Cluster B Personality Disorder

Aka: Cluster B Personality Disorder, Dramatic Personality Disorder, Histrionic Personality, Antisocial Personality, Narcissistic Personality, Sociopath, Psychopath

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II. Definitions

  1. Cluster B Personality Disorder
    1. Dramatic, emotional or eratic personalities

III. General Features of all Cluster B personalities

  1. Dissociation or Denial
    1. Inadvertent liars
    2. Borderline
    3. Abuse
  2. Splitting ("the good, the bad, and the ugly")
  3. Hysteria to Somatization
  4. Conversion ("now maybe you can see it")
  5. Acting Out ("I'll show you")

IV. Type: Antisocial Personality (Sociopath, Psychopath)

  1. Characteristics (onset as child)
    1. Disregards and violates other's rights
      1. Aggressive, fights, difficult peer relationships
      2. Hyperactive, irresponsible, frequent job change
      3. Lying, theft, Drug Abuse and Alcohol Abuse
    2. No remorse for wrongdoing and no empathy
    3. Consistently irresponsible, unable to maintain consistent work or to honor financial responsibilities
  2. Altered interpretation of illness and physician
    1. Anger, manipulation, lies mask fear
    2. Sense of entitlement
    3. Impulsive
  3. Recommended physician approach
    1. Communicate clearly in non-punishing manner
    2. Set limits clearly
    3. Carefully Look into patient's concerns and motives
      1. Check information - do not rely on self-report
  4. Evaluate for comorbid conditions
    1. Drug Abuse or Alcohol Abuse
    2. Schizophrenia
    3. Mania

V. Type: Borderline Personality

  1. See Borderline Personality
  2. Characteristics
    1. Emotional dysregulation
      1. Mood lability (changes within hours from intense transient dysphoria to irritability to anxiety)
      2. Inappropriate intense outbursts of anger, displaying a temper and may get into physical fights
      3. Recurrent suicidal behavior, gestures, threats or self-mutilation
      4. Impulsive (spending, sex, Drug Abuse, Binge Eating)
    2. Interpersonal problems
      1. Unstable relationships, self image, and affect
      2. Loneliness, boredom and sense of emptiness
      3. Unstable and intense interpersonal relationships fluctuating between idealization to devaluation
    3. Disturbed self-identity
      1. Unstable self-image persists
      2. Lacks integrated sense of self
    4. Associated Conditions
      1. High healthcare utilization
      2. Often associated with other mental health disorders
  3. Altered interpretation of illness and physician
    1. Often considered to be "difficult patients"
    2. Fears rejection and isolation
    3. Self-destructive behavior (e.g. exercising on an injury)
    4. Alternates admiration and devaluation of physician
  4. Recommended physician approach
    1. Avoid being overly familiar with patient
    2. Be aware of patient's feelings
    3. Encourage frequent clinic visits
    4. Offer clear, nontechnical explanations
    5. Set limits, but tolerate angry outbursts
    6. Consider psychiatry Consultation
    7. May respond to psychotherapy
  5. Evaluation for comorbid conditions
    1. Major Depression
    2. Delirium
    3. Drug Abuse (e.g. LSD)
    4. Reactive Psychosis

VI. Type: Histrionic Personality

  1. Characteristics (most often occurs in women)
    1. Outwardly appear charming, lively
    2. Inappropriately sexually seductive or provocative behavior
    3. Threatened self-esteem and sense of attractiveness
    4. Egocentric, shallow, immature and dramatic with exaggerated expression of emotion
    5. Seek excitement and attention, often exhibitionists, and uncomfortable when not the center of attention
    6. Suggestable, easily easily influenced by others
    7. Speech style lacks detail
    8. Describes relationships as more intimate than they are
  2. Altered interpretation of illness and physician
    1. Unable to focus on facts and details
    2. Somatization
  3. Recommended physician approach
    1. Avoid being overly familiar with patient
    2. Show professional concern for patient's feelings
    3. Focus on objective concerns
  4. Evaluate for comorbid conditions
    1. Major Depression (higher risk of Suicidality)
    2. Substance Abuse
    3. Somatization Disorders

VII. Type: Narcissistic Personality

  1. Characteristics
    1. Grandiosity, unrealistic self-expectation
    2. Preoccupied with fantasies of unlimited success, power, brilliance, beauty
    3. Believes that he or she is special, unique and can only be understood by high status people or institutions
    4. Sense of entitlement
    5. Need constant admiration
    6. Impulsive and anxious
    7. Takes advantage of others to achieve his or her own ends
    8. Doubts own adequacy
    9. Arrogant and displays haughty behavior
    10. Envious of others
    11. Lacks empathy
  2. Altered interpretation of illness and physician
    1. Alternates admiration and devaluation of physician
    2. Denies illness
    3. Demanding with sense of entitlement
  3. Recommended physician approach
    1. Acknowledge patient's concerns
    2. Respond to questions appropriately and factually
    3. Direct patient's skills to dealing with illness

