Cluster B Personality Disorders

Cluster B personality disorders are a group of mental health conditions representing styles of interacting with oneself and others. These styles of interacting involve dramatic and erratic behaviors. People diagnosed with these types of conditions have intense, unstable emotions and act impulsively.

The four types of Cluster B personality disorders include:

• Antisocial personality disorder (ASPD): People diagnosed with ASPD show a lack of respect toward others. They generally don’t follow socially accepted rules.
• Borderline personality disorder (BPD): People diagnosed with BPD have difficulty regulating their emotions. This results in low self-esteem, mood swings and impulsive behaviors.
• Histrionic personality disorder (HPD): People diagnosed with HPD have intense, unstable emotions and a distorted self-image. They have an overwhelming desire for others to notice them. They’re easily influenced by others.
• Narcissistic personality disorder (NPD): People diagnosed with NPD have a sense of being better than others. They have an intense need for praise. They lack empathy for others.

These behaviors and thinking patterns can cause distress in many areas of life. This includes work, relationships and socialization.

Traits of Cluster B personality disorders

In general, Cluster B disorder traits include:

• Being dramatic or overly emotional
• Impulsiveness
• Unpredictable or erratic behavior
• Difficulty keeping stable relationships

As with many of the other personality disorders (PDs), people living with Cluster B PDs often don’t realize there’s an issue with their behavior.

Cluster B personality disorders cause

Healthcare providers aren’t sure of the exact cause of Cluster B personality disorders. Research suggests that it’s complex and may involve many factors, from your genetics to certain experiences you had growing up.

Adverse childhood experiences (ACEs) are especially linked to Cluster B PDs. They include:

• Physical and sexual abuse
• Emotional abuse
• Neglect
• Household issues, like divorce, money difficulties and parental mental health conditions

Complications of these conditions

Compared to other personality disorder clusters, people with Cluster B disorders are at increased risk of:

• Substance use disorders, like alcohol use disorder
• Suicidal thoughts and attempts
• Crime (especially those living with antisocial personality disorder)

As with other PDs, people living with Cluster B PDs are more likely to be diagnosed with mood and/or anxiety disorders, as well.

How doctors diagnose this condition

Healthcare providers use criteria in the American Psychiatric Association’s DSM-5 to diagnose Cluster B personality disorders. Each PD type has specific criteria. Providers ask questions about a person’s medical, personal and social history to guide diagnosis.

Diagnosis can be difficult, as most people living with these conditions may not seek treatment. This is often due to community mental health stigma or a lack of insight into their behaviors. So, mental health professionals may also work with the person’s loved ones and other acquaintances to gather more information.

How is it treated?

Psychotherapy (talk therapy) can help you manage living with Cluster B personality disorders. You’ll work with a mental health professional, like a psychologist. They can provide support, education and guidance to you and your family. They can also help you learn healthier ways of navigating emotions and relationships.

There are several types of talk therapy. Some types may work better than others for certain Cluster B PDs. For example, dialectical behavior therapy (DBT) tends to be a more effective treatment for BPD. People with HPD often benefit from cognitive-behavioral therapy (CBT).

Currently, there are no FDA-approved medications to treat PDs directly. But you may take medications to treat symptoms of other mental health conditions you may have, like depression and anxiety.

What is the outlook for someone diagnosed with a cluster B personality disorder?

The outlook (prognosis) for Cluster B personality disorders varies. It depends on your willingness to get treatment and how severe your symptoms are.

Living with an undiagnosed and untreated Cluster B personality disorder may result in:

• Poor relationships, including a lack of stable, healthy partner and friend relationships
• Work issues
• Issues with social functioning, including inaccurately understanding and responding to others’ emotional cues and boundaries

But with treatment, it’s possible to improve your behaviors, thinking patterns and quality of life.