events. They might seek closeness with others, but fear of rejection, insecurity about their social skills, and a sense of being “misunderstood” can make them tense in relationships. Their conversation may feel slightly scattered or may follow an internal logic of its own, placing them in a cycle where they want to belong socially yet feel like an outsider (Morrison, 2023).

You might notice that the features described above are things we may all experience occasionally. We all withdraw at times, act cautiously, or struggle in social situations. What distinguishes individuals with Cluster A personality disorders is not merely the presence of these traits, but the fact that these patterns persist for many years, do not adapt to circumstances, and cause significant difficulties in social, occupational, or relational areas. The issue is not “Is this symptom present or not?” but rather how persistent, rigid, and life-limiting the pattern has become. For Cluster A, the common theme is odd and eccentric behaviors, as well as a tendency toward interpersonal detachment.

Odd and eccentric behaviors:

When we hear the terms “odd and eccentric,” we may think of momentary quirks during social situations, unusual reactions due to distraction, or temporary strangeness. But the DSM uses this term in a much more specific sense. It refers to a lasting way of organizing thought, perception, and social approach that differs from that of the general population. A person’s way of interpreting events often restructures how they experience reality. In paranoid structures, this appears as a tendency to find hidden messages or threats in neutral behaviors; in schizotypal structures, as forming symbolic or intuitive connections between events that seem unusual to others; and in schizoid structures, as experiencing social closeness and emotional sharing as unnecessary or foreign. In other words, “odd” here refers not to fleeting awkward behaviors, but to a fundamentally different way of understanding relationships, intentions, and social cues (Zandersen & Simonsen, 2021).

Interpersonal detachment:

Interpersonal detachment is another common theme of Cluster A personality disorders. It appears differently across the three patterns, though sharing a common core: close relationships may feel threatening, exhausting, or foreign. In paranoid structures, this distance emerges from distrust and suspicion about others’ intentions. In schizoid structures, it stems from a low need for emotional closeness and a preference for an inner, solitary world. In schizotypal structures, distance arises from wanting closeness but struggling due to fragile self-perception, uncertainty about social skills, and difficulties reading social cues. Therefore, interpersonal detachment in Cluster A is not simply “not liking people” or “being cold”; it is a chronic social distance that emerges from fundamental differences in perception of social interaction, emotional closeness, and trust (Wilson et al., 2017).

How are they distinguished?

Odd–eccentric behavior patterns and significant social–interpersonal detachment do not divide neatly, which makes distinguishing paranoid, schizoid, and schizotypal traits challenging in practice. Their cognitive style, ways of interpreting social cues, and cautious approach to relationships overlap significantly (Esterberg & Compton, 2010; Widiger & Trull, 2012). One person may exhibit varying degrees of paranoid suspiciousness, schizotypal unusual cognitive connections, and schizoid social withdrawal at the same time. Because of this shared foundation, it is not always clear “where one disorder ends and another begins.” Many individuals present not with a single category, but with a blended combination of multiple Cluster A patterns. This is one of the main criticisms of the current diagnostic system (Widiger & Simonsen, 2005).

Why do they emerge?

Cluster A does not arise from a single cause; it reflects an interplay of genetic predisposition, early relational experiences, and differences in cognitive-perceptual processing. Research shows that these structures are biologically linked to the schizophrenia spectrum and that individuals may organize their perception of social cues, intention interpretation, and perceptual coherence differently from an early age (Siever & Davis, 2004). Childhood experiences marked by inconsistent, threatening, or untrustworthy relational environments further reinforce caution, distance, and a tendency to turn inward. Over time, these features solidify into rigid, enduring personality patterns; the person comes to perceive the social world through a lens that is more cautious, more distant, or more intuitive than that of the general population (Zandersen & Simonsen, 2021).

What can be done?

Cluster A personality disorders can create genuinely challenging experiences within a person’s internal world and relationships, as processes related to perception, trust, and closeness often happen outside of their control. Professional support can help individuals understand how they interpret the world, recalibrate the distance or caution they feel in relationships, and build more sustainable social experiences(Merck Manual, 2023). Professional mental health support can foster flexibility and facilitate the development of alternative ways of relating that feel safer in daily life (Oldham, 2011).

