Cluster B personality disorders affect a person’s emotions and behaviors, leading to actions that others tend to consider dramatic, overly emotional, or erratic.
A personality disorder is a mental health condition that affects the ways that a person thinks, behaves, and relates to others.
These disorders can lead to significant distress and, in many cases, harmful coping strategies. People with cluster B disorders typically have trouble regulating their emotions and struggle to maintain relationships.
The National Institute of Mental Health (NIMH) suggest that around 9.1% of people in the United States meet the criteria for a personality disorder.
There are four types of cluster B personality disorders, each with a different set of diagnostic criteria and treatments:
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
This article explores these types, including their symptoms and treatment options.
People with these disorders typically have difficulty regulating their emotions and maintaining relationships. Their behavior may come across as dramatic, erratic, or extremely emotional.
Healthcare professionals use a guide called the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to help diagnose mental health conditions.
The DSM-5 identifies three main clusters of personality disorders:
- Cluster A: A person with this type behaves in a way that others consider unusual or eccentric. There are three cluster A disorders: paranoid, schizoid, and schizotypal personality disorders.
- Cluster B: A person with this type has difficulties regulating their emotions and behavior. Others may consider their behavior dramatic, emotional, or erratic. There are four cluster B disorders: antisocial, borderline, histrionic, and narcissistic personality disorders.
- Cluster C: A person with this type behaves in anxious or avoidant ways. There are three cluster C disorders: avoidant, dependent, and obsessive-compulsive personality disorders.
The symptoms of a cluster B personality disorder often affect a person’s well-being and ability to have typical relationships.
Behaviors associated with these conditions can lead to significant distress for the person and those around them.
Understanding the symptoms can help a person know when and how to seek treatment. Increased awareness can also help friends and relatives provide or locate support.
The following sections explore the symptoms, types, and prevalence of cluster B personality disorders.
A person with antisocial personality disorder behaves in a way that shows a disregard for the rights or needs of others. Common features include deceitful, manipulative, and criminal behavior.
Antisocial personality disorder is sometimes referred to as sociopathy, but this is not a clinical term.
Some estimates suggest that 1–4% of people have antisocial personality disorder. Males are up to five times more likely to receive this diagnosis than females.
Features of antisocial personality disorder include:
- manipulative or deceitful behavior for personal gain, such as lying or assuming false identities
- repeated antisocial actions, such as harassment or theft
- impulsive behavior, which might lead to frequent job or relationship changes
- irresponsible actions, which can affect occupational, social, and financial aspects of life, for example
- disregard for personal safety or the safety of others, such as speeding, driving while intoxicated, or neglecting a child
- irritable or aggressive behavior, which can include physical fights
A person with antisocial personality disorder usually does not show remorse. They may act indifferent to the outcomes of hurtful actions or rationalize the reasons for harming or deceiving others.
Borderline personality disorder causes instability in mood, behavior, and self-image.
A person with this condition may experience intense emotions, have a poor self-image, and display impulsive behaviors. A lack of stability in relationships is a main characteristic of this condition.
Features of borderline personality disorder include:
- a fear of being abandoned and attempts to avoid real or perceived abandonment
- unstable relationships that shift from extreme adoration to extreme dislike
- intense or extreme moods, such as anger, depression, emptiness, or anxiety
- stress-related paranoia or dissociation
- sudden or impulsive shifts in values or career plans
- impulsive, harmful behaviors, such as substance misuse or binge eating
- self-harm, and for some, suicidal thoughts or actions
People with this condition may react with intense anger or sadness in situations that others would not consider distressing. This can cause difficulties in relationships and can contribute to a poor self-image.
Histrionic personality disorder involves extreme emotionality and attention-seeking behavior. A person with this disorder may appear lively, enthusiastic, charming, and flirtatious.
They may act in a way that is considered inappropriate within their cultural context or more specific contexts, such as at work.
Some estimates say that 2–3% of the population meet the criteria for histrionic personality disorder. Females are four times as likely to receive this diagnosis, compared with males.
Features of histrionic personality disorder include:
- feeling uncomfortable when not the center of attention
- behaving in ways that others perceive as overly sexual or provocative
- having rapidly changing, shallow emotions
- using dramatic, theatrical expressions and emphasis when expressing emotion
- using physical appearance to draw attention
- being easily influenced by others.
