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Personality

What Are Cluster B Personality Disorders?

Making sense of antisocial, narcissistic, histrionic, and borderline disorders.

Key points

  • Antisocial personality disorder is a type of chronic mental illness in which a person's way of relating to others is abnormal—and destructive.
  • Those with narcissistic personality disorder believe they are superior to others and have little regard for other's feelings.
  • Histrionic means "dramatic or theatrical." These individuals have a strong desire to be noticed, and often behave inappropriately for attention.
  • People with borderline personality disorder often have trouble regulating emotions, show impulsive behavior, and have unstable relationships.
Melancholiaphotography / Pixabay
Source: Melancholiaphotography / Pixabay

The Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, identifies 10 unique personality disorders—conditions in which people have traits that cause them to feel and behave in socially distressing ways, limiting their ability to function in relationships and in other areas of their life, such as work or school.

Each of the 10 disorders belongs to one of three groups known as "clusters." Cluster A contains paranoid, schizoid, and schizotypal disorders. The categories for Cluster C are avoidant, dependent, and obsessive-compulsive personality disorders.

In Cluster B, discussed here, the DSM outlines diagnostic criteria for antisocial, narcissistic, histrionic, and borderline personality disorders. Here's what you should know.

1. Antisocial Personality Disorder

Antisocial personality disorder is a type of chronic mental illness in which a person's ways of thinking, perceiving situations, and relating to others are abnormal—and destructive. People with antisocial personality disorder typically have no regard for right and wrong. They may often violate the law and the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems. And people with antisocial personality disorder may not be able to fulfill responsibilities to family, work, or school.

Treatment for Antisocial Personality Disorders

Antisocial personality disorder is notoriously difficult to treat. People with this disorder may not even want treatment or think they need it. But because antisocial personality disorder is essentially a way of being, rather than a curable condition, affected people are likely to need close, long-term care, as well as consistent follow-up.

People with antisocial personality disorder may also need treatment for other conditions, such as depression and anxiety. Medical and mental health providers with experience treating antisocial personality disorder and commonly associated conditions are most likely to be helpful.

2. Narcissistic Personality Disorder

Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.

Narcissistic personality disorder symptoms may include:

  • Believing oneself to be better than others
  • Fantasizing about power, success, and attractiveness
  • Expecting constant praise and admiration
  • Believing that one is special and acting accordingly
  • Failing to recognize other people's emotions and feelings
  • Expecting others to go along with ideas and plans
  • Taking advantage of others
  • Expressing disdain for those seen as inferior
  • Being jealous of others
  • Believing that others are jealous of them
  • Trouble keeping healthy relationships
  • Setting unrealistic goals
  • Being easily hurt and rejected
  • Having a fragile self-esteem
  • Appearing tough-minded or unemotional

3. Histrionic Personal Disorder

People with Cluster B disorders tend to have intense, unstable emotions and distorted self-images. For people with histrionic personality disorder specifically, their self-esteem depends on the approval of others and does not arise from a true feeling of self-worth. They have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention. The word histrionic means dramatic or theatrical This disorder is more common in women than in men and usually is evident by adolescence or early adulthood.

4. Borderline Personality Disorder (BPD)

Borderline personality disorder is a serious mental illness marked by unstable moods, erratic behavior, and difficulties in relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed borderline personality disorder as a diagnosable illness for the first time.

Because some people with severe borderline personality disorder have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.

Most people who have borderline personality disorder suffer from:

  • Problems with regulating emotions and thoughts
  • Impulsive and reckless behavior
  • Unstable relationships with other people

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have borderline personality disorder in a given year.

Borderline personality disorder is often viewed as difficult to treat. However, recent research shows that borderline personality disorder can be treated effectively and that many people with this illness improve over time.

Suicide and Self-Harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors. As many as 80 percent of people with borderline personality disorder have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Yet some treatments can help reduce suicidal behaviors in people with borderline personality disorder. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy. DBT also reduced the use of the emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not typically stem from a desire to die. Some self-harming behaviors may still be life-threatening, however. Self-harming behaviors linked with borderline personality disorder include cutting, burning, hitting, head-banging, hair-pulling, and other harmful acts. People with borderline personality disorder may self-harm to help regulate their emotions, punish themselves, or express their pain. They do not always see these behaviors as harmful.

Risk Factors for Borderline Personality Disorder

Research is being done on the possible causes and risk factors for borderline personality disorder. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with borderline personality disorder suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for borderline personality disorder. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

What if I or Someone I Know Is In Crisis?

If you are thinking about harming yourself, or know someone who is:

  • Call 911 or your local emergency number, or go to a hospital emergency room to get immediate help. If you are unable to do this yourself, ask a friend or family member to help you.
  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
  • Call your doctor when appropriate.
  • If you are in a crisis, make sure you are not left alone.
  • If someone else is in a crisis, make sure he or she is not left alone.

When to Contact a Medical Professional

If you are concerned about symptoms of a Cluster B personality disorder in yourself or a close loved one, reach out to a therapist or other professional for assistance. To find help near you, visit the Psychology Today Therapy Directory.

©2021 Kevin Bennett, Ph.D. All rights reserved.

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