Cluster B personality disorders consist of four personality disorders, such as antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. People with these disorders often behave in an inappropriate, dramatic, and unpredictable manner.
What Are Cluster B Personality Disorders?
Cluster B disorders are the classification of four personality disorders categorized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). All these four personality disorders are extremely rare and it is quite difficult for single and separate diagnoses. Individuals with these disorders often manifest overlapping and other similar symptoms. They are more likely to act in an overly erratic and dramatic manner.
They are mostly unpredictable as well as don’t have the capacity to regulate their emotions. It affects several aspects of an individual’s life, including his/her thoughts, behaviors, social interactions, education, career, and interpersonal relationships. “Cluster B disorders are characterized by problems with emotion regulation, impulsivity, and interpersonal conflicts,” explains a 2018 study 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 .
Personality disorders refer to significant psychological conditions that affect a person’s thoughts, emotions, and behavioral patterns, and the ability to relate to others. There are a total of 10 personality disorders categorized into cluster A, cluster B, and Cluster C disorders. Each of these sections includes different personality traits that are classified based on their similarity of symptoms. Cluster B personality disorders include the following four conditions –
- Antisocial personality disorder (ASPD)
- Borderline personality disorder (BPD)
- Histrionic personality disorder (HPD)
- Narcissistic personality disorder (NPD)
Each of these conditions has 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 makes a person different from others. A person’s personality can be influenced by different factors, such as their environments, life situations, experiences, and inherited characters. A 2018 research paper 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 defined personality disorders (PDs) as “the manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both.”
Such disorders can be characterized by long-term behavioral and inner experience patterns and the types vary from person to person. A 2011 study 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 suggested that significant signs of personality disorder mostly occur during adolescence or later life. These symptoms often lead to extreme distress and impaired functioning if not treated properly.
People with cluster B personality disorders often experience extreme difficulty in regulating their emotions. Due to this, they struggle a lot to maintain their interpersonal relationships. Others may find their actions and behaviors overdramatic and emotional in certain social situations. A study 4 Fariba K, Gupta V, Kass E. Personality Disorder. [Updated 2021 Jun 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556058/ has reported that the prevalence of this personality disorder is around 1.5%. These personality disorders can have long-lasting negative impacts without proper treatment and may affect the following:
- 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 the severity and frequency of the symptoms. A 2015 research paper 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 suggested that people mostly experience the symptoms occur during teenage or adulthood when their personalities further develop. The signs and symptoms of cluster B personality disorders vary depending on the different traits. Some common symptoms of cluster B disorder include:
- People with this disorder are more likely to be attention-seekers and often experience a strong need of getting praised.
- They don’t pay attention to the safety of themselves and others.
- They have a tendency to feel extreme emptiness always.
- They mostly behave in a very arrogant way.
- They exaggerate things and dramatically express their emotions.
- They tend to have an extreme fear of abandonment.
- They tend to lie for unnecessary reasons and manipulate others for their personal gain.
- They have frequent self-harm and suicidal thoughts.
Types Of Cluster B Personality Disorders
Cluster B personality disorder includes the following four disorders:
1. Antisocial personality disorder
According to a recent 2020 study 6 Fisher, K. A., & Hany, M. (2021). Antisocial Personality Disorder. In StatPearls. StatPearls Publishing. , “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 appears as a pattern of violation of people’s physical and emotional rights. People with this disorder are more likely to be deceitful and they often try to manipulate others for their personal gain.
This mental health condition is also known as sociopathy. Due to no proper evidence, the term ’sociopathy’ is not used clinically. Certain genetic and environmental factors largely contribute to the development of antisocial personality disorder. A study 7 Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2021 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/ estimated that 1-4% of people tend to develop antisocial personality disorder symptoms during their adulthood. It also claims that men are three to five times more likely to suffer from this personality disorder.
