The 4 Types of Cluster B Personality Disorders

Medically reviewed by Elle Markman, PsyD, MPH

There are four types of cluster B (dramatic/emotional) personality disorders: borderline personality disorder (BPD), histrionic personality disorder (HPD), narcissistic personality disorder (NPD), and antisocial personality disorder (ASPD).

A personality disorder is a mental health condition characterized by long-lasting patterns of inner experience and behavior. People with cluster B personality disorders—the most common type of personality disorder—tend to exhibit dramatic emotional and/or erratic behavior. These fixed patterns hurt a person’s ability to function in work, school, relationships, and other aspects of daily life.

This article will discuss cluster B personality disorders, including their traits, causes, diagnosis, and treatment.

Cluster B Personality Disorders Types

Here is an overview of the four types of cluster B personality disorders.

Borderline Personality Disorder

Borderline personality disorder involves a pattern of unstable relationships and self-image, overwhelming emotions, and impulsivity. BPD affects approximately 1.4% of the adult population in the United States, although some estimates are much higher. About 75% of people diagnosed with BPD are women.

Some of the signs and symptoms of BPD include:

• Intense fear of abandonment

• Chronic feelings of emptiness

• Inappropriate anger

• Self-sabotage

• Unstable, intense interpersonal relationships

• Trouble forming consistent self-image

• Impulsive behavior (including substance use or other reckless behaviors)

• Self-harm and/or a history of suicide attempts

Histrionic Personality Disorder

Histrionic personality disorder involves excessive attention-seeking and emotional behavior. Estimates of the prevalence of HPD are around 1.8%. It is more commonly diagnosed in women than in men.

Some of the signs and symptoms of HPD include:

• Demands to be the center of attention

• Dramatic or attention-seeking behavior, appearance, or emotional expression

• Overly seductive behavior

• Impressionistic speech (lacks detail and emphasizes emotions—for example, just saying an event was "wonderful" without saying why it was)

• Rapid shifts in shallow emotions

• Chronic boredom (need to be stimulated by excitement or short-term gratification)

• Hyperfocus on appearance to gain attention

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) involves an inflated sense of self-importance, extreme self-centeredness, and a lack of empathy for other people. Although estimates vary considerably, one study found that about 4% of the population included had NPD. Between 50% and 75% of the people diagnosed with NPD are men.

Some of the signs and symptoms of NPD include:

• Willingness to exploit or take advantage of other people for personal gain

• Exaggerated sense of self-worth

• Preoccupation with grandiose ideas of beauty, power, talent, intelligence, success, or importance

• Selfish goals and behavior

• Lack of empathy for others

• Difficulty accepting criticism

• Feelings of entitlement to special treatment

• Requires excessive admiration

Antisocial Personality Disorder

Antisocial personality disorder involves long-lasting disregard for the rights, feelings, needs, and safety of others. About 3% to 5% of the general population meets the criteria for ASPD at some point during their lifetime, and it is more common among men than women. It is the most common psychiatric diagnosis among incarcerated people.

Some of the signs and symptoms of ASPD include:

• Repeatedly breaking the law and/or rules (at work or school)

• Manipulativeness

• Superficial charm and flattery

• Lying, cheating, and/or stealing

• Substance abuse

• Physical aggression

• Reckless behavior

• Willingness to exploit others and put them in danger

• Lack of remorse, guilt, compassion, and empathy

• Chronic irresponsibility

Comorbid Personality Disorders

It’s possible to have more than one personality disorder. A person may have two or more comorbid cluster B personality disorders or personality disorders across multiple clusters.

Related: Histrionic vs. Narcissistic Personality Disorder

Cluster B Personality Disorder Traits

Each of the four cluster B personality disorders is different. However, they tend to share certain maladaptive personality traits in common. Maladaptive traits affect someone’s ability to function, typically in work, school, relationships, and other parts of daily life.

Cluster B personality disorders are associated with the following traits:

• Emotional dysregulation (trouble managing one’s emotions and emotional responses)

• Dramatic or attention-seeking behavior

• Hypersensitivity

• Impulsivity

• Unpredictability

• Lack of inhibition

• Externalizing behaviors (no respect for authority, not following rules, or refusing to fit in with cultural norms)

Maladaptive cluster B personality traits are associated with higher rates of physical health conditions, divorce, and unemployment. They have also been linked to a higher risk of emotional distress, substance abuse, social isolation, hospitalization, and suicide.

