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Cluster B personality disorders

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Cluster B personality disorders

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High Yield Notes
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Cluster B personality disorders

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USMLE® Step 1 style questions USMLE

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USMLE® Step 2 style questions USMLE

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Preview

A 23-year-old woman is urgently reviewed by the psychiatric crisis team because of a suicide attempt an hour ago. Her mother states that she found her daughter on the floor cutting her wrists because her boyfriend broke up with her today. Medical history includes childhood sexual abuse and multiple previous admissions for suicide attempts. The patient states that she is in a good mood today because the man delivering her hospital food gave her an extra jello cup and she believes that he is in love with her. She states that he is “so much better than her ex-boyfriend”. Examination shows the patient sitting up in bed applying makeup. There are multiple scars on her wrists from previous suicide attempts. Which of the following personality disorders is this patient most likely exhibiting?

Transcript

Content Reviewers:

Rishi Desai, MD, MPH

Contributors:

Tanner Marshall, MS

If you were asked to describe a friend’s personality, you might describe them as generally being a creative type, or easy-going but nervous in groups.

Basically, you’re trying to summarize the personal traits that make them who they are—either how they think or how they act.

Sometimes these thought patterns or behaviors which make up a person’s personality can actually be harmful in the sense that they interfere with their day-to-day functioning in their personal life, at work, or in social settings.

If this were the case, we would say that the individual has a personality disorder.

The DSM-5, or the diagnostic and statistical manual for mental disorders, the 5th edition, lists ten personality disorders that are split into three different ‘clusters’, referred to as clusters A, B, and C.

These used to be under the category “Axis 2” but that way of organizing isn’t really used anymore.

Cluster B includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

All four of these have a genetic relationship with mood disorders- like depression and bipolar disorder, as well as substance use disorders.

Okay, so antisocial personality disorder—this sounds like they don’t get along well with others, but in fact, it’s the opposite, they can be really charming and often use that to manipulate others for their personal gain.

These individuals disregard moral values and societal norms, have little empathy, and poor impulse control.

This combination makes them willing to hurt others if it helps them, making them prone to aggressive and unlawful behavior, at times earning the label sociopath or psychopath.

In fact, individuals with this disorder tend to be overrepresented in prison populations and have higher rates of substance use.

These individuals typically fail to show remorse or guilt and rarely accept responsibility for any of the harm that they cause others.

This disorder is also unique in that individuals must be over 18 years old and have a history of conduct disorder in order to meet the diagnosis.

Next up is borderline personality disorder which is where individuals have unstable moods.

They go from intense joy one minute to rage the next minute; this leads to intense, sometimes wonderful relationships that generally become dramatic and sour over time.

This pattern is sometimes called stable instability, because the only consistent thing is instability.

These people often use a defense mechanism called splitting where people and important things, like a job, are seen as either completely good or completely bad.