This disorder includes some other significant psychological symptoms, such as lack of empathy, irresponsibility, antisocial behaviors and actions, impulsiveness, irritableness, and intense aggression. ASPD sufferers often treat others very harshly and they have no feeling of remorse for any harm caused to others. A 2002 research paper 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 mentioned that antisocial personality disorder is closely associated with drug and alcohol addiction.
2. Borderline personality disorder
IBorderline personality disorder involves hypersensitivity towards rejection that can disrupt a person’s self-image, behavior, emotions, and relationships. This condition often leads to unstable relationships. A 2016 study 9 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 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.”
Another symptom of this disorder is a chronic fear of emptiness and abandonment. Studies 10 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/ suggest that borderline personality disorder is also associated with self-harm and suicidal tendencies. A person may experience intense emotions and behaves impulsively. A 2007 study 11 Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2021 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/ result showed that the prevalence of this disorder is around 1.6%. This study also reported that women are two times more likely to develop these symptoms than men. The sufferers often engage themselves in risky behaviors such as binge eating, abusing alcohol and drugs, shopping sprees, and promiscuous sex.
3. Histrionic personality disorder
Histrionic personality disorder, also known as dramatic personality disorder, can be characterized by several significant symptoms self-centeredness, attention-seeking behavior, over-dramatic emotions, seductive and sexually provocative behaviors. The sufferer may appear very charming, lively, and flirtatious in social interactions. A research paper 12 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/ suggested that 2-3% of people develops the symptoms of histrionic personality disorder.
Females have more risk to be diagnosed with this disorder compared to males. It causes a person to change their behaviors and actions rapidly. They often try to use their physical appearance to be in 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 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/ . The symptoms mostly occur later in life and people experience extreme difficulties in their personal and professional relationships.
4. Narcissistic personality disorder
According to a research paper 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/ , the prevalence of narcissistic personality disorder is around 0.5-5% of the population, and males are more likely to be diagnosed with this disorder than females. People with this disorder feel a strong need for admiration, behave as superior, and with grandiosity. They like to exaggerate their achievements in front of others and fantasize about unlimited success, power, and beauty.
Studies 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 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 symptoms, including a need for extreme admiration, a sense of entitlement, a feeling of envy and jealousy, lack of empathy, arrogance, and condescending attitudes. A 2018 study 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 explained that narcissistic personality disorder patients can cause significant distress to even close ones as they express vulnerable self-esteem and are extremely sensitive to criticism
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Causes Of Cluster B Personality Disorders
The ultimate causes of this disorder are not known yet as it requires more detailed research. Some significant factors like different genetics, environmental factors, and early life experiences are closely associated with the development of the symptoms in people. Similar to other mental illnesses, personality disorders are believed to be extremely complicated.
Some of the significant causes of developing cluster B disorder are:
1. Earlier life experiences
A 2016 study 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 mentioned a strong association between borderline personality disorder and the experience of childhood sexual trauma. The study showed that childhood experiences of trauma, abuse, or unhealthy relationships play a pivotal role in developing personality disorder symptoms during early or late adulthood. According to a 2001 research paper 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 , people who experienced verbal abuse by their parents have more risk to be diagnosed with borderline and narcissistic personality disorders.
2. Genetics
Genetics plays a very important role in developing personality disorders. A 2010 study 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 has found that having a family member who is suffering from a personality disorder increases the risk of developing the symptoms in a person. Another research 20 Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2021 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/ has reported that the range of heritability in antisocial personality disorder is 38-69%.
3. Certain Human Brain Chemistry
A 2017 study 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 has explained that there are a few similarities in the anatomic features of the brains of cluster B patients. The study mentioned that a few typical brain features that may affect a specific region called the amygdala which is responsible for regulating emotions.
Diagnosis Of Cluster B Personality Disorders
Only a trained mental health professional can diagnose a personality disorder based on reviews and characterization of signs. Self-diagnosis is believed to be very harmful for oneself otherwise. The diagnosis process includes psychiatric evaluation, physical examinations, and in-depth interviews. Mental health specialist often use the DSM-5 criteria 22 Esbec, E., & Echeburúa, E. (2011). New criteria for personality disorders in DSM-V. Actas espanolas de psiquiatria, 39(1), 1–11. to identify the characteristics of the emerging symptoms of this disorder.