VIII. Management: Sub-Cluster 1 - Depression

  1. Target symptoms
    1. Major Depression
    2. Interpersonal sensitivity
    3. Impulsivity and Aggression
  2. Medications
    1. SSRI
    2. Consider Mood stabilizer
    3. Consider Atypical Antipsychotic

IX. Management: Sub-Cluster 2 - Bipolar or Mania

  1. Target symptoms
    1. Mood lability
    2. Impulsivity and Aggression
  2. Medications
    1. Mood stabilizer
    2. Consider SSRI
    3. Consider Atypical Antipsychotic

X. Management: Sub-Cluster 3 - Psychosis

  1. Target symptoms
    1. Paranoia
    2. Psychosis
    3. Hostility
    4. Anxiety
  2. Medications
    1. Atypical Antipsychotic
    2. Consider Mood stabilizer
    3. Consider SSRI

XI. References

  1. Tomb (1992) Psychiatry, p. 147-52
  2. (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Washington D.C., APA
  3. Angstman (2011) Am Fam Physician 84(11): 1253-60 [PubMed]
  4. Ward (2004) Am Fam Physician 70(8):1505-12 [PubMed]

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Related Studies

Ontology: Antisocial Personality Disorder (C0003431)

Definition (NCI) A disorder characterized by a pervasive pattern of disregard for and violation of the rights of others that is manifested in childhood or early adolescence. (adapted from DSM-IV)
Definition (MSH) A personality disorder whose essential feature is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. The individual must be at least age 18 and must have a history of some symptoms of CONDUCT DISORDER before age 15. (From DSM-IV, 1994)
Definition (PSY) Personality disorder characterized by conflict with others, low frustration tolerance, inadequate conscience development, and rejection of authority and discipline.
Definition (CSP) personality disorder whose essential feature is a pervasive pattern of disregard for, and violation of, the rights of others through aggressive, antisocial behavior, without remorse or loyalty to anyone.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D000987
ICD9 301.7
ICD10 F60.2
SnomedCT 191769004, 268759009, 191777000, 192487000, 26665006
DSM4 301.7
English Antisocial Personalities, Antisocial Personality, Antisocial Personality Disorder, Disorder, Antisocial Personality, Disorders, Antisocial Personality, Personalities, Antisocial, Personalities, Psychopathic, Personalities, Sociopathic, Personality Disorder, Antisocial, Personality Disorders, Antisocial, Personality, Sociopathic, Psychopathic Personalities, Psychopathic Personality, Sociopathic Personalities, Sociopathic Personality, Antisocial Personality Disorders, Antisocial personality, Personality, Antisocial, Personality, Psychopathic, Psychopathic personality, Sociopathic personality, Antisocial personality disord, Psychopath personality disord, Sociopathic personality disord, Psychopath, Sociopath, ANTISOCIAL PERSONALITY DIS, PERSONALITY DIS ANTISOCIAL, psychopathic personality, sociopathic personality, antisocial personality disorder (diagnosis), antisocial personality disorder, psychopathic constitution, dyssocial personality, Asocial personality, Psychopathic personality (disorder), Asocial personality (disorder), Sociopathic personality (disorder), Antisocial Personality Disorder [Disease/Finding], ASP disorder, Personality;antisocial, dissocial personality disorder, psychopath, psychopaths, sociopathic personalities, sociopathic personality disorder, antisocial personality disorders, sociopaths, sociopath, Sociopathy, Psychopathy, Antisocial or sociopathic personality disorder, Psychopath.personality, Dissocial personality disorder (disorder), Antisocial personality disorders, Antisocial personality disorder, Dissocial personality disorder, Psychopathic personality disorder, Sociopathic personality disorder, Antisocial personality disorder (disorder), asocial personality, asocial; personality disorder, disorder; dissocial personality, disorder; sociopathic, dissocial personality; disorder, dissocial; personality disorder, personality disorder; antisocial, personality disorder; asocial, personality disorder; dissocial, personality disorder; psychopathic, personality disorder; sociopathic, psychopathic; personality disorder, sociopathic; disorder, sociopathic; personality disorder, antisocial; personality disorder, antisocial; personality, Dyssocial personality, antisocial personality, psychopathy
Italian Disturbo di personalità antisociale, Personalità asociale, Disturbo di personalità asociale, Psicopatico, Sociopatico, Personalità antisociale, Personalità sociopatica, Personalità psicopatica, Disturbo antisociale di personalità
