So now that we've covered cluster A, let's move on to the next letter of the alphabet and talk about cluster B. As you'll remember from our personality disorder party mnemonic, cluster B consists of borderline, antisocial, narcissistic, and histrionic personality disorders, which are the most likely to get banned from future parties. Cluster B personality disorders are very common in clinical settings. For this reason, we'll be covering these disorders in a higher level of detail including entire videos on borderline personality disorder and antisocial personality disorder. In this particular lecture, we'll focus primarily on the underlying patterns common to all four cluster B personality disorders, and then explore reasons for the differences in clinical presentation between them.
This cluster is sometimes known as the wild cluster due to the emotional instability associated with each disorder. Indeed, one of the core factors linking all patients with cluster B personality disorders together is the ability to connect the two. is their sense that their emotions are unbalanced, with feelings of sadness, dissatisfaction, anger, irritability, and emptiness being common. The involvement of extreme emotional states makes these disorders commonly misdiagnosed as mood disorders like depression and bipolar disorder. However, it's important to realize that cluster B personality disorders are not defined by any single mood state but rather by a tendency towards negative emotions of all kinds.
This tendency maps to the ocean trait of high neuroticism which is a characteristic found in all four of these disorders. In addition, people with cluster B personality disorders often suffer from low self-esteem, an unstable sense of identity, and an extreme sensitivity to rejection or criticism. These patients are sometimes said to lack the same thickness of emotional skin that most people have, and will often be deeply wounded by even seemingly slight indignities. This combination of emotional instability and poor self-image is at the heart of all four cluster B personality disorders.
Despite these shared roots, however, there are some pretty significant differences in how patients with each of these disorders will present clinically. The differences between borderline, antisocial, narcissistic, and histrionic personality disorder end up being based primarily on two things, severity and gender. Borderline and antisocial personality disorders are both incredibly disabling, with many patients finding themselves unemployed, socially isolated, and even repeatedly hospitalized or incarcerated.
In contrast, narcissistic and histrionic personality disorders are often less impairing, and many patients are able to hold jobs and support themselves. Instead, the dysfunction here tends to manifest primarily in terms of maintaining social relationships. The other differentiating factor to be aware of here is gender. Borderline and histrionic personality disorder are diagnosed more often in women, while antisocial and narcissistic personality disorder are diagnosed more often in men. This mostly has to do with culture-bound differences in how men and women are allowed to express emotion and distress, as we'll see when we talk about each disorder.
The important thing to keep in mind here is that the core cluster B pattern of emotional instability plus poor self-image is equally common in both men and women. Okay, now that we have a conceptual basis for cluster B, let's talk about each of the four disorders in more detail. starting with Borderline Personality Disorder, or BPD.
BPD is a syndrome of chronic instability in multiple areas of life. The mnemonic eye despair can be used to remember the core signs and symptoms of this disorder, including identity disturbance and poor self-image, chronic dysphoria and feelings of emptiness, emotional instability with rapid swings from one emotion to another, a tendency towards suicidal acts and self-harm, psychosis-like or dissociative symptoms, especially during times of stress, chronic anger and even hostility towards others, recurrent impulsivity with a tendency to act quickly without fully considering the consequences, and finally unstable relationships characterized by a high sensitivity to interpersonal rejection, frantic efforts to avoid abandonment, an intolerance of being alone, and a tendency to see the world in extreme or black and white terms known as splitting. BPD is on the severe end of the cluster B spectrum, and patients often have trouble holding a job, staying in school, and maintaining close relationships.
It's diagnosed more commonly in women than men, as almost all of the core symptoms of this disorder are more associated with cultural expectations of women compared to men. Luckily, treatment for BPD does exist, with dialectical behavior therapy, or DBT, being the most well-known example. That's only a very brief overview. but if you want to learn more about this challenging and fascinating disorder, we do a deeper dive in another lecture, so go check that out when you have a chance.
Next, antisocial personality disorder is characterized by a persistent pattern of behavior that infringes on the rights of others. You can use the mnemonic acid liar to remember the important features here. First, out of all the personality disorders, ASPD is the only one that cannot be diagnosed in children, with the DSM requiring that the diagnosis be reserved only for adults over the age of 18. The rest of the acronym spells out the specific ways in which patients with ASPD engage in antisocial behavior, including recurrent criminality, a high degree of impulsivity and difficulty controlling their behavior, a reckless disregard for their own safety and the safety of others, frequent lying, cheating, or deceit, chronic irresponsibility and failure to honor debts or care for their families, outright aggression or even physical violence, and finally a pattern of remorselessness when asked about their behavior.
