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Cluster‌ ‌B‌ ‌Personality Disorders

Cluster B personality disorders involve unpredictable, inappropriate, overly dramatic & emotional thoughts and behaviors. It involves antisocial personality disorder, borderline personality disorder, histrionic personality disorder & narcissistic personality disorder.


What Are Cluster B Personality Disorders?

Cluster B disorders refers to a classification of personality disorders as categorized by American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). This is done as these personality disorders are very rare for a single and separate diagnosis. Moreover, patients in this classification of personalities often exhibit overlapping and similar symptoms. Individuals with such types of personalities tend to behave in an overly erratic and dramatic manner. They also tend to be unpredictable with a lack of or no emotional regulation. These groups of disorders affect the sufferer’s thoughts, behaviors, social interactions, relationships, education, career and personal lives. “Cluster B disorders are characterized by problems with emotion regulation, impulsivity and interpersonal conflicts,” explains a 2018 study 1 .

Personality disorders are psychological conditions that result in unhealthy thought, emotion and behavior patterns and affect the individual’s ability to relate to others. There are a total of 10 personality disorders that are categorized into cluster A, cluster B and cluster C disorders. Each of these categorizations includes separate and distinct traits and are classified based on the similarity of symptoms. Cluster B personality disorders includes the following four conditions –

  • Antisocial personality disorder (ASPD)
  • Borderline personality disorder (BPD)
  • Histrionic personality disorder (HPD)
  • Narcissistic personality disorder (NPD)

Each of these conditions have specific diagnostic criteria as well as treatment approaches. A 2018 study explains “Individuals with a Cluster B personality typically present as ‘dramatic, emotional, or erratic’, although some have argued that the predominant theme is a lack of empathy.”

Understanding Cluster B Personality Disorders

Personality is something that makes a person different from others. People’s personalities can be influenced by their environments, life situations, experiences, and inherited characters. Personality disorders (PDs) can be defined 2 as “the manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both.” Such disorders generally consist of long-term behavioral and inner experience patterns which differ from person to person. A 2011 study 3 suggested that personality disorder signs mostly occur during adolescence or later life and can cause extreme distress and impaired functioning, when left untreated.

People with cluster B personality disorders often find it difficult to regulate their emotions and struggle a lot to maintain their relationships. Other people may find their actions and behaviors dramatic, overly emotional, unpredictable, or erratic in social situations. A study 4 has estimated that the prevalence of this personality disorder is around 1.5%. This set of personality disorders can be long-lasting without proper treatment and may affect the following areas:

  • Way of thinking about oneself and others
  • Way of reacting emotionally
  • Way of maintaining relationships with others
  • Way of controlling one’s behavior and feelings

Signs And Symptoms

A personality disorder can be identified by diagnosing several factors, such as severity and frequency of the symptoms. A 2015 research paper 5 suggested that personality disorder symptoms mostly emerge during teens or adulthood when the personality further develops and matures. The symptoms and signs of cluster B personality disorders vary depending on the different traits. The following are some of the commonly observed symptoms of this disorder.

  • People with this disorder like to be the center of attention in social situations and often experience a strong need of getting praised.
  • The disorder prevents the sufferers from caring about the safety of themselves and others.
  • The sufferers tend to feel an extreme emptiness or struggle a lot to feel any emotions.
  • The symptoms always consist of a pattern of behaving in a very arrogant way.
  • The sufferers often like to exaggerate things and dramatically express their emotions.
  • This disorder develops an extreme fear of abandonment in the sufferers.
  • This disorder allows people to lie for unnecessary reasons and engage themselves in the practice of manipulation for their personal gain.
  • The sufferers tend to have frequent self-harm and suicidal thoughts.

Types Of Cluster B Personality Disorders

The four personality disorders categorized under Cluster B includes include the following:

1. Antisocial personality disorder

According to a recent 2020 study 6 , “Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitative, delinquent, and criminal behavior with no remorse.” It is a pattern of disregard for and violation of the physical and emotional rights of others. People with this disorder use deceitfulness and manipulation for their personal gain. This mental health condition is often referred to as sociopathy. But this term is not used clinically as it has no proper evidence. Both genetic and environmental factors are responsible for the development of antisocial personality disorder. A study 7 suggested that 1-4% of people tend to have antisocial personality disorder symptoms. This study explains that males are three to five times more likely to be diagnosed with this disorder.

Other features of this disorder include lack of empathy, irresponsibility, antisocial behaviors and actions, impulsiveness, irritableness, and intense aggression. People with this disorder tend to treat others very harshly and feel no remorse for any harm caused to others. A 2002 research paper 8 mentioned that these people are more likely to get addicted to drugs and alcohol.

