Personality Disorder Series Part III

Cluster B Personality Disorders

Cluster B has four types of disorders. They all have a quality to their symptom criteria that it is an underlying and pervasive patterns of behaviors and is not related to or a symptoms of mood, anxiety, or thought disorders.

The first in this cluster is the Antisocial Personality Disorder. People with this particular disorder has a disregard for and violation of the rights of others. It initially manifests around middle adolescence (15 to 17 years;usually diagnosed with Conduct Disorder). This diagnose is reserved for someone over the age of 18. Inidividuals with antisocial personality disorder are characterized by failure to comply with social norms with respent to lawful behaviors which often leads to multiple arrests. These individuals are deceitful (i.e. lying repeatedly, usage of ailias, conning others for their own profit/pleasure), impulsive, easily agitated and resort to aggressive behaviors readily (i.e., fights, assaultive behaviors). They are also exhibit reckless disregard for the safety of others or self and are consistently irresponsible as evidenced by inability to maintain a job or honor financial obligations. The most significant characteristic of someone with antisocial personality disorder is that they lack remorse. They are indifferent to or rationalize having to hurt, mistreat, or steal from others for their gain or pleasure.

The second in the cluster is Borderline Personalit Disorder. Symptoms start to manifest in middle to late adolescence and is marked by instability of interpersonal relationships, self-image, and affects, as well as higher than norm impulsivity. Individuals with Borderline Personality Disorder is characterized by showing frantic efforts to avoid real or imagine abandonement. They also exhibit a pattern of unstable and intense interpersonal relationship marked by alternating between extremes of idealization and devaluation (e.g., "you are the best person even" to "I hate you"). They have unstable self image or sense of self and show impulsivity in potentially self-harming areas (e.g., excessive spending, sex, gambling, self-mutilation). They also often exhibit suicidal behaviors, gestures, or threats, and experience intense moods/reactions that are not congruent to situation or event at hand. They report chronic feelings of emptiness, have inappropriate and intense anger that they cannot control which can lead to physical fights or frequent displays of temper and anger without clear provocation. Lastly, these individuals experience transient, stress-related paranoia or severe dissociative symptoms. Most patients diagnosed with BPD are women between the ages of 16 to 45 and most likely have a history of abuse (most often of sexual in nature).

The third disorder is called the Histrionic Personality Disorder. This one is marked by excessive emotionality and attention seeking behaviors. It usually emerges in early adulthood. Characteristics of this disorder are feelings of discomfort in situations in which they are not the center of attention, interaction with others that are inappropriately sexually seductive or provocative in nature, displays of rapidly shifting emotions with superficial expression. Individuals with histronic personality disorder consistently use physical appearance to draw attention to themselves and has a style of speech that is excessively impressionistic but lacks in any substantive details. They often show self-dramatization, theatricality and exaggerates emotional expression (drama queens), and is quite suggestible or easily influenced by others/circumstances. These people consider relationships to be more intimate than they actually are and often will reveal provocative information about themselves or their lives.

The last in this cluster is called the Narcissistic Personality Disorder. This disorder is characterized by a pattern of grandiosity, need for admiration (undeserved), and lack empathy. Individuals with narcissistic personality disorder have grandiose sense of self-importance and are preoccupied with fantasies of success, power, beauty, intelligence or perfect relationships. They believe that they are special and unique and can only be understood by other special or high-status people. These individuals require excessive admiration and have a sense of entitlement (i.e., unreasonable expectations of favorable treatment or abiding by their wishes without question). They are exploitative in their interpersonal relationships and take advantage of others to achieve their own ends. They lack empathy and are unwilling to recognize or identify needs and feelings of others. They are often envious of others or believe that others are envious of them. Lastly, they are arrogant, haughty in behaviors or attitudes.

Cluster B diagnoses are most often seen in practice vs. A or B. They most often have issues that they feel are cause or originated by or due to others around them and have difficult time accepting and working in treatment.

Next blog will address the last of the three personality clusters so stay tuned.

Personality Disorder Series Part II

Cluster A Personality Disorder

As stated in the previous blog, personality disorders have 3 subcategories. Today, I will discuss the first of the three, Cluster A Personality disorders

First is called the Paranoid Personality Disorder. It is characterized by pervasive distrust and/or suspiciousness of others to the point that their motives are interpreted as malicious and malevolent, but that such feelings are not related to or experienced during a course of thought disorders such as schizophrenia, or mood disorders with psychotic features. This disorder emerges in early adulthood.

People with this disorder often suspect that they are being exploited, harmed, or deceaved wihtout any evidence to support their suspicion. They also are preoccupied with unjustified doubts about their loved ones' loyalty and trustworthiness and often are resistent to confide in other due to unprovoked fear that the information shared will be used against them somehow. Symptoms of paranoid personality disorder also consists of reading hidden demeaning and threatening meanings into remarks and situations that are benign, and persistently baring grudges, reacts angrily to others due to perceived attack on their reputation and character, which are not apparent to others. Lastly, people with paranoid personality disorders exhibit recurrent suspicion, without justification, about faithfulness of their spouse or sexual partner.

The second is the Schizoid Personality Disorder. This one is characterized by a pervasive pattern of disconnection from social relationships and when in social settings, range of emotional expressions displayed are quite restricted. This disorder emerges in early adulthood and the symptoms are not related to thought or mood disorder episodes.

People with schizoid personality disorder does not feel the need for or enjoy interpersonal relationships or connections (family included). They choose activities that are solitary in nature and has little or no pleasure from them. They have little or no interest in sexual interaction with another person and appears to other to be indifferent to the praise or criticism by others. Individuals with this disorder are often described as cold, detached, or flat in affectivity. They don't care for the company of others but is not averted by it either.

The last type in the cluster A, is called Schizotypal Personality Disorder. It is a pervasive pattern of social/interpersonal marked by extreme discomfort from close relationships, with cognitive and perceptual distortion. It is characterized by eccentricities of behavior, which begins in the early adulthood and the occurence of symptoms are not related to episodes of thought or mood disorders.

People with Schizotypal personality disorders experience idea of reference (inncuous events or caused by or is related to them personally), has odd beliefs or magical thinking that influences their behavior, which is most often not consistent with the societal norms (fantasies, belief in clairvoyance), and exhibits odd thinking and speech. They are quite suspicious and paranoid, their affect is not appropriate for the occasion or mood. They are odd, eccentric, or peculiar and lack close friend or relationships outside of their first degree relatives (parents, siblings). Finally, excessive social anxiety does not diminish with increased familiarity and such anxiety to related, not to negative judgment about self, but paranoid fears.

People who are diagnosed with these personality disorders can be described as odd, eccentric, weird, loners, or bizarre. Treatment for such disorders exist but most often is quite difficult to treat. Also, medication usually has little or no effect on symptoms, mostly because they originate from one personality and not due to issues with brain chemistry.

Next blog will deal with Cluster B personality disorders, which are the most often identified and seen.