Dutch asociale persoonlijkhied, antisociale persoonlijkheid, sociopaat, dissociale persoonlijkheidsstoornis, sociopathische persoonlijkheid, psychopaat, antisociaal; persoonlijkheidsstoornis, antisociaal; persoonlijkheid, asociaal; persoonlijkheidsstoornis, dissociaal; persoonlijkheidsstoornis, dissociale persoonlijkheid; stoornis, persoonlijkheidsstoornis; antisociaal, persoonlijkheidsstoornis; asociaal, persoonlijkheidsstoornis; dissociaal, persoonlijkheidsstoornis; psychopathisch, persoonlijkheidsstoornis; sociopathisch, psychopathisch; persoonlijkheidsstoornis, sociopathisch; persoonlijkheidsstoornis, sociopathisch; stoornis, stoornis; dissociale persoonlijkheid, stoornis; sociopathisch, Dissociale persoonlijkheidsstoornis, antisociale persoonlijkheidsstoornis, psychopatische persoonlijkheid, Antisociale persoonlijkheidsstoornis, Persoonlijkheidsstoornis, antisociale, Psychopathische persoonlijkheid, Sociopathische persoonlijkheid
French Personnalité anti-sociale, Personnalité asociale, Psychopathe, Trouble de personnalité antisociale, Personnalité antisociale, Personnalité psychopathique, Personnalité sociopathique, Trouble de la personnalité de type antisocial
German asoziale Persoenlichkeit, soziopathische Persoenlichkeit, antisoziale Persoenlichkeit, dissoziale Persoenlichkeitsstoerung, Soziopath, Dissoziale Persoenlichkeitsstoerung, antisoziale Persoenlichkeitsstoerung, psychopathische Persoenlichkeit, Psychopath, Abnorme Persönlichkeit, Antisoziale Persönlichkeitsstörung, Persönlichkeitsstörung, antisoziale, Psychopathische Persönlichkeit, Soziopathische Persönlichkeit
Portuguese Sociopata, Perturbação dissociada da personalidade, Psicopata, Personalidade anti-social, Personalidade associal, Personalidade sociopática, Transtorno da Personalidade Antissocial, Doença de personalidade antisocial, Personalidade psicopática, Personalidade Psicopática, Personalidade Sociopática
Spanish Personalidad asocial, Sociópata, Personalidad antisocial, Trastorno disocial de la personalidad, Psicópata, Personalidad sociopática, trastorno antisocial de la personalidad, trastorno antisocial de la personalidad (trastorno), trastorno de la personalidad antisocial (trastorno), trastorno de la personalidad antisocial, trastorno psicopático de la personalidad, trastorno sociopático de la personalidad, Trastorno antisocial de la personalidad, Personalidad psicopática, Personalidad Psicopática, Personalidad Sociopática, Trastorno de Personalidad Antisocial
Japanese 社会病質, 非社交的人格, 反社会性人格, ｼｬｶｲﾋﾞｮｳｼﾂｼﾞﾝｶｸ, ｾｲｼﾝﾋﾞｮｳｼﾂｼﾞﾝｶｸ, ﾊﾝｼｬｶｲｾｲｼﾞﾝｶｸ, ｾｲｼﾝﾋﾞｮｳｼﾂ, ｼｬｶｲﾋﾞｮｳｼﾂ, ﾋｼｬｺｳﾃｷｼﾞﾝｶｸ, 人格異常-反社会的, 反社会的人格異常, 精神病質, 病的人格, 病的人格者, 人格障害-反社会的, 社会病質人格, 非社会的人格, 非社会的行動, 精神病質人格, 異常性格者, 反社会的人格障害, ﾊﾝｼｬｶｲﾃｷﾊﾟｰｿﾅﾘﾃｨｼｮｳｶﾞｲ, 反社会的パーソナリティ障害, 反社会性パーソナリティ障害, ﾊﾝｼｬｶｲｾｲﾊﾟｰｿﾅﾘﾃｨｼｮｳｶﾞｲ
Swedish Antisocial personlighetsstörning
Czech asociální osobnost, antisociální poruchy osobnosti, Psychopat, Psychopatická osobnost, Sociopat, Antisociální osobnost, Antisociální porucha osobnosti, Asociální osobnost, Disociální porucha osobnosti, Sociopatická osobnost
Finnish Epäsosiaalinen persoonallisuus
Russian SOTSIOPATICHESKAIA LICHNOST', ASOTSIAL'NOE POVEDENIE, LICHNOST' ASOTSIAL'NAIA, PSIKHOPATICHESKAIA LICHNOST', ANTISOTSIAL'NYE RASSTROISTVA LICHNOSTI, LICHNOSTI RASSTROISTVA ANTISOTSIAL'NYE, АНТИСОЦИАЛЬНЫЕ РАССТРОЙСТВА ЛИЧНОСТИ, АСОЦИАЛЬНОЕ ПОВЕДЕНИЕ, ЛИЧНОСТИ РАССТРОЙСТВА АНТИСОЦИАЛЬНЫЕ, ЛИЧНОСТЬ АСОЦИАЛЬНАЯ, ПСИХОПАТИЧЕСКАЯ ЛИЧНОСТЬ, СОЦИОПАТИЧЕСКАЯ ЛИЧНОСТЬ
Korean 비사회적 인격장애
Croatian ASOCIJALNA LIČNOST, POREMEĆAJ
Polish Zaburzenie osobowości antyspołeczne, Osobowość asocjalna, Osobowość antysocjalna, Zachowanie dyssocjalne, Antyspołeczne zaburzenie osobowości, Osobowość psychopatyczna, ASPD, Osobowość antyspołeczna
Hungarian Antiszociális személyiségzavar, Antiszociális személyiség, Dissocialis személyiségzavar, Szociopátia, Psychopathiás személy, Aszociális személyiség, Sociopathiás személyiség, Psychopathiás személyiség
Norwegian Dissosial personlighetsforstyrrelse, Personlighetsforstyrrelse, sadistisk, Personlighetsforstyrrelse, sosiopatisk, Psykopati, Sosiopatisk personlighetsforstyrrelse, Personlighetsforstyrrelse, amoralsk, Personlighetsforstyrrelse, dissosial, Sadistisk personlighetsforstyrrelse, Antisosial personlighet, Amoralsk personlighetsforstyrrelse, Antisosial personlighetsforstyrrelse, Personlighetsforstyrrelse, dyssosial, Personlighetsforstyrrelse, psykopatisk, Psykopatisk personlighet, Dyssosial personlighetsforstyrrelse, Personlighetsforstyrrelse, antisosial
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Narcissistic Personality Disorder (C0027402)

