Cluster B - Personality Disorders

Disorder Etiology Presentation Diagnosis TreatmentAntisocial Personality Disorder

Prevalence3% in men1% in women

Higher incidence in poor urban areas

Genetic ComponentFive times increased risk among first degree relatives

Develops in adolescence

Can appear composed and credible but beneath the veneer there is tension, hostility, and rage Good at putting up a front but

are unhappy people

3 of more: Failure to conform to social

norms Deceitful/manipulative Impulsive Irritable/aggressive Recklessness and disregard

for safety of self or others Lack of remorse for others Irresponsibility/failure to

sustain work or honor financial obligations

PsychotherapyHospitalized patients

more amenableFirm limits a mustThey can “sex up” their

stories – be seductiveTherapist must overcome

patient’s fear of intimacy – they don’t want relationships

PharmacotherapyMany are substance

abusers so be careful Individual components of

the disorder may be treated (IE Ritalin for ADHD)

Borderline Personality Disorder

Genetics5xs more common in 1st

degree relatives

Stand on the border of neurosis and psychosis characterized by extraordinarily unstable mood, affect, and behavior

4 main categories of signs and symptoms1. Unstable relationships2. Unstable self-image3. Unstable emotions4. Impulsivity

5 of More: Desperate efforts to avoid real

or imagined abandonment Unstable, intense

interpersonal relationships Unstable self image Impulsivity in at least 2

potentially harmful ways Recurrent suicidal threats or

attempts, self-mutilation General feeling of emptiness Difficulty in controlling anger Transient, stress related

paranoid ideations or dissociative sx

Disorder Etiology Presentation Diagnosis TreatmentHistrionic Epidemiology

Prevalence: 2-4%Women > Men

High degree of attention getting behavior

Exaggerate thoughts and feelings

Catastrophizes Gestures and dramatic

punctuation Temper tantrums, tears and

accusations if not the center of attention

Seductive Constant need for

reassurance May act on sexual impulses

5 of More: Uncomfortable when not

the center of attention Inappropriately seductive Uses physical appearance to

draw attention to self Dramatic Easily influenced by others Perceives relationships as

more intimate than they are

Psychoanalytical based therapy group or individual

Treat targeted symptoms medicallyIE: anxiety

Narcissistic EpidemiologyPrevalence: <1%Men > Women

Develops in early adulthood but not recognized until middle adulthood

Grandiose sense of self importance

Consider themselves special Striking sense of entitlement Handle criticism poorly Fragile relationships Interpersonal exploitive

5 or More: Exaggerated sense of self-

importance Preoccupied w/ fantasies of

unlimited money, success, brilliance

Believes that he/she is “special” and can only associate w/ other high stats people

Needs excessive admiration Sense of entitlement Takes advantages of others

for self-gain Lacks empathy Envious of others or

believes others are envious Arrogant or haughty