Like BPD, ASPD is on the severe end of the cluster B spectrum, with many patients ending up with criminal records and being unable to hold a job or maintain relationships. Unlike BPD, however, ASPD is diagnosed more commonly in men than women. as irritability and aggression are seen as more culturally acceptable for men compared to the self-harm and care-seeking patterns that define BPD. Nevertheless, for most patients with ASPD, the core pattern here is the same as for BPD, emotional instability plus poor self-image that leads to impulsive acts.
Treatment for ASPD is notoriously difficult with many patients showing poor motivation for treatment. This is another disorder where there is so much more to say, so please stay tuned to learn more about ASPD in an upcoming lecture. Next, narcissistic personality disorder is characterized by a sense of inflated self-importance. People with this disorder believe that they are superior to those around them, demand to be admired for their supposed greatness, have a sense of entitlement with expectations of special treatment, tend to be arrogant towards or dismissive of others, frequently fantasize about personal success or power, and are obsessed with the idea that other people are envious of them.
These behaviors are often accompanied by an inability to empathize with others'feelings, leading to them trampling upon the emotions of others by manipulating or taking advantage of them. While people with narcissistic personality disorder act in a way that suggests a strong sense of self-worth, in reality these behaviors are really just coping strategies to hide the same sense of insecurity and fear of being unloved that is found across all cluster B personality disorders. High emotional reactivity is often seen as well, particularly when it comes to receiving criticism or not being the center of attention. Compared to other cluster B disorders, narcissistic personality disorder is on the less severe end of the spectrum and is not quite as impairing as borderline or antisocial personality disorder. While these patients can often be manipulative, they usually don't hit the same level of the reckless disregard for the safety of others as seen in ASPD.
In addition, their impulse control is generally better than in either BPD or ASPD, and most are able to support themselves and may even be highly successful in their careers. Instead, the place where people with narcissistic personality disorder struggle the most is when it comes to relationships, as their constant bragging, attention seeking, and need for validation can be incredibly wearying for those around them. Narcissistic personality disorder is diagnosed almost twice as often in men as in women. as, in many societies, it is more culturally acceptable for men to use accomplishments and success as a way to mask an inner insecurity.
Finally, histrionic personality disorder is defined as a pattern of excessive or exaggerated behaviors intended to become the center of attention or gain the approval of others. These include seductive or provocative behaviors, over-the-top expressions of emotion, flashy dress or makeup, theatrical speech, and an unstable affect. These behaviors are often accompanied by a high degree of suggestibility and proneness to peer pressure, as well as a tendency to feel that relationships are more intimate than they actually are.
Like all cluster-free disorders, these patterns stem from an intense desire to be loved, which is itself related to a poor self-image and an unstable sense of identity. In a lot of ways, the core pattern of histrionic personality disorder is very similar to narcissistic personality disorder, and that both are characterized by an inner insecurity for which patients engage in compensatory behaviors to gain attention or approval. In histrionic personality disorder, this takes the form of dramatic, flirtatious, or provocative behaviors, while in narcissistic personality disorder, it involves repeatedly boasting about one's accomplishments or self-worth. Given that histrionic personality disorder is diagnosed four times as often in women than men, it is likely that these differences in expression of the same core disorder are mediated by societal expectations for each gender, with it being more acceptable for women to engage in flirtatious behaviors while men are encouraged to brag or boast. On the severity scale, histrionic personality disorder is the least impairing disorder in cluster V. While the behavior people with histrionic personality disorder can come across as manipulative or obnoxious, it tends to lack the anger, destructiveness, and impulsivity seen in BPD or ASPD and is seldom associated with severe impairment in the same way that they are.
Notably, histrionic personality disorder is the only one in cluster B that does not have a clear relationship to a history of childhood abuse. It's likely that people with histrionic personality disorder share a similar vulnerability to other cluster B disorders, but take a different path in life due to having experienced fewer environmental stressors during development. For all these reasons, histrionic personality disorder is the least likely of the four cluster B disorders to come to clinical attention as a primary diagnosis. So those are the cluster B personality disorders in a nutshell. I hope that this video has convinced you that the four cluster B personality disorders all have the same pathology at their core, with the main distinctions being the level of severity as well as culturally mediated differences in expression along gender lines.
In the next video, we'll dive into the final cluster of personality disorders. In the meantime, consider leaving a like, commenting below, subscribing to the channel, or checking out my books on Amazon. Bye for now.