Cluster B Personality Disorders

Persons afflicted with personality disorders are commonly found in the mainstream. They do not look strange and their public behaviour falls within acceptable and tolerable parameters. However, they can be dangerous... [they] always create victims. Victims experience physical, mental and emotional losses. Victims experience a reduction in self worth, unnecessary guilt, and emotional trauma... It is through the creation of these victims that the intrinsic needs of the personality disordered person are met. Their actions have purpose and intent. The pain and suffering experienced by the victim is premeditated. It is only through the creation of these feelings that the needs of the disordered person are fulfilled. These disordered persons find no fault with their behaviour, and accept no responsibility for the victim's predicament or feelings.
(Source: Further reading 1)

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations...and its onset can be traced back to early adulthood or adolescence. 
(Source: Further reading 2)


In other words, a personality disorder is a "maladaptive way of relating to the world", and has potential to cause harm to self and/or others. According to DSM-5's "hybrid methodology", there are six personality disorder types (originally, it was 10 types, grouped into three 'clusters': A - "odd, eccentric", B - "dramatic, emotional, erratic", and C - "anxious, fearful" - see diagram below).

These six are:

1. Borderline Personality Disorder
2. Obsessive-Compulsive Personality Disorder
3. Avoidant Personality Disorder
4. Schizotypal Personality Disorder
5. Antisocial Personality Disorder
6. Narcissistic Personality Disorder

Narcissistic Personality Disorder (NPD) is still often referred to as a "Cluster B" Personality Disorder, along with Antisocial and Borderline Personality Disorders (and another 'Cluster B' type, not included in the above list, is Histrionic Personality Disorder).

These are characterised by problems with impulse control, interpersonal relationships and emotional regulation and/or unpredictable thinking or behaviour. A rather crass (but nevertheless reasonably useful) simplification of the three clusters - 'Mad, Bad and Sad' - is shown below. (To clarify, "schizotypal", considered a "mild, arrested or premorbid form of schizophrenia", is classified as 'A', and "avoidant" and "obsessive compulsive" are classified as 'C'.) Obviously there are different gradations of each disorder; for example, someone may exhibit numerous narcissistic traits but this does not mean that a diagnosis of NPD is necessarily appropriate - narcissism is best considered on a continuum or 'spectrum' (see my post 'Are malignant narcissists evil?')

In very basic terms, the characteristics of the Cluster B disorders are as follows (although they often overlap):

1. A person with antisocial personality disorder (APD) might be referred to as a sociopath or a psychopath, although there is no clinical diagnosis for either sociopathy or psychopathy, and it is important to remember that these are three distinct categorisations. (I will write more about psychopathy and sociopathy in other posts, as technically all psychopaths and sociopaths are narcissists, but only the worst malignant narcissists will pass the so-called 'Psychopath Test'.) People with APD often feel little or no empathy toward other people, no remorse for causing hurt (which they do, constantly) and many possess a "glib, superficial charm" which enables them to ensnare a succession of unsuspecting partners (they also tend to be sexually promiscuous or immoral). They are generally irresponsible, which is often reflected in a destructive propensity to break the law and indulge in a variety of addictions.

2. Borderline Personality Disorder is characterised by impulsive, unstable and erratic emotions and reactions, and people with BPD frequently experience heightened anxiety (including panic attacks), distressing emotional states (including fear, loneliness, intense sadness and desperation), difficulty in establishing relationships, and they may self-harm. (I think it's a little unfair categorising BPD with the so-called 'bad' disorders, because unlike the other three, those with BPD do seem to genuinely suffer from their condition, whereas those with the other Cluster B disorders tend to cause suffering for everyone else.)
For more about the symptoms, prognosis and treatment of BPD, click here.

3. A person with Histrionic Personality Disorder has a low boredom threshold and extremely short attention span, craving constant attention and demanding instant gratification. This disorder is characterised by excessively intense emotions and mood swings, a tendency to over-dramatise, an obsessive need for public approval and praise, and disproportionately high energy levels, which can understandably be a source of great stress, vexation and exhaustion to friends and family.

4. Those with Narcissistic Personality Disorder may have elements of all three other Cluster B disorders. Certainly they have a distinctly undeveloped (or non-existent) conscience, and they 'project' uncomfortable feelings such as remorse, shame or guilt. As the Mayo Clinic website so succinctly explains, NPD "is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."



Further reading:

1. Dobbert, Duane Understanding Personality Disorders: An Introduction, Rowman & Littlefield, 2010

2. http://psychcentral.com/disorders/

NPD information sources