The Cluster B Personality Disorders of the DSM-5

Antisocial, Borderline, Narcissistic, and Histrionic

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Mental health disorders can be confusing: Many have similar or even overlapping characteristics that can make it challenging to distinguish and understand them. In order to classify the numerous personality disorders that have been identified, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) groups them into clusters.

Among what are labeled the Cluster B personality disorders are four specific types of borderline personality disorder (BPD), each characterized by dramatic, over-emotional, or unpredictable (erratic) thinking or behavior. This behavior first appears during adolescence or early adulthood and can cause a great deal of distress over a person's entire lifetime, disrupting her ability to enjoy life, maintain meaningful relationships, or do well in school or at work.

Here's an overview of the four personality disorders that make up Cluster B of the DSM-5. Note that many people with one personality disorder also have signs and symptoms of at least one more.

Antisocial Personality Disorder

The DSM-5 defines antisocial personality disorder as a “pervasive pattern of disregard for, and violation of, the rights of others that begins in early childhood or early adolescence and continues into adulthood.”

People with antisocial personality disorder have been described as lacking empathy—the ability to put yourself in someone else’s shoes in order to understand their feelings. They often act irresponsibly, lie, steal, or repeatedly break the law. The antisocial personality disorder is also linked to impulsive behavior, aggression (doing physical harm to other people, for example), disregard for one's own or others' safety, irresponsible behavior, and lack of remorse.

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is associated with specific problems with interpersonal relationships, self-image, emotions, behaviors, and thinking.

People with BPD tend to have unstable, intense relationships with conflict, many arguments, and frequent breakups. They're often afraid of being abandoned and have a negative image of themselves. They may say they feel as if they're on an emotional roller coaster with very quick shifts in mood, such as going from feeling okay to feeling depressed within a few minutes.

Another hallmark of BPD is a tendency to engage in risky behaviors, such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs, engaging in promiscuous sex, binge eating, or self-harm (cutting themselves or threatening or attempting suicide).

Narcissistic Personality Disorder

The key feature of narcissistic personality disorder is an inflated sense of self-importance. Someone with this disorder may believe that she's special—more important than other people and entitled to special treatment. She may seek excessive attention, take advantage of other people, and lack empathy. Others may regard her as arrogant.

People with narcissistic personality disorder also exaggerate their achievements and fantasize about being powerful, attractive, and successful. They have no interest in others' feelings and needs, but they do have unreasonable expectations of what others should do for them. Sometimes they're jealous of others, but they often believe that they are envied.

Histrionic Personality Disorder

The most telling characteristic of histrionic personality disorder is a rapid shift between intense, dramatic expressions of emotion and excessive, attention-seeking behavior. Someone with this disorder doesn't like when someone else is getting more attention than she is and may engage in dramatic, seductive, or sexually provocative behavior or use her physical appearance to regain the limelight.

A person with a histrionic personality disorder may believe that her personal relationships are stronger than they really are, use dramatic statements to express her opinions, and be easily influenced by other people.