- believing and behaving as if others are closer than they actually are
A person with this disorder tends to believe that their behavior is typical and may not see that it causes problems.
People often receive the diagnosis later in life, after their patterns of behavior have interfered with their personal or professional relationships.
A person with narcissistic personality disorder tends to act as if they are superior to others, display patterns of grandiose behavior, have a need for admiration, and show a lack of empathy.
Studies suggest that 0.5–5% of the U.S. population meets the criteria for narcissistic personality disorder. Males receive this diagnosis more often than females.
Features of narcissistic personality disorder include:
- a pattern of self-important or grandiose behavior, such as exaggerating achievements and expecting to be recognized as superior
- fantasies of unlimited success, power, beauty, or perfect love
- a belief of importance, specialness, and uniqueness that only other high-status people can understand
- a need for excessive admiration
- a sense of entitlement, such as unreasonable expectations of favorable treatment
- a tendency to take advantage of others for personal gain
- a lack of empathy
- envy of others and the belief that others are envious
- arrogant, condescending behaviors or attitudes
People with this condition typically have vulnerable self-esteem and are sensitive to criticism or defeat, though this may not show outwardly.
Researchers do not know the exact causes of personality disorders. It is likely that both environmental and genetic factors play a role.
Many individuals with personality disorders have a history of traumatic experiences, and many have close family members with mental health conditions.
For example, studies suggest that 70% of people with borderline personality disorder have experienced mistreatment during childhood, such as physical abuse, sexual abuse, or neglect.
Another 2017 study reported that some people with cluster B personality disorders share atypical brain features, some of which affect the amygdala, a region that assists in regulating emotion.
However, fully understanding the underlying causes will require more research.
Mental health professionals can diagnose personality disorders with an in-depth interview.
They will ask the person about their clinical history, experiences, emotions, and behaviors. They may also speak with the person’s family, partner, or others who are close.
As part of the diagnostic process, the mental health professional will gather information about the person’s:
- life experiences
- thoughts and thought patterns
- emotions and moods
- behaviors and reactions in various situations
According to the DSM-5, when diagnosing a personality disorder, the relevant characteristics must:
- be consistent across times, places, and changes in circumstances
- lead to distress and affect the person’s well-being
- have followed a stable, long-standing pattern
- not result from a different disorder
- not have resulted from an isolated stressful situation
People should not attempt to diagnose themselves or others. Anyone who may have a cluster B personality disorder, or believes that someone else has this type of condition, should speak with a mental health professional.
Treatments aim to help manage negative experiences, such as anger, anxiety, and depression. The goal is to reduce disruptive behaviors, which benefits the person and those around them.
What works for one person may not work for another — it is important to work with a doctor to develop the right treatment plan.
The plan may include:
- Talking therapy: Also called psychotherapy, this encourages a person to express themselves verbally to a therapist, who will listen without judgment and may offer advice.
- Cognitive behavioral therapy: Usually called CBT, this helps a person examine their thought patterns and behaviors and develop practical ways to adjust them.
- Dialectical behavioral therapy: This, known as DBT, teaches people new skills, with the aim of making positive life changes.
- Medication: There are no specific drugs for personality disorders. However, mood stabilizers, antidepressants, antipsychotics, and antianxiety medications may improve specific symptoms and can help with co-occurring problems, including anxiety and depression.
People may also find that self-care strategies — such as getting regular exercise, practicing meditation or mindfulness, and maintaining a healthful diet — can boost their mood, reduce frustration, and help manage their symptoms.
People with personality disorders, particularly borderline or narcissistic personality disorders, may have a higher risk of attempting suicide than the general population. This is distressing for all involved, and help is available.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
While there is no cure for a personality disorder, treatments can help manage distressing emotions and behaviors and reduce harmful actions.
The symptoms of some personality disorders naturally reduce with age. For instance, the features of antisocial personality disorder tend to peak during early adulthood and become less disruptive over time.
With the right support, many people with cluster B personality disorders maintain healthy, happy relationships.
Cluster B personality disorders affect a person’s emotions and behaviors. They are characterized by actions that others see as dramatic, overly emotional, or erratic.
While there is no cure, treatments can help people manage their moods, change disruptive behaviors, and treat co-occurring problems, such as anxiety and depression.
Also, various online resources can help family members and friends learn to support people with mental health conditions while looking after themselves.