2. Borderline personality disorder

It is marked by hypersensitivity towards rejection 9 that can disrupt the sufferer’s self-image, behavior, emotions and relationships. A 2016 study 10 states “The term ‘Borderline Personality Disorder’ (BPD) refers to a psychiatric syndrome that is characterized by emotion dysregulation, impulsivity, risk-taking behavior, irritability, feelings of emptiness, self-injury and fear of abandonment, as well as unstable interpersonal relationships.”

Borderline personality disorder refers to chronic instability in mood, behavior, and self-image that often leads to unstable relationships. People with this disorder tend to have a chronic fear of emptiness and abandonment. Studies 11 suggest that borderline personality disorder is associated with self-harm and suicidal tendencies. The sufferers may experience intense emotions and display impulsive behaviors. A 2007 study result showed that borderline personality disorder affects around 1.6% of the population. This study also estimated that women are twice as likely to develop symptoms than men. People with this disorder often engage in risky behaviors such as shopping sprees, abusing alcohol and drugs, binge eating, and promiscuous sex.

3. Histrionic personality disorder

Also known as dramatic personality disorder 12 , histrionic personality disorder can be characterized by self-centeredness, attention-seeking behavior, over-dramatic emotions, seductive and sexually provocative behaviors. But a person with this disorder may appear very charming, lively, and flirtatious in social interactions. A research paper 13 suggested that 2-3% of people experience the symptoms of histrionic personality disorder and females are more likely to be diagnosed with this disorder compared to males. The sufferers tend to change their behaviors and actions rapidly. They often try to use their physical appearance to regain the limelight. “People with histrionic personality disorder may feel underappreciated or disregarded when they are not the center of attention. They may be vibrant, enchanting, overly seductive, or inappropriately sexual with most of the people they meet, even when they are not sexually attracted to them,” according to research. Most of the symptoms occur later in life that leads to interfering with their personal and professional relationships.

4. Narcissistic personality disorder

According to a research paper 14 , narcissistic personality disorder affects 0.5-5% of the population, and males experience this disorder more often than females. People with this disorder have a strong need for admiration, act as superior and behave with grandiosity. They tend to exaggerate their achievements in front of others and have fantasies of unlimited success, power, and beauty. Studies 15 have found that “Individuals with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment.” The DSM-5 recognizes this disorder by certain key features such as a lack of empathy, a sense of entitlement, a need for extreme admiration, a feeling of envy and jealousy, arrogance, and condescending attitudes. A 2018 study 16 explained that a person with narcissistic personality disorder can cause significant distress to even the closed ones as they tend to have vulnerable self-esteem and are very sensitive to criticism.

Read More About Narcissism here

Causes Of Cluster B Personality Disorders

The exact causes of this disorder are not well-identified yet as it requires more research. Different genetics, environmental factors, and early life experiences influence the development of the symptoms in people. Personality disorders are considered to be extremely complicated like other mental health problems.

Some of the significant causes of developing cluster B disorder include:

1. Earlier life experiences

A 2016 study 17 mentioned a strong correlation between borderline personality disorder and childhood sexual trauma. It showed that earlier experiences of trauma, abuse, or unhealthy relationships play a key role in developing personality disorder symptoms during early or late adulthood. According to a 2001 research paper 18 , people who experienced verbal abuse by their parents are more likely to be diagnosed with borderline and narcissistic personality disorders.

2. Genetics

Researchers believe that genetics plays a pivotal role in personality disorders. A 2010 study 19 has found that having a family member with this personality disorder increases the risk of developing the symptoms in a person. Another research 20 has estimated the range of heritability in antisocial personality disorder as 38-69%.

3. Certain Human Brain Chemistry

A 2017 study 21 has explained certain similarities in the anatomic features of the brains of people with this disorder. It mentioned a few typical brain features that may affect the region called the amygdala. This part of the human brain is responsible for regulating emotions.

Diagnosis Of Cluster B Personality Disorders

A personality disorder cannot be diagnosed without the help of a trained mental health professional. Self-diagnosis may cause harm to oneself otherwise. Only a mental health specialist can accurately identify the symptoms based on reviews and characterization of signs. The diagnosis process of this specific personality disorder includes psychiatric evaluation, physical examinations, and in-depth interviews. Professionals often use the DSM-5 criteria 22 to identify the characteristics of the emerging symptoms of this disorder. The sufferer may need to attend a few sessions with a therapist before the official diagnosis. A doctor may conduct a psychological evaluation, conduct an interview and ask about the patient’s medical and family history. But one has to be very honest about all the answers. They can have a conversation with the sufferer’s family members, friends, or partner for a better understanding.