Takeaways:

Personality disorder involves enduring patterns that differ from cultural norms, influencing thoughts, emotions, impulses, and relationships over time.
These patterns affect self-perception, emotions, relationships, and behavior regulation.
Within years, mental health professionals categorized personality disorders into diagnoses under three clusters: A, B, and C.
Cluster A involves personality patterns that many people perceive as “odd,” “socially distant,” or “hard to understand.”
Cluster A includes three diagnostic groups: Paranoid, Schizoid, and Schizotypal personality disorders. Common themes include odd–eccentric behavior patterns and significant social–interpersonal detachment
Cluster A does not arise from a single cause; it reflects an interplay of genetic predisposition, early relational experiences, and differences in cognitive-perceptual processing.
Professional support can help individuals understand how they interpret the world, recalibrate the distance or caution they feel in relationships, and build more sustainable social experiences.

References:

Coolidge FL, Segal DL. Evolution of personality disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Clin Psychol Rev. 1998 Aug;18(5):585-99. doi: 10.1016/s0272-7358(98)00002-6. PMID: 9740979.
Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Esterberg, M., & Compton, M. (2010). Cluster A personality disorders. Current Psychiatry Reports, 12(1), 50–59.
Gunderson, J. G. (1979). Defining borderline personality disorder. Current Psychiatry, 38(3), 1–11.
Livesley, W. J. (2001). Handbook of Personality Disorders: Theory, Research, and Treatment. Guilford Press.
Merck Manual Professional Edition. (2023). Overview of Personality Disorders.
Millon, T. (1996). Disorders of Personality: DSM–IV and Beyond (2nd ed.). Wiley.
Millon, T. (2011). Personality Disorders in Modern Life (2nd ed.). Wiley.
Morrison, J. (2023). DSM-5-TR® Made Easy: The Clinician’s Guide to Diagnosis. Guilford Publications.
Oltmanns, T. F., & Balsis, S. (1998). The Evolution of Personality Disorders. Aging and Mental Health Lab, University of Colorado.
Oldham, J. (2011). Personality Disorders. American Family Physician, 84(11), 1253–1260.
Siever, L. J., & Davis, K. L. (2004). A psychobiological perspective on personality disorders. American Journal of Psychiatry, 161(3), 398–406.
Spitzer, R. L., Endicott, J., & Gibbon, M. (1979). A comparative study of three structured diagnostic interviews for DSM. Archives of General Psychiatry, 36(7), 775–781.
Tyrer, P. (1988). Personality Disorders. Wright/Butterworth.
Zandersen, M., & Simonsen, E. (2021). A Personality Disorders: Schizotypal, Schizoid, and Paranoid Personality Disorders in Childhood and Adolescence. NCBI Bookshelf.
Widiger, T. A., & Simonsen, E. (2005). Alternative dimensional models of personality disorder. International Review of Psychiatry, 17(1), 5–13.
Widiger, T. A., & Trull, T. (2012). Personality disorders and the Five-Factor Model. Journal of Personality, 60(2), 251–275.
Wilson, S., Stroud, C. B., & Durbin, C. E. (2017). Interpersonal dysfunction in personality disorders: A meta-analytic review. Psychological bulletin, 143(7), 677.

Book Now! Find a Specialist!

At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance, and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy.

Whether you’re seeking guidance on a specific issue or need help navigating difficult emotions, we’re ready to assist you every step of the way.

Contact us today to learn more about our services and schedule a session with our mental health professionals to begin your healing journey. To get started with therapy, visit our booking page.

First, decide if you’ll be paying out-of-pocket or using insurance. If you’re a self-pay client, you can book directly through the “Book Now” page or fill out the “Self-Pay/Out-of-network Inquiry Form.” If you’re using insurance, fill out the “Insurance Verification Form” to receive details about your costs and availability. Please let us know your preferred therapist. If your preferred therapist isn’t available, you can join the waitlist by emailing us. Once your appointment is confirmed, you’ll receive intake documents to complete before your first session.

This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.