The patients are generally advised to attend a few sessions with a therapist before the official diagnosis. A doctor may conduct a psychological evaluation, an interview and ask about the patient’s medical and family history. However, one has to be very honest about all the answers. The doctor can also have a conversation with the patient’s family members, friends, or partner for a better understanding.
A doctor may ask the patients:
- About life experience
- About thought patterns
- About clinical history
- About moods and emotions
- About behaviors and way of responding to various situations.
The guide of DSM-5 mentions some important criteria that the sufferer requires to meet including:
- Symptoms first occurred during adulthood
- Symptoms that lead to cause distress and problems in one’s daily activities.
- Symptoms should be constant and stable for minimum one year
- Symptoms that are not the result of another illness or other stressful situationsSymptoms that are consistent across time, places, changes in circumstances
Treatments For Cluster B Personality Disorders
Treatments of this disorder include various beneficial methods and therapies to manage the negative emotional impacts such as anger, anxiety, depression, and disruptive behaviors. Cluster B consists of a variety of significant issues that are quite difficult to treat. The symptoms eventually continue to engender impairment with the patients and those around them even after little improvement. Thus, it is very important for the patients to cooperate with the doctor and follow the treatment properly.
Here are some of the treatments used by doctors to treat this personality disorder.
1. Cognitive Behavioral Therapy (CBT)
It is one of the most beneficial psychotherapy to treat this disorder. It makes the sufferers to identify their thought patterns and behaviors. CBT allows them to find practical ways to control the symptoms. Cognitive-behavioral therapy 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 helps to solve the problems first and teaches the patients certain skills to reduce negative thoughts and practices.
Read More About Cognitive Behavioral Therapy Here
2. Dialectical Behavioral Therapy (DBT)
This therapy helps the sufferers learn different skills to make positive life changes. Dialectical behavioral therapy involves several group or individual sessions. A 2016 research paper 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 suggested that DBT is the most effective psychotherapy to treat borderline personality disorder.
3. Talking therapy
It is one of the essential parts of the psychotherapy process. It helps the patients to express their emotions regarding their previous experiences, problems, and emotions verbally to the mental health specialist. Talking therapy 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/ is believed to be very beneficial as most people express themselves without any hesitation in this therapy and the therapist listens to them without judging.
4. Medications
One of the negative aspects of this disorder is that there are no specific medicines available for the treatment. The mental health professionals may prescribe certain stabilizers, antidepressants, antipsychotics, and anti-anxiety medicines for the improvement of symptoms. These medicines help one to manage co-occurring problems, such as depression and anxiety. One should avoid consuming drugs and alcohol while on medication as it may worsen the condition.
Coping With Cluster B Personality Disorder
There are certain important self-care strategies to manage the extreme negative impacts of the symptoms such as, regular exercises, a healthy diet, meditation, and mindfulness practices. These coping techniques can help the patients to boost their mood and reduce frustration. Personality disorders are mostly treatable but not curable. It is important to seek medical help before the symptoms get deteriorated. Mild symptoms may not be a matter of concern unless they begin to interfere with one’s daily activities.
Supporting a cluster B patient can be extremely challenging, but it is essential to encourage the sufferer for getting professional help. It has been observed that borderline 26 Paris J. (2019). Suicidality in Borderline Personality Disorder. Medicina (Kaunas, Lithuania), 55(6), 223. https://doi.org/10.3390/medicina55060223 and narcissistic 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 personality disorder patients have a higher risk of committing suicide. However, 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 struggle a lot in maintaining a healthy relationship with others. They are mostly over-dramatic and extremely emotional and behave impulsively. One can manage the negative impact of the symptoms, but it is not completely curable. Certain symptoms naturally decrease over time, some don’t. The family and friends of the patient should be transparent, supportive, and non-judgmental towards him/her. There are various online resources available through which people can learn how to support personality disorder patients.