Cluster B personality disorders

Cluster B personality disorders are a categorization of personality disorders as defined in the DSM-IV and DSM-5.[1]

These disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior and interactions with others. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.[2]

The British National Health Service has described those with this disorder as someone who, "struggles to relate to others. As a result, they show patterns of behaviour most would regard as dramatic, erratic and threatening or disturbing."[3]

Four Recognized Cluster B Personality Disorders:[2]

Each of these disorders, while similar, have a variety of symptoms, diagnoses, and causes.

• Antisocial personality disorder[4] (DSM-IV code 301.7): Symptoms: Indifferent and routine manipulation, exploitation, and violation of the rights of others. It can also be characterized by routine law breaking.[4] Cause: Signs of Antisocial Personality disorder often first become evident in childhood. Consequently, although the cause is unknown, it is believed that a more difficult childhood can lead to APD.[5] Diagnosis: While symptoms can start to show themselves in the early teen years, a diagnosis cannot be made until adulthood. To be diagnosed, the patient must fit at least three of the most common indicators such as recklessness, irresponsibility, apathy, and irritability.[5]
• Borderline personality disorder (DSM-IV code 301.83): Symptoms: Difficulty regulating emotions, impulsivity, self harm, dissociative feelings, and even psychotic episodes. Cause: 1. Genetics - Those with a family member who has BPD are considered more likely to develop the disorder. 2. Trauma - Trauma such as assault or neglect early in life may lead to BPD. Diagnosis: Unlike many psychological disorders, there is no strict guideline for the diagnosis of Borderline Personality Disorder.[6]
• Histrionic personality disorder (DSM-IV code 301.50): Symptoms: an overwhelming desire for attention, chronically unstable emotions, sensitivity, gullibility, and reckless behavior. Cause: It is believed that Histrionic Personality Disorder can either be inherited genetically or learned behavior in early childhood. Diagnosis: To diagnose the disorder, there is no strict guideline; however, a doctor may begin by evaluating the patient's medical history and physical well-being to ensure that the causes of the symptoms are mental rather than physical.[7]
• Narcissistic personality disorder (DSM-IV code 301.81): Symptoms: a magnified sense of self importance, underlying deep self esteem issues, exaggeration, manipulation, envy, arrogance, impatience, depression. Like HPD, it can cause an excessive need for attention and approval. Causes: It can be caused by genetics, environment, or neurobiology. Diagnosis: NPD may often go misdiagnosed or undiagnosed, as patients often display symptoms similar to other disorders, or may not be willing to admit there is anything wrong. It may be treated with talk therapy (psychotherapy).[8]

Cluster B traits and common symptoms

Cluster B personality disorders are all characterized by emotional dysregulation, impulsivity, and frequent interpersonal conflicts.[9][10] These individuals present as "dramatic", "emotional", and "erratic".[11] The predominant theme and shared trait among Cluster B personalities is a lack of emotional empathy and the presence of egocentrism.[12] Dr. Simon Baron-Cohen posited that empathy is a spectrum, at one end of the distribution lies the "zero-negative empathy"; this is where antisocial, borderline, and narcissistic personality disorders are placed, which is why individuals with these personality disorders are capable of dehumanizing others, leading to acts of cruelty. Borderlines, sociopaths, and narcissists are considered "zero-negative empathy" because they are "unequivocally bad for the sufferers and all those around them". Dr. Baron-Cohen did not include histrionic personality disorder in the zero negative empathy category because they are capable of empathy. Individuals with histrionic personality disorder have a greater capacity for dependent relations than do those with narcissistic, borderline, and antisocial personality disorders, and they are more emotionally expressive and less dismissive of others.[13][14]

Causes and Risk Factors

Personality disorders are likely caused by a combination of genetics and environmental factors. In a study, information found a strong correlation between borderline personality disorder and history of sexual trauma. Research has found a significant link between cluster B personality disorders and family history as well. Having a parent or sibling with a personality disorder increases your risk for developing the disorder.

Treatment and Medications

Treatment is centered around the use of psychotherapy. There are no medications approved by the U.S. Food and Drug Administration for the treatment of personality disorders. However, medications are sometimes prescribed to target symptom domains (e.g. aggression and explosive anger, impulsivity) or treat co-occurring mental health problems.

References

1. Kristalyn Salters-Pedneault (May 6, 2016). "Understanding the Cluster B Personality Disorders/The Cluster B Personality Disorders: What Are the Cluster B Personality Disorders?". Verywell. Archived from the original on September 6, 2010.
2. "Personality disorders - Symptoms and causes". Mayo Clinic. Retrieved 26 January 2019.
3. "Personality disorder". nhs.uk. 26 October 2017. Retrieved 26 January 2019.
4. "Antisocial personality disorder: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-10-29.
5. "Antisocial personality disorder". nhs.uk. 2018-03-21. Retrieved 2019-10-29.
6. "Borderline Personality Disorder". National Alliance on Mental Illness. December 2017.
7. "Histrionic Personality Disorder". Cleveland Clinic. Retrieved 2019-10-29.
8. "Narcissistic personality disorder - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2019-10-29.
9. Nioche, A; Pham, TH; Ducro, C; de Beaurepaire, C; Chudzik, L; Courtois, R; Réveillère, C (June 2010). "Psychopathy and Associated Personality Disorders: Searching for a Particular Effect of the Borderline Personality Disorder?". Encephale. 36 (3): 253–9. doi:10.1016/j.encep.2009.07.004. PMID 20620268. Retrieved 7 June 2020.
10. Borges, LM; Naugke, AE (8 November 2017). "The role of emotion regulation in predicting personality dimensions". Personality and Mental Health. 11 (4): 314–334. doi:10.1002/pmh.1390. Retrieved 7 June 2020.
11. Young, C.; Habarth, J.; Bongar, B.; Packman, W. (2013). "Diagnostic and statistical manual of mental disorders". Psychiatry, Psychology, and Law : An Interdisciplinary Journal of the Australian and New Zealand Association of Psychiatry, Psychology and Law (5th ed.). American Psychiatric Association. 25 (5): 706–723. doi:10.1080/13218719.2018.1474816. PMC 6818303. PMID 31984047.
12. Kraus, G; Reynolds, DJ (April 2001). "The "A-B-C's" of the cluster B's: identifying, understanding, and treating cluster B personality disorders". Clinical Psychology Review. 21 (3): 345–373. doi:10.1016/s0272-7358(99)00052-5. PMC 6818303. PMID 11288605.
13. Caligor, E.; Levy, KN; Yeomans, FE (5 May 2015). "Narcissistic Personality Disorder: Diagnostic and Clinical Challenges". The American Journal of Psychiatry. 172 (5): 415–422. doi:10.1176/appi.ajp.2014.14060723. PMID 25930131.
14. Baron-Cohen, Simon (2011). Zero Degrees of Empathy: A New Theory of Human Cruelty. London, UK: Penguin Books. p. 190. ISBN 9780713997910. Retrieved 26 March 2020.