Kenneth Price74
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joined Oct 2007
Cluster B Personality Disorders
We will examine the Cluster B personality disorders here—those categorized by dramatic, emotional, and erratic behaviors. This group consists of four distinct diagnoses: histrionic, narcissistic, antisocial, and borderline personality disorders.
What connects these various conditions? A shared tendency to utilize specific defense mechanisms, such as dissociation, denial, "splitting," and the phenomenon known as "acting out." Beyond these primary psychological defenses, these specific personalities
frequently experience mood disorders and somatic symptom disorders as well.
Histrionic Personality Disorder
Individuals with this disorder constantly crave attention and exhibit intense emotionality. However, their emotions are often superficial and prone to rapid shifts. These individuals are frequently perceived as attractive or seductive, placing an exaggerated emphasis on their physical appearance.
The behavioral pattern involves pervasive emotionality and a relentless pursuit of the spotlight, typically manifesting in early adulthood. A hallmark of this disorder is a profound sense of discomfort when one is not the center of attention. Social interactions may be characterized by inappropriate sexualization, seduction, or provocation. Furthermore, their emotional expressions lack sincerity; they are shallow and volatile. Such individuals habitually leverage their physical looks to command attention. Their speech is often theatrical and impressionistic but lacks substantive detail. Additionally, there is an increased susceptibility to suggestion from others or circumstances, along with an overemphasis on the importance of certain social connections and acquaintances.
Alongside these core symptoms, mood disorders and somatization—where psychological distress manifests as physical ailments—are common occurrences.
Treatment protocols include both individual and group psychotherapy, supplemented by medication, particularly antidepressants.
Narcissistic Personality Disorder
Those diagnosed with this disorder possess a sense of grandiosity regarding their own importance, yet they remain hyper-sensitive to any form of criticism. They often lack the capacity for empathy, remaining more preoccupied with outward perception than actual substance.
Affected individuals demonstrate grandiosity through either active fantasy or specific mannerisms, expressing a constant need for admiration and a deficiency in empathy that begins in early adulthood.
As previously noted, these individuals project a grandiose sense of self-importance, which may manifest as an excessive exaggeration of their personal achievements or talents. They are often consumed by fantasies of unlimited success, power, uniqueness, beauty, or the perfect love. They operate under the belief that they are special and unique, capable of being understood only by high-status individuals, while simultaneously demanding constant admiration. Moreover, they harbor unreasonable expectations of others to comply with or automatically agree with their views. Their interpersonal relationships are typically exploitative, occurring at the expense of others. Empathy is absent, and they frequently perceive others as being envious or jealous of them. Arrogance is a frequent trait.
Consistent with other disorders in this cluster, affected individuals often struggle with mood disorders—primarily depression and depressive episodes. An obsession with their own image is extremely pronounced. Somatization also presents as a significant issue.
Treatment involves both individual and group psychotherapy.
Antisocial Personality Disorder
Individuals suffering from this disorder have a documented history of persistent and chronic antisocial behavior, which includes violating the fundamental rights of others.
The central issue in this condition is an inability to control impulses. Those affected show a profound lack of regard for others. They are egocentric, selfish, and excessively demanding. Furthermore, signs of anxiety, remorse, or guilt are frequently absent in these individuals.
Violating community laws and social norms is a hallmark of this personality disorder. Terms such as "sociopath" or "psychopath" are frequently applied to individuals exhibiting particularly deviant antisocial behavior.
This condition is considered lifelong; for an accurate diagnosis, behavioral disturbances must be evident as far back as adolescence.
Individuals using illegal substances often fall within the spectrum of antisocial disorders. However, if a person's issues stem exclusively from substance abuse—and if they actually feel guilt regarding their actions—then a diagnosis of antisocial personality disorder can be ruled out.
Research conducted in the United States indicates that approximately 3% of men suffer from this disorder.
The exact origins of this disorder remain somewhat unclear. There is often a documented history of similar disorders within the family. Consequently, modern consensus suggests that both environmental factors during upbringing and genetic predispositions play significant roles. Family struggles involving alcoholism also increase the risk of antisocial behavior.
Antisocial behavior can also emerge as a consequence of brain trauma or encephalitis.
Treatment must be administered exclusively in clinical settings, where group therapy has proven to be a more effective method.
In addition to psychodynamic approaches, some patients may see improvement through medication.
"Borderline" or Borderline Personality Disorder
The core issue is instability regarding self-perception, interpersonal relationships, and mood.
The characteristic pattern involves instability in interpersonal relations, self-image, affect, and impulse control, beginning in early adulthood.
The condition is marked by frantic efforts to avoid real or imagined abandonment. Interpersonal relationships are unstable and intense. Self-identity is fragile and disordered. Impulsivity is present in at least two potentially self-damaging activities (such as sex, substance abuse, or binge eating). Suicidal behavior or self-harming tendencies may be present. A chronic sense of emptiness is common. Anger is often intense, uncontrolled, and inappropriate to the situation.
This type of disorder affects about 1-2% of the population. Diagnoses are twice as frequent in women. The cause most likely stems from disruptions in early personality development. Childhood abuse is a frequent finding.
Therapy utilizes psychodynamic approaches, though medication is also used.
Written by: Dr. Robert Miller.
References: Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV)