Cluster A and Cluster C Personality Disorders

The 10 personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) are divided into three “clusters” (A, B, and C) based on the maladaptive or harmful personality traits that people with each disorder tend to have.

People with cluster A personality disorders—paranoid personality disorder (PPD), schizoid personality disorder (SPD), and schizotypal personality disorder (STPD)—have odd and eccentric traits.

People with cluster C personality disorders—dependent personality disorder (DPD), obsessive-compulsive personality disorder (OCPD), and avoidant personality disorder (APD)—have excessive fear and anxiety.

Cluster B Personality Disorders Causes

There is no single known cause of cluster B personality disorders. However, several factors appear to increase the risk of developing a cluster B personality disorder, including:

• Genetics: Research suggests that family history and certain genetic variations may contribute to the risk of developing a cluster B personality disorder. People with at least one immediate family member with HPD, NPD, BPD, or ASPD are significantly more likely to meet the diagnostic criteria for the same disorder.

• Brain structure: Research suggests that differences in brain structure and chemistry may play a role in the development and severity of cluster B personality disorders. For example, many people with ASPD have impaired function in the prefrontal cortex—an area of the brain involved in complex thinking and decision-making.

• Environmental factors: Certain early childhood events, experiences, and parenting styles may increase the risk of developing a cluster B personality disorder. Studies have shown, for example, that children whose parents are slow to display affection and who excessively praise them are more likely to develop narcissistic traits and/or NPD. Some researchers believe that people with HPD craved attention from neglectful or distracted caregivers as children.

• Trauma: Experiencing trauma, such as physical, emotional, and/or sexual abuse (especially during childhood), significantly increases the risk of developing a personality disorder. For example, studies have found that a significant percentage of people with BPD experienced severe childhood abuse or neglect. Children with at least one parent with a substance use disorder (SUD), such as alcohol use disorder (AUD), are significantly more likely to develop ASPD later in life.
  

Cluster B Personality Disorders Diagnosis

A mental health professional can diagnose a cluster B personality disorder using the criteria in the DSM-5. Most people are not diagnosed with personality disorders until they are 18 years old or older.

To be diagnosed with a personality disorder, your symptoms must have lasted a specific amount of time. Your symptoms must also negatively affect your ability to function and your quality of life in at least one major area (such as work, school, family life, or romantic relationships).

With your permission, your healthcare provider may talk to your spouse, family members, or other loved ones to gain insight into your behavior.

Cluster B Personality Disorders Treatment

Evidence-based therapies are more widely available for some cluster B personality disorders than for others. Treatment for HPD, ASPD, BPD, and NPD typically starts with psychotherapy.

If you have a cluster B personality disorder, these are some types of therapy that may be beneficial:

• Dialectical behavior therapy (DBT): DBT is a specialized form of psychotherapy that helps to reduce self-harm, suicidal impulses, and emotional instability. It is especially effective in treating BPD.

• Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that can help people recognize and change maladaptive thinking and behavior. It has been shown to improve social functioning and emotional expression in people with personality disorders.

• Couples or family counseling: Many people with cluster B personality disorders have trouble forming and maintaining healthy, long-lasting connections with loved ones. Couples counseling, family counseling, and educating family members about the diagnosis may help reduce conflict and improve relationships.

• Psychoeducation: Recent research suggests that psychoeducation—improving a person's understanding of their condition—may reduce harmful drug and alcohol use by people with ASPD.

• Medication: The Food and Drug Administration (FDA) has not approved any medication specifically to treat personality disorders. However, some prescribed medications, including anti-anxiety medication, antidepressants, and antipsychotics, may reduce symptoms of comorbid mental health conditions.

• Treatment of other mental health conditions: About 85% of people with a personality disorder meet the criteria for at least one other mental health condition, like substance use disorder or depression. To function well, a person needs access to treatment for all mental health conditions they have.

