DSM-5: The Cluster B Personality Disorders

Antisocial, Borderline, Narcissistic, and Histrionic

Depression
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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), the gold standard by which mental health disorders are diagnosed, groups them into clusters. Here's a closer look at the Cluster B personality disorders.

Understanding Personality Disorders

Your personality is defined by how you think, behave, and feel. A personality disorder is a type of mental health disorder that signifies that your personality differs significantly from what your culture expects. When you have a personality disorder, it first appears during adolescence or early adulthood and it can create a great deal of distress over your entire lifetime, disrupting your ability to enjoy life, maintain meaningful relationships, and do well in school or at work. An estimated 15 percent of adults have at least one personality disorder.

With all personality disorders, the abnormal and likely inflexible way you think, perceive situations, and behave becomes a pattern that follows you throughout your life. This pattern can be seen in two or more of these areas:

  • How you think about yourself and others, including your interactions with others
  • The way you relate to others
  • How you control your behavior
  • Your emotional responses

There are 10 specific types of personality disorders, which DSM-5 breaks into three clusters: A, B, and C. Cluster A is defined as odd or eccentric behavior and affects 5.7 percent of adults; Cluster B affects 1.5 percent of adults; and Cluster C personality disorders consist of fearful and anxious behaviors, affecting 6 percent of adults.

Among what are labeled the Cluster B personality disorders are four specific types, each characterized by dramatic, over-emotional, or unpredictable (erratic) thinking or behavior: antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, and histrionic personality disorder. 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. Antisocial personality disorder is also linked to impulsive behavior, aggression (doing physical harm to yourself or other people, for example), disregard for your own or others' safety, irresponsible behavior, and lack of remorse over your behavior.

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 a lot of 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 OK 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 yourself 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 he'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 him 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're 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 it when someone else is getting more attention than he or she is and may engage in dramatic, seductive, or sexually provocative behavior or use his or her physical appearance to regain the limelight.

A person with a histrionic personality disorder may believe that his or her personal relationships are stronger than they really are, use dramatic statements to express his or her opinions, and be easily influenced by other people. He or she also tends to be overly concerned about physical appearance.

Causes

Your personality—the way you think, feel, and behave that makes you YOU—forms during your childhood. Both the genes you inherit and your environment, which includes interactions with people you were close to, situations you were in, events that happened, and where you grew up, help to shape your personality.

It's not understood what the exact causes are behind personality disorders, but as with everyone's personality, they're believed to be caused by a combination of genetic factors and environmental influences. Research shows that there are brain abnormalities in people with Cluster B personality disorders, indicating that you can inherit these abnormalities, which in turn may make you more susceptible to developing a personality disorder. Childhood trauma, abuse, chaos, instability, or neglect and a family history of personality disorders are also seen as contributing factors to developing a personality disorder. If you have the genetic component, experiencing any of these negative environmental factors can trigger a personality disorder.

Diagnosis

Avoid the temptation to try to diagnose yourself or a loved one on your own. Only a trained mental health professional can accurately diagnose a personality disorder. If you think you or a loved one has a personality disorder, talk to your doctor. A diagnosis includes a physical exam, a psychiatric evaluation, and meeting specific criteria in the DSM-5 as determined by an experienced mental health professional.

Treatment

Treatment can go a long way in helping you attain a better quality of life if you stick with it. The two most common treatments are psychotherapy and medication, but if your situation requires it, you may need to be hospitalized or referred to a residential treatment program.

Psychotherapy

Usually, the best treatment for personality disorders is psychotherapy, also known as talk therapy or counseling. You may learn some life skills that help you cope with your emotions, while also learning how to respond appropriately and manage your relationships.

The most commonly used psychotherapies for personality disorders are:

  • Dialectical behavior therapy (DBT)
  • Cognitive behavioral therapy (CBT)
  • Psychoanalysis
  • Group therapy

Education for you and your family regarding your disorder and how to cope with it is also often an important part of psychotherapy.

Medications

Though there aren't any medications that are approved by the Food and Drug Administration (FDA) to treat personality disorders specifically, some of your symptoms, which could be due to a co-existing mood disorder like depression or bipolar disorder, can be reduced with these medications:

  • Antidepressants: These can help if you have depression symptoms such as a low mood, anger, hopelessness, worthlessness, or irritability.
  • Anti-anxiety medications: If you have problems with anxiety or insomnia, these medications may help decrease these symptoms. However, they can also lead to increased impulsiveness in some people, so whether or not you're prescribed these will depend on your individual situation.
  • Antipsychotics: For people who have problems with psychosis, anger, or anxiety, antipsychotics may alleviate these symptoms.
  • Mood stabilizers: These medications can help balance your moods so your mood swings are less frequent and less severe. They may also help reduce impulsive behavior and aggression.
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Article Sources
  • American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC; American Psychiatric Association: 2013.

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  • Mayo Clinic Staff. Personality Disorders. Mayo Clinic. Updated September 23, 2016. https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

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