Cluster B Dramatic and Emotional Personality Disorders

Clnster B includes the so-called dramatic and emotional disorders. This group is comprised of antisocial personality disorder (ASPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and histrionic personality disorder (HPD). In each of these disorders, the person is attention seeking, is emotionally unstable, and finds it difhcnlt to conform to social norms. Unlike the odd and eccentric Cluster A patients and the anxious and withdrawn Cluster C patients, those with Cluster B personality disorders seldom escape clinical attention for very long. The disruptive nature of these personality disorders often leads them to psychiatric or legal intervention no later than their early adult life. 

Despite overlapping symptoms in the Clnster B personality disorders, there are key distingnishing characteristics of each. Antisocial personality disorder (ASPD) is characterized by a patient s lack of concern for and repeated victimization of others. For this reason, the popnlar terms sociopath and psychopath have been applied to those with an antisocial personality. This indifference toward the feelings of others can also be seen in those with a narcissistic personality, bnt in that case it serves to feed the narcissist s need for admiration. The antisocial patient instead nses others as a means to gain some material or hnancial beneht. Of course, there are patients who fnlhll the diagnostic criteria for both narcissistic and antisocial personality disorders. 

Borderline personality disorder (BPD) is the most common and best described of all the personality disorders. These patients lack stability in their relationships, have a clonded concept of their own identity, and have trouble modulating their mood. Their lives are often characterized by chaos as they frantically seek intensely 

The patient with histrionic personality disorder (HPD) craves attention from others and resorts to excessive displays of emotion to obtain it. Like the narcissistic patient, the histrionic demands to be the center of attention but typically without the haughty arrogance of the narcissist. They are also manipulative and easily frustrated like the antisocial patient but able to experience remorse and are generally more law abiding. Finally, the histrionic patient experiences mood instability much like the borderline patient but is typically not as severely impaired. Whereas the borderline patient is frequently self-destructive and feels chronically empty, the histrionic patient is usually not prone to these more severe disturbances. 

The prevalence of the Cluster B disorders parallels that of the other personality disorders. Rates range from 1% to 2% of the general population for each of the Cluster B disorders. Despite these rates that parallel the other personality disorder clusters. Cluster B patients command a considerable bulk of our clinical resources. In particular, BPD is the most common of the personality disorders receiving care in most psychiatric settings. The dramatic nature of the Cluster B disorders leads to severely disruptive and erratic behavior that commands clinical attention as opposed to the quiet and unobtrusive psychopathology seen in the Cluster A and Cluster C disorders. 

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