People with ASPD are unlikely to seek treatment on their own. They often only get a diagnosis and start treatment if they are required to (for example, because they are in an inpatient setting or have been ordered to get treatment by a court of law).

The outlook might be better for people with other personality disorders who are more likely to seek or accept treatment. For example, many people with BPD who receive treatment achieve remission of their symptoms for a year or more.

Related: What Is Dialectical Behavior Therapy?

When to Talk to a Healthcare Provider

Talk to your healthcare provider if you have any of these possible signs of a cluster B personality disorder:

• Relationship challenges

• Frequent conflicts with others

• Out-of-control emotions (such as anger, hopelessness, or emptiness)

• Trouble connecting and relating to other people
  

• Impulsivity or chronic boredom

• Problems at work or school

• Putting yourself in risky situations

• Excessive drug or alcohol use

• Conflicts with the law
  

Seek Help

If you or a loved one is thinking about self-harm or harming someone else, seek help right away. If you or a loved one is having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. For more mental health resources, see our National Helpline Database. If you or someone else is at immediate risk, dial 911.

Outlook for Cluster B Personality Disorder

Cluster B personality disorders are lifelong (chronic). They are not curable, but people may go into remission if their symptoms are well controlled. Some personality disorder symptoms can peak during adolescence and may become less pronounced as a person gets older.

Some personality disorders tend to have better outlooks than others. For example, people with ASPD often only get a diagnosis and start treatment if they are required to (e.g., after being admitted to an inpatient treatment setting or being ordered to get treatment by a court of law).

Sometimes, people with personality disorders don't seek help because they're ashamed or they do not have access to medical care that could offer diagnosis and treatment.

When people with personality disorders can seek, access, and accept treatment, their outlook is often much better. For example, many people with BPD who receive early treatment achieve remission of their symptoms for a year or longer.

Living with a cluster B personality disorder can be challenging, especially if a person is not able to access support. Research has shown that people living with cluster B personality disorders are more likely to use healthcare, especially in emergency settings (including mental health services), and may have a lower life expectancy due to factors like other medical conditions and suicide.

If you're having symptoms you think could be from a personality disorder, don’t be afraid to talk to your healthcare provider. Getting a diagnosis, learning about your condition, and finding a treatment that works for you can improve your emotional health, relationships, quality of life, and overall well-being.

How to Relate to Someone With a Cluster B Personality Disorder

If someone you care about or live with has a cluster B personality disorder, it's important to balance showing them compassion with taking care of your own needs.

While you should encourage your friend or loved one to seek help and support, you also need to make your boundaries and expectations clear. You can be willing to hear the other person out about their concerns, but you still need to prioritize your mental health and safety.

Keep triggers in mind when you’re interacting with someone with a personality disorder. Every personality disorder is associated with different possible emotional triggers. The triggers you should watch for will depend on what personality disorder a person has.

For example, people with narcissistic personality disorder (NPD) often react strongly to perceived criticism or humiliation. Meanwhile, people with borderline personality disorder (BPD) have an overwhelming fear of abandonment or the perceived threat of abandonment. People with histrionic personality disorder (HPD) may get frustrated when they don't feel they're getting the right kind of attention or enough attention.

Remember that people with personality disorders often face stigma and shame. Having an open mind, empathy, and a non-judgmental attitude can help you communicate effectively with a person who has a personality disorder.

Lend the person a friendly listening ear, but set boundaries with them. If you need to detach from someone with a personality disorder, clearly state that you are going to end your relationship with them and follow through.

You may want to talk to a therapist and reach out to your support system. If your safety is at risk, ask for help and leave the situation as soon as possible.

Summary

Cluster B personality disorders are chronic mental health conditions that involve long-term patterns of dramatic, emotional, and/or erratic thinking and behavior. The four types of cluster B personality disorders are borderline personality disorder (BPD), histrionic personality disorder (HPD), narcissistic personality disorder (NPD), and antisocial personality disorder (ASPD).

Many possible factors contribute to the development of cluster B personality disorders, including genetics, environmental factors, childhood trauma, and brain structure.

The first-line treatment for cluster B personality disorders is psychotherapy. In some cases, medication may be prescribed to help with certain symptoms.

Read the original article on Verywell Health.