People with personality disorders tend to exhibit distortions in the way they interpret and think about the world, and in the way they think about themselves. Not surprisingly, people with personality disorders think about things quite differently than people with healthy personalities. They may have thinking patterns that are very extreme and somewhat distorted. These dysfunctional patterns are most evident when someone attempts to understand their interactions with others. Examples of these problematic interpretations of the self-in-the-world include:

1) extreme black-or-white thinking patterns;

2) patterns of idealizing then devaluing other people or themselves;

3) patterns of distrustful, suspicious thoughts;

4) patterns that frequently include unusual or odd beliefs that are contrary to cultural standards; or,

5) patterns of thoughts that include perceptual distortions and bodily illusions. Let's look at these five thought patterns a little more closely:

Black-or-white thinking

Black-or-white thinking can also be referred to as all-or-nothing thinking. Thoughts become polarized as either-or; "always this" or "never that." Some examples of this type of thinking might be: "I never get anything right!" or, "If I am not brilliant, then I must stupid" or, "A woman can't have a career and be a stay-home mom" or, "If he does not love me, then he must hate me" or, "If I can't do this perfectly, then I won't do it at all!" You can see these kinds of thoughts leave no room for shades of gray and do not allow for compromise, or a consideration of multiple alternatives or possibilities. For instance, the conclusion, "If I am right, then you must be wrong" does not include the possibility that we could both be right, or both be wrong.

Vacillation between idealization and devaluation

A specific type of black-or-white thinking is the tendency to vacillate between over-idealizing, then completely devaluing, other people or oneself. This thinking pattern can be summarized by the statement, "If you are not entirely good, then you must be entirely bad. Most healthy people recognize that we each have some good, and some bad qualities; i.e., we behave well sometimes, but certainly not all the time. However, with a vacillating pattern of extreme thinking, people are seen as either all good, or all bad, but not both.

This distorted thinking pattern can be played out when a client begins to work with a new therapist. Initially, the client sees the therapist is seen as the perfect human being. The therapist is viewed as someone who has all the answers to all their problems, who knows everything, never makes any mistakes, and who will never disappoint or frustrate them. However,the moment there is the slightest indication that the therapist has ordinary human limitations, this idealization quickly becomes disgust or even rage. Sometimes therapists get sick and must miss therapy appointments. Sometimes there is no immediate solution to the client's problems. Therapists often must say or do things that frustrate clients. When these things occur, the all-good therapist suddenly becomes a completely horrible, incompetent, and ignorant person in their client's eyes.

This pattern can also be played out in friendships, romantic relationships, or family relationships. In particular, this pattern is quite common during the initial stages of romantic relationships. It is quite common to idealize a new romantic partner. However, healthy adults gradually adopt of more realistic and balanced view of their partner. They come to accept their partner has both strengths and weaknesses. They realize their partner behaves well most of the time, but not always. However, if a person personality disorder has this thinking pattern, they do not easily see these shades of grey. Instead, the moment their partner does something that frustrates, disappoints, or annoys them, their partner suddenly becomes someone who is "all bad" rather than someone who has momentarily engaged in a "bad" behavior. This type of thinking creates a great deal of grief and conflict for everyone. Understandably, partners of such folks are often baffled by this type of thinking. They have difficulty understanding why a single "bad" action suddenly defines the entirety of who they are,

Suspiciousness and distrust

A third pattern of distorted thinking is a heightened level of suspiciousness. This includes being distrustful of others, and believing that most other people are dishonest and potentially harmful. With this pattern of thinking, other people's actions and motivations are nearly always questioned and considered suspect. A person with this pattern of thinking will interpret even the kindest gestures in a negative way. For example, a simple gift might be interpreted as a disguised attempt to manipulate them. It is very easy to imagine that suspiciousness and distrust can cause tremendous distress, and certainly interferes with the formation healthy and enjoyable relationships with others.

Odd or unusual beliefs

Some people with personality disorders have some very odd beliefs including superstitions, unusual religious beliefs, and worldviews that are extremely out of tune with a person's culture, religion, and environment. This is not to say that everyone who has religious beliefs or superstitions has a personality disorder. It is very important to emphasize that the beliefs have to be extreme and markedly different from the person's cultural norms and expectations. By way of example, let's consider a Christian man who grew up in the United States. Assume he is still living in the USA and he thinks that carrying around a slice of cheddar cheese in his pocket all day will help him get to heaven after death. Many people in the Judeo-Christian culture of the USA believe in heaven and some sort of afterlife. However, the belief that cheese has something to do with heaven and an after-life is certainly uncommon. People from this culture would consider the notion that cheese gets you into heaven, an unusual and odd belief.

Perceptual distortions

Another type of distorted thinking is perceptual distortion. Perceptual distortions are particularly common in people with Schizotypal Personality Disorder. Examples of perceptual distortions are things such as seeing another person's face morph right before your eyes, but then as you look closer, you realize the face is actually still the same. Another example would be feeling as though someone is calling your name, but when you turn around, no one is there. These perceptual distortions are typically fleeting and the person who experiences them is usually able to distinguish these experiences from reality. In other words, they realize these distortions do not represent a factual event. This is quite different from visual or auditory hallucinations that are indistinguishable from reality by the person who experiences them.