As it’s a part of the therapy sessions, the professional may ask the sufferers:

  • About their life experience
  • About their thought patterns
  • About their clinical history
  • About their moods and emotions
  • About their behaviors and way of responding to various situations.

The guide of DSM-5 mentions certain important criteria that the sufferer requires to meet. These relevant criteria include:

  • Symptoms first occurred during adulthood
  • Symptoms that lead to causing distress and problems in one’s well-being
  • Symptoms should be constant and stable for a minimum of one year
  • Symptoms that are not the result of another disorder or other stressful situations
  • Symptoms that are consistent across time, places, changes in circumstances

Treatments For Cluster B Personality Disorders

Treatments of this disorder include various methods and therapies to help manage the negative impacts such as anger, anxiety, depression, disruptive behaviors. This disorder consists of a variety of significant issues and is quite difficult to treat. The symptoms may continue to engender impairment with the sufferers and those around them even after little improvement. Hence, it is crucial that the patient cooperates with the doctor and follows the treatment plan properly.

The following are some of the treatments used by mental health professionals to treat this personality disorder.

1. Cognitive Behavioral Therapy (CBT)

This therapy is one of the most effective psychotherapy approaches to treat this disorder. It helps the sufferers to identify their thought patterns and behaviors. CBT allows them to develop practical ways to adjust and control the symptoms. Cognitive behavioral therapy 23 aims to solve the problems first and teaches the skills to reduce problematic thoughts and practices.

Read More About Cognitive Behavioral Therapy Here

2. Dialectical Behavioral Therapy (DBT)

This therapy mostly focuses on making the sufferers learn different new skills to make positive life changes. Dialectical behavioral therapy often involves a few group or individual sessions. A 2016 research paper 24 suggested that DBT is the most beneficial psychotherapy to treat borderline personality disorder.

3. Talking therapy

It is an essential part of the psychotherapy process. It helps the sufferers to express their previous experiences, problems, and emotions verbally to the mental health specialist. Talking therapy 25 is often proved to be very beneficial as most people express themselves without any hesitation knowing that the therapist will listen to them without judging.

4. Medications

There are no specific medicines available for this disorder. The mental health professionals may prescribe certain stabilizers, antidepressants, antipsychotics, and anti-anxiety medicines for the improvement of specific symptoms. These medications can help manage co-occurring problems, such as depression and anxiety. One should not consume drugs and alcohol while on medication as it may worsen the condition.

Coping With Cluster B Personality Disorder

People with this disorder can adapt some self-care strategies to manage the extreme impacts of the symptoms. Regular exercises, a healthy diet, meditation, and mindfulness practices can help to boost their mood and reduce frustration. Personality disorders are treatable but not curable. It is important to seek help at the correct time before the symptoms get deteriorated. Mild symptoms of these disorders may not be a matter of concern unless they begin to interfere with one’s life.

Supporting someone with this disorder can be challenging, but it is essential to encourage the sufferer for professional help. It has been observed that people with borderline 26 and narcissistic 27 personality disorder have a higher risk of committing suicide. Thus, it is important to observe the symptoms as well as help them to overcome this disorder.

Overcome Cluster B Personality Disorders

People with Cluster B personality disorders often experience difficulty in maintaining a healthy relationship with others. They mostly display over-dramatic and extreme emotions and impulsive behaviors. One can manage the negative impact of the occurring symptoms, but it is not completely curable. Certain symptoms of this disorder naturally decrease over time. Family and friends should be transparent, supportive, and non-judgmental towards the sufferers. There are various resources available online through which one can learn how to support people with this personality disorder.

