Cluster B Personality Disorders: Types, Symptoms and Treatments

What is a Personality Disorder?

Around 9% of people have a personality disorder; that is almost 1 in 10 U.S. adults. The stigmas and misconceptions surrounding personality disorders are harsh. It is a stigma that, even if the individual accepts their diagnosis, may follow them throughout their life. 

Personality Disorders also raise the question “What is normal?” Just because someone deviates from the societal norm does not mean they have a mental health disorder. 

That’s why therapists focus on the final part of any personality disorder diagnosis: a dysfunction or distress that severely negatively impacts oneself or others around them. If your personality is not inherently distressing to you, stops you from functioning in day-to-day life, or is consistently harmful to those around you, then you don’t have a Personality Disorder. 

Also, it’s worth noting that Personality Disorders, like all personalities, are formed through a mixture of genetics and early life experiences. Many people who struggle with Personality Disorders also struggle with trauma, PTSD, or complex PTSD (a subtype of PTSD primarily caused by childhood trauma).

What are the Cluster B Personality Disorders?

Therapists have separated Personality Disorders into three clusters based on shared symptoms. The clusters are as follows. They are defined as dysfunctional patterns of: 

• Cluster A: Suspicion or lack of interest in others
• Cluster B: Dramatic, overly emotional thinking or unpredictable behavior
• Cluster C: Anxious thinking or behaving

Unlike other mental health disorders, Personality Disorders must be present from an early age and continue for most of one’s lifespan. Through treatment, control over the dysfunctional patterns and eventual remission is possible. In fact, it is a common misconception that personality disorders are completely incurable. Although many people will continue to display heightened anxiety, suspicion, or overly emotional patterns to the point of difficulty, most will improve over time until they no longer meet the criteria for personality disorders.

This blog will focus on Cluster B Personality disorders. Cluster B Personality Disorders are the most well-known. While this can increase the awareness surrounding personality disorders, it can also perpetuate many harmful myths and stereotypes about Cluster B Personality Disorders, which we’ll debunk here.

Narcissistic Personality Disorder

Narcissistic Personality disorder, or NPD for short, is one of the most well-known personality disorders, despite only affecting 6% of the adult population. 

Awareness of NPD is largely due to the rise in conversation around narcissistic abuse, which is when a narcissist abuses their partner or loved one. Usually, this abuse is emotional and mental and relies heavily on gaslighting and manipulation tactics. Although people with NPD are more likely to abuse loved ones, not all people with NPD are abusers. Abuse is a behavior, and like all behaviors, it can be chosen. 

Through therapy, people with NPD can change their behavior and heal their deeply held, negative beliefs about themselves. Although some traits will remain, they can get in remission for NPD. 

Symptoms of NPD include:

• Grandiose sense of self-importance
• Believing they deserve success, power, love, beauty, and other highly valued qualities.
• Thinking they are unique or superior 
• Preoccupation with what others think
• Sense of entitlement
• Consciously or unconsciously using others
• Lack of empathy
• Seeing the desires and needs of others as a weakness
• Belittling others’ achievements
• Envious of others’ success
• Arrogance, often resulting in snobbiness or talking down to others 

The inner “wound” of someone with narcissistic personality disorder is a low sense of self-concept, which includes self-esteem, self-worth, and self-image. This means they are unable to provide internal validation for who they are, and must seek it from outside sources. 

Finally, it’s important to note that having Narcissistic Personality Disorder is very different from having high levels of narcissism, which is a personality trait. 

Borderline Personality Disorder

Borderline Personality Disorder, or BPD, is the other commonly known personality disorder. The prevalence is relatively unknown, with best estimates in between .7% and 2.7% in the adult U.S. population. Similar to NPD—and most Cluster B Personality Disorders—the core issue of BPD is an unstable sense of self. Their perception of themselves and others shifts rapidly, which can make it difficult to manage healthy, long-term relationships. 

