Cluster B Personality Disorders: Symptoms, Diagnosis, And Treatment

Cluster B personality disorders include antisocial personality disorder (ASPD), borderline personality disorder (BPD), histrionic personality disorder (HPD), and narcissistic personality disorder (NPD). These and other types of personality disorders may impact a person’s mental health, and symptoms can also make it challenging to manage relationships and daily responsibilities at home, work, or school. Seeking support from a mental health professional is typically key to improving overall health, functioning, and quality of life for those living with a personality disorder. Below, we’ll explore the symptoms, diagnosis, and treatment options available for people living with a Cluster B personality disorder. 

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Overview of personality disorders

Per the DSM-5, there are 10 recognized personality disorders, which are divided into three groups, or clusters:

• Cluster A (characterized by odd and eccentric behaviors)

• Paranoid personality disorder

• Schizoid personality disorder

• Schizotypal personality disorder

• Cluster B (characterized by dramatic, emotional, impulsive behaviors)

• Borderline personality disorder

• Narcissistic personality disorder

• Antisocial personality disorder

• Histrionic personality disorder

• Cluster C (characterized by anxiety and fear-related behaviors)

• Avoidant personality disorder

• Dependent personality disorder

• Obsessive-compulsive personality disorder

Each of these personality disorders has different symptoms and may affect a person in different ways. Generally speaking, Cluster A personality disorders manifest as odd or eccentric behaviors. For example, mood swings and paranoia may be common and individuals may appear cold and distant. Individuals with a Cluster B personality disorder may exhibit high levels of impulsivity and may have a hard time recognizing or regulating emotions, while Cluster C personality disorders may cause high levels of anxiety or fear.    

Cluster B personality disorders and their symptoms

Cluster B personality disorders are often characterized by dramatic, overly emotional responses and/or unpredictable thinking and behavior. They include antisocial personality disorder (ASPD), borderline personality disorder (BPD), histrionic personality disorder (HPD), and narcissistic personality disorder (NPD). While each one has distinct features, they share some common traits and patterns. Here’s a closer look at each of the four disorders and their symptoms. 

Antisocial personality disorder (ASPD)

ASPD is a personality disorder that’s also commonly referred to as sociopathy. Individuals with ASPD may tend to exhibit characteristics that are not considered socially appropriate, such as lying or deceitful behavior, and they may also put themselves at risk through impulsivity and a general disregard for safety. Individuals with ASPD may not feel remorse as readily as people without the disorder, which can contribute to unstable relationships. 

Common symptoms of antisocial personality disorder (ASPD)

Some common symptoms of ASPD include: 

• Lack of empathy. For individuals with ASPD, it may be challenging to recognize emotions and feel empathy for other people. 
• Manipulative behavior. A person with antisocial personality disorder may lie or be deceitful to get what they want or to achieve a personal goal. 
• Disregard for norms or laws. Run-ins with the law may happen more frequently for someone with ASPD due to the belief that rules do not apply to them. 
• Impulsivity. Someone with this personality disorder may act impulsively without concern for future consequences, and they may not usually plan ahead. 
• Consistent irresponsibility. It can be challenging for a person with ASPD to pay bills on time or otherwise manage daily responsibilities. 
• Aggressiveness and irritability. Individuals with this type of disorder may have a short temper or be irritated quickly. This may lead to physical violence or aggression that could result in injury or legal consequences. 
• Lack of remorse. Individuals with ASPD may not feel bad or guilty after violating rules or the rights of others. 
• Reckless disregard for safety. A person with ASPD may take risky actions and engage in behavior that puts themselves or others in danger without considering the potential consequences.

Borderline personality disorder (BPD)

Borderline personality disorder, or BPD, is a disorder that impacts a person’s ability to manage their emotions. This can affect decision-making and self-perception, which may negatively affect interpersonal relationships and mental health. Individuals with BPD may tend to view things as all bad or all good with little middle ground. It’s also common for people living with this type of personality disorder to also have other comorbid conditions that can make diagnosis and treatment more challenging. 