References:
  1. Young, C., Habarth, J., Bongar, B., & Packman, W. (2018). Disorder in the Court: Cluster B Personality Disorders in United States Case Law. Psychiatry, psychology, and law : an interdisciplinary journal of the Australian and New Zealand Association of Psychiatry, Psychology and Law, 25(5), 706–723. https://doi.org/10.1080/13218719.2018.1474816 []
  2. Ekselius L. (2018). Personality disorder: a disease in disguise. Upsala journal of medical sciences, 123(4), 194–204. https://doi.org/10.1080/03009734.2018.1526235 []
  3. Oltmanns, T. F., & Balsis, S. (2011). Personality disorders in later life: questions about the measurement, course, and impact of disorders. Annual review of clinical psychology, 7, 321–349. https://doi.org/10.1146/annurev-clinpsy-090310-120435 []
  4. Fariba K, Gupta V, Kass E. Personality Disorder. [Updated 2021 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556058/ []
  5. Kongerslev, M. T., Chanen, A. M., & Simonsen, E. (2015). Personality disorder in childhood and adolescence comes of age: A review of the current evidence and prospects for future research. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 3(1), 31-48. https://doi.org/10.21307/sjcapp-2015-004 []
  6. Fisher, K. A., & Hany, M. (2020). Antisocial Personality Disorder. In StatPearls. StatPearls Publishing. []
  7. Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2020 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/ []
  8. Bahlmann, M., Preuss, U. W., & Soyka, M. (2002). Chronological relationship between antisocial personality disorder and alcohol dependence. European addiction research, 8(4), 195–200. https://doi.org/10.1159/000066132 []
  9. Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/ []
  10. Brüne M. (2016). Borderline Personality Disorder: Why ‘fast and furious’?. Evolution, medicine, and public health, 2016(1), 52–66. https://doi.org/10.1093/emph/eow002 []
  11. National Collaborating Centre for Mental Health (UK). Borderline Personality Disorder: Treatment and Management. Leicester (UK): British Psychological Society; 2009. (NICE Clinical Guidelines, No. 78.) 2, BORDERLINE PERSONALITY DISORDER. Available from: https://www.ncbi.nlm.nih.gov/books/NBK55415/ []
  12. French, J. H., & Shrestha, S. (2020). Histrionic Personality Disorder. In StatPearls. StatPearls Publishing. []
  13. French JH, Shrestha S. Histrionic Personality Disorder. [Updated 2020 Nov 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542325/ []
  14. Mitra P, Fluyau D. Narcissistic Personality Disorder. [Updated 2021 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/ []
  15. Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness. Behavioral medicine (Washington, D.C.), 43(3), 156–164. https://doi.org/10.1080/08964289.2017.1301875 []
  16. Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness. Behavioral medicine (Washington, D.C.), 43(3), 156–164. https://doi.org/10.1080/08964289.2017.1301875 []
  17. Menon, P., Chaudhari, B., Saldanha, D., Devabhaktuni, S., & Bhattacharya, L. (2016). Childhood sexual abuse in adult patients with borderline personality disorder. Industrial psychiatry journal, 25(1), 101–106. https://doi.org/10.4103/0972-6748.196046 []
  18. Johnson, J. G., Cohen, P., Smailes, E. M., Skodol, A. E., Brown, J., & Oldham, J. M. (2001). Childhood verbal abuse and risk for personality disorders during adolescence and early adulthood. Comprehensive psychiatry, 42(1), 16–23. https://doi.org/10.1053/comp.2001.19755 []
  19. Reichborn-Kjennerud T. (2010). The genetic epidemiology of personality disorders. Dialogues in clinical neuroscience, 12(1), 103–114. https://doi.org/10.31887/DCNS.2010.12.1/trkjennerud []
  20. Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2020 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/ []
  21. Perugula, M. L., Narang, P. D., & Lippmann, S. B. (2017). The Biological Basis to Personality Disorders. The primary care companion for CNS disorders, 19(2), 10.4088/PCC.16br02076. https://doi.org/10.4088/PCC.16br02076 []
  22. Esbec, E., & Echeburúa, E. (2011). New criteria for personality disorders in DSM-V. Actas espanolas de psiquiatria, 39(1), 1–11. []
  23. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The effectiveness of cognitive behavioral therapy for personality disorders. The Psychiatric clinics of North America, 33(3), 657–685. https://doi.org/10.1016/j.psc.2010.04.007 []
  24. May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62 []
  25. National Collaborating Centre for Mental Health (UK). Borderline Personality Disorder: Treatment and Management. Leicester (UK): British Psychological Society; 2009. (NICE Clinical Guidelines, No. 78.) 5, PSYCHOLOGICAL AND PSYCHOSOCIAL TREATMENTS IN THE MANAGEMENT OF BORDERLINE PERSONALITY DISORDER. Available from: https://www.ncbi.nlm.nih.gov/books/NBK55410/ []
  26. Paris J. (2019). Suicidality in Borderline Personality Disorder. Medicina (Kaunas, Lithuania), 55(6), 223. https://doi.org/10.3390/medicina55060223 []
  27. Coleman, D., Lawrence, R., Parekh, A., Galfalvy, H., Blasco-Fontecilla, H., Brent, D. A., Mann, J. J., Baca-Garcia, E., & Oquendo, M. A. (2017). Narcissistic Personality Disorder and suicidal behavior in mood disorders. Journal of psychiatric research, 85, 24–28. https://doi.org/10.1016/j.jpsychires.2016.10.020 []