Personality disorders—atypical ways of thinking about oneself and relating to other people—are grouped into three clusters: A, B, and C. Cluster B disorders are marked by inappropriate, volatile emotionality and often unpredictable behavior. The disorders in Cluster B are antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.
Cluster B disorders are taxonomically grouped together by the DSM-V because a single, clear-cut diagnosis is very rare, and patients often exhibit a number of overlapping symptoms. For example, someone with borderline tendencies (such as intense mood swings) may present with histrionic symptom overlap (for example, behaving erratically to garner attention). Similarly, someone who exhibits signs of both narcissistic personality disorder and antisocial personality disorder is sometimes referred to as a “malignant narcissist.”
There are four personality disorders within Cluster B. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Though the disorders can occur alone, symptoms and diagnoses can overlap, either within one cluster or across several.
Antisocial personality disorder describes a pattern of behavior in which an individual regularly violates the physical or emotional rights of others; behaves recklessly, violently, or deceitfully; and lacks remorse for any harm caused to others. Its estimated prevalence rate is between 0.2 and 3.3 percent.
Borderline personality disorder is a condition characterized by chronic mood instability, unstable behavior, difficulty maintaining personal relationships (often caused by an intense fear of abandonment), and frequent instances of self-harm or suicidal behavior. BPD is thought to affect from 1.6 to 5.9 percent of adults, and is more common in women than men.
People with histrionic personality disorder are self-centered, constantly seek attention, and may behave or dress in inappropriate or seductive ways. They are highly dramatic and may display extreme emotions in public, often creating relationship problems as a result. The disorder is thought to affect approximately 2 percent of the population.
Narcissistic personality disorder, thought to affect anywhere from 1 to 6 percent of the population, is characterized by grandiosity; a need for excessive admiration; a lack of empathy; and manipulative, self-centered, or demanding behavior. Someone with NPD can cause significant distress for anyone who associates with them.
All personality disorders are deeply ingrained, rigid ways of behaving and thinking that can greatly affect the individual’s relationships and mental well-being. There is wide variety in the symptomatology and interpersonal challenges caused by personality disorders; based on similarities between certain disorders and a greater possibility for overlap, the 10 disorders currently in the category are divided into three clusters: A, B, and C.
Though Cluster B disorders draw significant attention because they are frequently portrayed in the media—and because those with the disorders often wreak havoc in their personal relationships—they are the least common personality disorders, according to DSM estimates. They are characterized by dramatic, manipulative, or emotional behaviors. Cluster A is characterized by odd or erratic behaviors, while Cluster C disorders are characterized by anxious or fearful behaviors. Within clusters, there is significant overlap between the disorders; overlap can occur across clusters as well.
Cluster B disorders have a combined estimated prevalence rate of 1.5 percent, according to DSM estimates.
The causes of Cluster B disorders are not well-understood. For each, genetics, early life experiences, and environmental influences are thought to play a role. Genetics are strongly implicated in antisocial personality disorder and borderline personality disorder; having a close relative with either disorder greatly increases one’s likelihood of developing it.
Not necessarily, though they can be. Some personality disorders primarily cause the individual significant mental distress—without necessarily harming others—while other disorders cause others frustration but do not trigger serious harm. In some cases, however—notably with antisocial personality disorder or narcissistic personality disorder—the individual’s lack of empathy may lead to physical violence or emotional abuse.
The disorders in Cluster A include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Though symptoms of each disorder vary, the cluster is characterized by patterns of thinking or behavior that appear unusual, eccentric, or suspicious.
The three disorders in Cluster C are avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Cluster C disorders are characterized by anxious, fearful personalities and behavior.
Though medication and certain therapy approaches have shown some promise, on the whole, Cluster B and all other personality disorders are difficult to treat. As such, they can continue to engender impairment for the individual and pain for those within the afflicted person’s orbit even after treatment is initiated.
Treatment is complicated by the fact that many people with personality disorders do not seek professional help, and may not feel as if anything is wrong with them; those with narcissistic personality disorder and antisocial personality disorder, in particular, may not seek help unless requested by a family member or ordered by the legal system.
Personality disorders, by definition, are chronic maladaptive patterns of behavior. While improvement is possible and some overt symptoms do appear to go into “remission” after treatment, in most cases, the individual will likely continue to struggle with behavioral symptoms and/or internal distress for the remainder of their lives.
BPD is typically treated with dialectical behavioral therapy (DBT), mentalization-based therapy (MBT), cognitive behavioral therapy (CBT), or psychodynamic psychotherapy. Some studies have suggested that DBT may be the most effective, but general psychotherapy and psychodynamic approaches have also shown promise.
Few people with narcissistic personality disorder seek or want help. But when asked to do so by others (such as a partner), evidence suggests that some narcissists are capable of growth and change. The process, however, is slow and arduous; many clients drop out without significantly altering their negative behavior.
Psychotherapy for narcissism is a long, slow process. Though individual approaches vary, it tends to involve helping clients understand their primary defensive reactions, recognize how their actions affect others, and replace maladaptive behavior patterns with more positive coping mechanisms.
Dealing with someone who has a Cluster B disorder can be very difficult. But it's important to remember that while no one chooses to have a personality disorder, individuals can choose how they respond to Cluster B behaviors.
If forced to deal with an individual with a Cluster B disorder on a regular basis (because they are a coworker, family member, or partner), it’s more effective to modify your own behavior and emotional responses; trying to force or persuade the individual to behave differently will likely be ineffective and may increase hostility and frustration. Regardless of how one responds when confronted with a Cluster B personality, it’s wise to avoid the urge to diagnose someone outside of a formal clinical setting.
Key signs of narcissism include self-enhancement, a sense of entitlement, lack of awareness (or concern) about the effects of their behavior, and a strong need for approval or attention from others. Narcissists tend to blame others for their failings and have fragile self-esteem, becoming defensive or aggressive when challenged.
Crisis-prone individuals revel in drama and become distraught over small problems. When dealing with such a person, look at the situation objectively to determine if immediate action is truly needed. If the crisis is manufactured, it can be helpful to address the needs behind the “crisis”—boredom, for instance, or a desire for attention.
To avoid provoking a Cluster B individual further, it’s also important to counteract one's automatic defensive posture, and listen and ask questions instead of engaging in a tug-of-war. To achieve this, a strategy known as the CARS method may prove useful: Connecting; Analyzing choices; Responding; Setting limits.