The DSM-5 categorizes personality disorders into 3 main clusters:

• Cluster A (odd, bizarre, eccentric) – Paranoid, Schizoid and Schizotypal
• Cluster B (dramatic, erratic, emotional) – Antisocial, Borderline, Histrionic and Narcissistic
• Cluster C (anxious, fearful) – Avoidant, Dependent and Obsessive-compulsive

For individuals diagnosed under Cluster A, art therapy is typically best delivered in group sessions and utilized as a process of encouraging social inclusion. In this case, art therapy would prove beneficial in a mental health unit setting.

Art therapy is beneficial for the B & C Cluster personality disorders in private therapy settings. Personality disorders under Cluster B are often considered resistant to therapeutic treatment as the behavioural traits are considered an inherent part of the individual’s personality. It’s possible for someone in the Cluster B category to have insight into the dysfunction of their behaviour and attempt to find ways to commit to treatment. Typically individuals who are diagnosed with a personality disorder believe their daily behaviour is ‘normal’ and may only seek treatment at times of heightened stress. This can often mean there are long breaks between therapy sessions. It can also mean that the session may focus specifically on a high-stress situation rather than focus on long-term behavioural insight and change.

We can all exhibit behaviours that would fall under all clusters, however, these behaviours are typically short-lived and may be in response to a specific situation that is eventually resolved. Individuals who are diagnosed with a personality disorder often exhibit these behaviours over a longer period of time. The behaviours are considered enduring patterns and typically have a significant negative effect on the daily functioning of the individual in terms of social, interpersonal and work situations.

For Cluster B disorders that exhibit overly emotional behaviours, art therapy can present as an opportunity to disengage dramatic and emotional verbal conversations and instead engage in mindful, mood-regulating activities that focus on creating focused art. Artistic expression can be cathartic and provide valuable insight through personal reflection. This process is integral in helping an individual with a personality disorder to focus on personal behaviours instead of focusing on external influences that distract the individual from reflecting on personal behaviour.

For Cluster C disorders, art therapy enables the individual to explore internal conflicts that stem from fear based thought patterns. Individuals diagnosed with Cluster C personality disorders may be reluctant to discuss obsessive and compulsive thoughts or behaviours. Art therapy helps circumvent these feelings of embarrassment by allowing free expression through less confronting non-verbal techniques.

Self-expression through art therapy techniques can provide the client with a process of exploring identity and also help formulate a positive self-image through reflection and insight gained from this self-expression. This insight can have a positive impact on the ability of the client to self-regulate emotional distress.

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