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

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  1. Definition
    1. Dramatic, emotional or eratic personalities
  2. 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")
  3. 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 and Alcohol Abuse
      2. No remorse for wrongdoing and no empathy
    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
  4. Type: Borderline Personality
    1. Characteristics
      1. Unstable relationships, self image, and affect
      2. Loneliness, boredom and sense of emptiness
      3. Impulsive, mood lability to angry and anxious
    2. Altered interpretation of illness and physician
      1. Fears rejection and isolation
      2. Self-destructive behavior
      3. Alternates admiration and devaluation of physician
    3. 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
    4. Evaluation for comorbid conditions
      1. Major Depression
      2. Delirium
      3. Drug Abuse (e.g. LSD)
      4. Reactive Psychosis
  5. Type: Histrionic Personality
    1. Characteristics (most often occurs in women)
      1. Outwardly appear charming, lively, and seductive
      2. Threatened self-esteem and sense of attractiveness
      3. Egocentric, shallow, immature and dramatic
      4. Seek excitement and attention: often exhibitionists
    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
  6. Type: Narcissistic Personality
    1. Characteristics
      1. Grandiosity, unrealistic self-expectation
      2. Need constant admiration
      3. Impulsive and anxious
      4. Doubts own adequacy
    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
  7. 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
  8. 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
  9. 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
  10. References
    1. Ward (2004) Am Fam Physician 70(8):1505
    2. Tomb (1992) Psychiatry, p. 147-52

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