Common symptoms of borderline personality disorder (BPD)

Some common symptoms of BPD include: 

• Fear of abandonment. People with BPD may have an intense fear of being abandoned or left alone.
• Unstable relationships. Developing healthy relationships can be challenging for individuals with BPD. They may experience intense and unstable connections with others, often swinging between idealization and devaluation.
• Identity disturbance. A markedly unstable self-image or sense of self is common for those with this type of personality disorder.
• Impulsivity. Individuals with BPD may engage in potentially self-damaging behaviors, such as spending sprees, unsafe sex, and substance use or misuse.
• Emotional Instability. Rapid mood changes and intense emotional reactions are common symptoms of borderline personality disorder. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Histrionic personality disorder (HPD)

Individuals with HPD may experience a strong and pervasive need for attention, which may result in highly emotional and theatrical actions. When they are not the center of attention, a person with HPD may feel marginalized or underappreciated. Symptoms of this type of personality disorder may begin in late adolescence or early adulthood and often last throughout a person’s life. 

Common symptoms of histrionic personality disorder (HPD)

Some common symptoms of HPD include: 

• Attention-seeking. Histrionic personality disorder may cause a constant need for attention and admiration, even in situations where it’s not appropriate.
• Excessive emotionality. A person with HPD may frequently display overly dramatic emotional expressions.
• Inappropriate seductiveness. Inappropriate seductive or provocative behavior may be present in people with HPD. For example, they may engage in flirtatious behavior at inappropriate times, such as at work or school, and they may express their sexuality without regard for social norms. 
• Shallow emotions. For a person with HPD, emotions may be fleeting, rapidly shifting, and shallow. This can make it challenging to build authentic relationships with others. 
• Suggestibility. Because of their drive to keep attention on themselves, a person with this type of personality disorder may be easily influenced by others or by circumstances. In some cases, this may result in poor decision-making and risks to safety.

Narcissistic personality disorder (NPD)

NPD is a mental health condition that impacts around 1–2% of the population. This type of personality disorder can be challenging to diagnose. Key symptoms of a person with NPD often include a pervasive sense of superiority and feeling like they deserve special admiration. These may be coupled with a lack of empathy for others, which can make it challenging to develop personal relationships. 

Common symptoms of narcissistic personality disorder (NPD)

Some common symptoms of NPD include: 

• Grandiosity. A person with NPD may have an exaggerated sense of self-importance and superiority, which can cause them to look down on others or dismiss their opinions. This perspective can make it challenging to build and maintain relationships. 
• Need for admiration. A constant need for excessive admiration and attention is a common symptom for individuals with narcissistic personality disorder. They may tell elaborate lies or otherwise go to great lengths to exaggerate their accomplishments. 
• Lack of empathy. An inability to recognize or identify with the feelings and needs of others is common in those with NPD. 
• Sense of entitlement. Unreasonable expectations of favorable treatment or automatic submission to one’s expectations or desires may cause frustration and stress for both the person experiencing NPD and their friends and family members. 
• Exploitative relationships. A person with NPD may take advantage of others to achieve personal goals.

Diagnosing Cluster B personality disorders

The process of diagnosing Cluster B personality disorders is slightly different for each disorder in this category. While you may be able to identify some symptoms independently and decide to seek support, a healthcare provider must evaluate your mental health holistically in order to make a diagnosis based on their expertise. 

A provider may begin by asking you questions about your mental and physical health and overall health history. They may ask you about any symptoms you’re experiencing, including how severe they are and how long you’ve been experiencing them. Using the criteria listed in the DSM-5, this information may help them make a diagnosis, if applicable.

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​​Treatment options for Cluster B personality disorders

Treating Cluster B personality disorders can be a multifaceted and complex process. Mental health professionals and doctors often recommend a combination of medications and therapy for symptom management. 

When it comes to medication, there’s no single type that will treat this type of disorder as a whole. Instead, some medications like antipsychotics, antidepressants, and mood stabilizers may help address certain symptoms in some cases. Whether or not medication is recommended, a mental health professional may also encourage the individual to attend psychotherapy sessions to reduce the impact of symptoms and help the person develop healthy coping mechanisms. 

If you’re interested in seeking therapy for symptoms of a personality disorder or another mental health challenge, you can typically choose between in-person and online sessions. Those who have a busy schedule or would feel more comfortable speaking to someone about their symptoms via phone, video, or messaging might prefer online therapy. It allows you to get matched with a licensed therapist and meet with them from the comfort of home. Research suggests that online therapy can be an effective way to manage symptoms of personality disorders in many cases.