Personality disorders - Cluster B Notes

NOTES NOTES PERSONALITY DISORDERS: CLUSTER B GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES DIAGNOSIS ▪ Antisocial, borderline, histrionic, narcissistic personality disorders ▪ Deviations from cultural expectations → affects day-to-day life, relationships ▪ Linked to depressive, substance use disorders ▪ Unusual behaviors/traits ▪ Not explained by other condition/substance CAUSES ▪ May be genetic, environmental SIGNS & SYMPTOMS TREATMENT MEDICATIONS ▪ Antidepressants PSYCHOTHERAPY ▪ See individual disorders ▪ Unusual behavior ▪ Poor relationships Figure 99.1 Illustration depicting the four cluster B personality disorders: antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. 724 OSMOSIS.ORG

Chapter 99 Personality Disorders: Cluster B ANTISOCIAL PERSONALITY DISORDER osms.it/antisocial-personality-disorder PATHOLOGY & CAUSES DIAGNOSIS ▪ Uses charisma to manipulate others. ▪ Disregard for moral values, societal norms, rights of others ▪ Poor impulse control, lacks empathy ▪ Willing to hurt others for own benefit → aggressive, unlawful behavior → often given “sociopath”/“psychopath” label ▪ Associated with substance use disorders, overrepresented in prisons ▪ ≥ three of following ▫ Does not conform to societal norms ▫ Deceitful ▫ Impulsive ▫ Irritable/aggressive ▫ Reckless ▫ Irresponsible ▫ Unremorseful ▪ Age > 18, conduct disorder since age < 15 ▪ Not explained by other condition CAUSES ▪ May be genetic, environmental; more common in biological males SIGNS & SYMPTOMS ▪ Outwardly normal behavior ▪ Hidden hostility, callousness, disregard for others MNEMONIC: CC/AA Conduct disorder/antisocial personality disorder Conduct disorder is seen in children Antisocial personality disorder is seen in adults TREATMENT PSYCHOTHERAPY ▪ E.g. self help groups Figure 99.2 Illustration depicting thoughts and symptoms of antisocial personality disorder. OSMOSIS.ORG 725

BORDERLINE PERSONALITY DISORDER osms.it/borderline-personality-disorder PATHOLOGY & CAUSES ▪ Unstable moods (intense joy ← → rage) ▪ Intense relationships that sour over time ▪ “Stable instability” (consistent pattern of instability) ▪ Splitting (extreme perspectives: things seen as completely good/completely bad) ▪ Fear of abandonment CAUSES ▪ May be genetic, environmental SIGNS & SYMPTOMS ▪ ▪ ▪ ▪ Unstable mood Fear of abandonment (real/imagined) Splitting Suicidal/self-harming behavior DIAGNOSIS ▪ ≥ five of following ▫ Frantic avoidance of abandonment ▫ Unstable, intense relationships ▫ Unstable self-image ▫ Self-destructive impulsivity ▫ Suicidal/self-harming behavior ▫ Emotional instability ▫ Feeling empty ▫ Anger management issues ▫ Transient paranoid thinking ▫ Not explained by other condition TREATMENT MEDICATIONS ▪ Antipsychotics, antidepressants PSYCHOTHERAPY ▪ E.g. dialectical behavior therapy, mentalization-based therapy, transferencefocused therapy Figure 99.3 Illustration depicting thoughts and symptoms of borderline personality disorder. 726 OSMOSIS.ORG

Chapter 99 Personality Disorders: Cluster B HISTRIONIC PERSONALITY DISORDER osms.it/histrionic-personality-disorder ▪ ▪ ▪ ▪ PATHOLOGY & CAUSES DIAGNOSIS Attention-seeking, excessive emotionality. Manipulative tendencies Superficial relationships Shallow, flighty, egocentric ▪ ≥ five of following ▫ Must be center of attention ▫ Inappropriate (e.g. provocative) interactions ▫ Fast changing, shallow emotions ▫ Uses appearance to draw attention ▫ Vague speech ▫ Exaggerated manner ▫ Easily affected by others/situations ▫ Mistakes relationships as more intimate ▪ Not explained by other condition CAUSES ▪ May be genetic, environmental SIGNS & SYMPTOMS ▪ Exaggerated thoughts, feelings (e.g. tantrums) ▪ Superficial relationships ▪ Excessively seductive behavior ▪ Attention-seeking behavior TREATMENT PSYCHOTHERAPY ▪ Psychoanalytic therapy Figure 99.4 Illustration depicting thoughts and symptoms of histrionic personality disorder. OSMOSIS.ORG 727

NARCISSISTIC PERSONALITY DISORDER osms.it/narcissistic-personality-disorder PATHOLOGY & CAUSES ▪ ▪ ▪ ▪ ▪ ▪ ▪ Grandiose self-image Demands special treatment Thinks ideas are best, should be supported Fragile self-esteem, lashes out if slighted Lacks empathy Exploitative of others Only involved in what advances personal agenda CAUSES ▪ May be genetic, environmental SIGNS & SYMPTOMS ▪ ▪ ▪ ▪ Sense of entitlement Arrogant behavior Vulnerable to criticism Exploitative of others DIAGNOSIS ▪ ≥ five of following ▫ Grandiose self-image ▫ Fantasies of grandiosity ▫ Believes they are “special” ▫ Seeks admiration ▫ Entitled ▫ Exploitative ▫ Thoughtless ▫ Envious/jealous ▫ Arrogant ▪ Not explained by other condition TREATMENT MEDICATIONS ▪ Lithium, SSRIs, other antidepressants PSYCHOTHERAPY ▪ Psychoanalytic therapy, group therapy Figure 99.5 Illustration depicting thoughts and symptoms of narcissistic personality disorder. 728 OSMOSIS.ORG