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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

Antisocial Personality Disorder (C0003431)

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 (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.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9301.7, 301.7, 301.9
MSHD000987
EnglishAntisocial or sociopathic personality disorder, Antisocial Personalities, Antisocial Personality, ANTISOCIAL PERSONALITY DIS, Antisocial Personality Disorder, Antisocial personality disorders, asocial personality, ASP disorder, Dissocial personality disorder, dyssocial personality, PERSONALITY DIS ANTISOCIAL, Psychopath.personality, psychopathic constitution, Psychopathic Personalities, Psychopathic personality, Psychopathic personality disorder, Sociopathic Personalities, sociopathic personality, Sociopathic personality disorder
Spanishtrastorno antisocial de la personalidad, trastorno de la personalidad antisocial, trastorno psicopatico de la personalidad, trastorno sociopatico de la personalidad
Parent ConceptsPersonality Disorders (C0031212), Cluster B personality disorder (C0009086), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, ICD9CM, LCH, MSH, MTH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Borderline Personality Disorder (C0006012)

Definition (MSH)A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. (DSM-IV)
Definition (CSP)severe personality disorder that develops in early childhood; characterized by a lack of control of anger, intense and frequent mood changes, impulsive acts, disturbed interpersonal relationships, and life-threatening behaviors.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9301.83
MSHD001883
EnglishBORDERLINE PERSONALITY, BORDERLINE PERSONALITY DIS, Borderline Personality Disorder, Borderline Personality Disorders, BPD, DIS BORDERLINE PERSONALITY, PERSONALITY DIS BORDERLINE
Spanishtrastorno de personalidad borderline, trastorno fronterizo de la personalidad, trastorno limite de la personalidad, trastorno limitrofe de la personalidad
Parent ConceptsOther personality disorder NOS (C0029707), Personality Disorders (C0031212), Cluster B personality disorder (C0009086), Emotionally unstable personality disorder (C0338970)
SourcesAOD, COSTAR, CSP, ICD9CM, LCH, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Narcissistic Personality Disorder (C0027402)

ConceptsMental or Behavioral Dysfunction (T048)
ICD9301.81
MSHD010554
EnglishNARCISSISTIC PERSONALITY, NARCISSISTIC PERSONALITY DIS, Narcissistic Personality Disorder
Spanishtrastorno narcisista de la personalidad
Parent ConceptsOther personality disorder NOS (C0029707), Cluster B personality disorder (C0009086)
SourcesAOD, ICD9CM, MSH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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