Definition (NCI) A disorder characterized by an enduring pattern of grandiose beliefs and arrogant behavior together with an overwhelming need for admiration and a lack of empathy for (and even exploitation of) others.
Definition (PSY) Personality disorder characterized by excessive self-love, egocentrism, grandiosity, exhibitionism, excessive needs for attention, and sensitivity to criticism.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D010554
ICD9 301.81
ICD10 F60.81
SnomedCT 192493008, 80711002
DSM4 301.81
English Narcissistic personality, Narcissistic personal disorder, Personality Disorder, Narcissistic, NARCISSISTIC PERSONALITY DIS, narcissistic personality disorder (diagnosis), narcissistic personality disorder, narcissistic personality, narcissistic personalities, [X]Narcissistic personality disorder, Narcissistic personality disorder, Narcissistic personality disorder (disorder), narcissistic; personality disorder, personality disorder; narcissistic, Narcissistic Personality Disorder
Italian Disturbo narcisistico della personalità, Personalità narcisista
Dutch narcistische persoonlijkheid, narcistisch; persoonlijkheidsstoornis, persoonlijkheidsstoornis; narcistisch, narcistische persoonlijkheidsstoornis, Narcistische persoonlijkheidsstoornis
German narzisstische Persoenlichkeit, Narzißtische Persönlichkeitsstörung, narzisstische Persoenlichkeitsstoerung
Portuguese Personalidade narcísica, Transtorno da Personalidade Narcisista, Perturbação narcísica da personalidade
Spanish Personalidad narcisista, Trastorno de Personalidad Narcisista, trastorno narcisista de la personalidad (trastorno), trastorno narcisista de la personalidad, Trastorno narcisista de la personalidad
Japanese 自己愛性人格, ｼﾞｺｱｲｾｲｼﾞﾝｶｸ, 自己愛性パーソナリティ障害, ｼﾞｺｱｲｾｲﾊﾟｰｿﾅﾘﾃｨｼｮｳｶﾞｲ
French Personnalité narcissique, Trouble de la personnalité de type narcissique, Trouble de la personnalité narcissique
Czech Narcistická osobnost, Narcistická porucha osobnosti, narcistická porucha osobnosti
Hungarian Narcisztikus személyiségzavar, Narcisztikus személyiség
Norwegian Narsissistisk personlighetsforstyrrelse, Personlighetsforstyrrelse, narsissistisk
Derived from the NIH UMLS (Unified Medical Language System)

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