Symptoms of Borderline Personality Disorder include:

• Intense fear of abandonment, which leads to frantic efforts to avoid real or imagined separation.
• Unstable relationships are marked by alternating between idealization and devaluation.
• Persistently unstable self-image or sense of self.
• Impulsive behaviors like spending sprees, unsafe sex, substance abuse, reckless driving, binge eating, or sabotaging success.
• Recurrent suicidal behaviors, threats, gestures, or self-injurious behavior.
• Mood swings that can last from a few hours to a few days, which can include intense episodic sadness, irritability, or anxiety.
• Chronic feelings of emptiness and loneliness.
• Inappropriate, intense anger or difficulty controlling anger.

It is estimated that the heritability of BPD is about 40%—meaning around 40% of BPD is caused by genetics and the rest by environmental factors—however, more research must be done to determine how important genetics are to the development of BPD and the interplay between genetics and environment. 

Almost all studies show a correlation between adverse childhood experiences and trauma to the development of BPD. It is commonly also found in people with PTSD, depression, anxiety, and substance use, which can complicate recovery but does not make it impossible.

Antisocial Personality Disorder

Antisocial Personality Disorder, or ASPD, is commonly known as sociopathy. ASPD is a challenging disorder because it frequently involves disregard for others and disruptive, illegal behaviors. 

However, not everyone with ASPD is inherently violent. There are violent sociopaths, yes. Sadism—finding joy in the suffering of others—is linked to higher levels of psychopathy, which can be a symptom of ASPD. More research has to be done in this interconnecting field, but the current consensus is that psychopathy is a severe form of ASPD. So while most psychopaths have ASPD, very few people with ASPD are also psychopathic. Personality disorders, like all mental health disorders, are on a spectrum.

Symptoms of Antisocial Personality Disorder include:

• Disregard for right and wrong, leading to repeated violations of the law.
• Deceitfulness, lying, conning others for personal profit or pleasure.
• Impulsivity or failure to plan ahead.
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
• Reckless disregard for safety of self or others.
• Consistent irresponsibility, like failing to honor financial obligations or work commitments.
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

ASPD is a long-term disorder, but through therapy, treatment, and support, people with ASPD can get into remission from their symptoms. They will, however, likely experience some levels of symptoms for the rest of their life. 

Finally, in a theme you’ll see for all of these disorders, childhood trauma likely played a big role in the development of this disorder, along with genetic factors.

Histrionic Personality Disorder

Histrionic Personality Disorder (HPD) is probably the least well-known of Cluster B personality disorders, despite having about the same prevalence as the other disorders mentioned here. (HPD has a prevalence of between .4% to 1.8%.)

The core issue of histrionic personality disorder is the need to be the center of attention. They may come across as overly dramatic, extroverted, flirtatious, seductive, insincere, and attention-seeking. However, this behavior is driven by a deep fear of not being valued, which is compensated for by attempting to always be in the spotlight.

Symptoms of Histrionic Personality Disorder include:

• Constantly seeking attention or reassurance, often by acting dramatically or provocatively.
• Engaging in inappropriate behaviors to gain attention, like wearing seductive clothing or flirting excessively.
• Shifting emotions rapidly and uncontrollably, often reacting dramatically to minor events.
• Being easily influenced by others or situations, especially those that could provide attention or approval.
• Consistently being concerned with physical appearance and using it to gain attention or approval.
• Having a shallow expression of emotions, and appearing to lack genuine warmth or empathy.
• Being easily bored or unsatisfied with routine activities and seeking stimulation or novelty to feel alive.

Treatment for Histrionic Personality Disorder is still being researched. Talk therapy seems to be less effective for histrionic personality disorder, but can be helpful when addressing common comorbidities like substance use, anxiety, and depression.

Conclusion

Through therapy, medication, and a strong support system, people with Cluster B Personality Disorders can learn from their behavior, address their past trauma, and change for the better. 

If you have a personality disorder, Lifebulb Counseling can help. We have experienced specialist therapists who are comfortable treating Cluster B Personality Disorders. Call our team to learn more, or browse our list of therapists to find one that suits your needs.

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