DSM-IV-TR: The Ten Personality Disorders: Cluster B

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

Cluster B: The Dramatic, Emotional, Erratic Cluster

Cluster B includes Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, and Antisocial Personality Disorder. Disorders in this cluster share problems with impulse control and emotional regulation.

The Antisocial Personality Disorder* is characterized by repeated participation in illegal acts, hostile-aggressive behaviors towards others, deceitfulness, and reckless behavior. Some of these hostile-aggressive and deceitful behaviors may first appear during childhood, before age 18, such as hurting animals, or bullying and intimidating of others. When this is the case, Conduct Disorder (a juvenile form of Antisocial Personality Disorder) may be an appropriate diagnosis. Persons with Antisocial Personality Disorder typically do not experience genuine remorse for the harm they cause others, although they can become quite adept at feigning remorse when it is in their best interest to do so (such as when standing before a judge). The aggressive features of this personality disorder make it stand out among other personality disorders as individuals with this disorder take a unique toll on society.

Persons with Histrionic Personality Disorder* tend to be very dramatic and prefer to be the center of attention. People with this disorder are often quite flirtatious or seductive, and like to dress in a manner that draws attention to them. The way they express themselves tends to be exaggerated, and yet at the same time, is vague, shallow, and lacking in detail. People with Histrionic Personality Disorder often appear flighty and fickle, and while their behavioral style often gets in the way of truly intimate relationships, it is also the case that they are uncomfortable being alone. They tend to feel depressed when they are not the center of attention. When they are in relationships, they often assume these relationships to be more intimate in nature than they actually are. People with Histrionic Personality Disorder tend to be suggestible; that is, they are easily influenced by other people's suggestions and opinions. A literary character that exemplifies the Histrionic Personality Disorder is the character of Blanche DuBois in Tennessee William's classic play, "Streetcar Named Desire."

People with Narcissistic Personality Disorder* have significant problems with their sense of self-worth stemming from a powerful sense of entitlement that leads them to believe they deserve special treatment, and to assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive. Their sense of entitlement can lead them to exhibit haughty and arrogant attitudes towards others and to act in ways that fundamentally disregard and disrespect the worth of those around them. Status is very important to people with Narcissistic Personality Disorder. Associating with famous and special people provides them a sense of importance. These individuals can quickly shift from over-idealizing others to devaluing them. However, the same is true of their self-judgments. They tend to vacillate between feeling like they have unlimited abilities, and then feeling deflated, worthless, and devastated when they encounter their normal, average human limitations. Despite their bravado, people with Narcissistic Personality Disorder require a lot of admiration from other people in order to bolster their own fragile self-esteem. They can be quite manipulative in extracting the necessary attention from those people around them.

Borderline Personality Disorder* is one of the most widely studied personality disorders. People with Borderline Personality Disorder tend to experience intense and unstable emotions and moods that can shift fairly quickly. They generally have a hard time calming down once they become upset. As a result, they frequently have angry outbursts and engage in impulsive behaviors such as substance abuse, risky sexual liaisons, self-injury, overspending, or binge eating; behaviors that function to sooth them in the short-term but harm them in the longer term. People with Borderline Personality Disorder tend to see the world in polarized, over-simplified, all-or-nothing terms. They apply their harsh either/or judgments to others and to themselves and their perceptions of themselves and others may quickly vacillate back and forth between "all good" and "all bad." This tendency leads to an unstable sense of self, so that persons with this disorder tend to have a hard time being consistent. They can frequently change careers, relationships, life goals, or residences. Quite often these radical changes occur without any warning or advance preparation.

*The above list only briefly summarizes these individual Cluster B personality disorders. Richer, more detailed descriptions of these disorders are found in the section describing the four core features of personality disorders.

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