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M.Sc – Applied w w w. s l i d e d e s i g n . i n

Psychology
Personality Disorder Cluster B
People diagnosed with the Cluster B personality disorders -
antisocial, borderline, histrionic and narcissistic - all have
behaviors that have been described as dramatic, emotional and
erratic.
 Antisocial Personality
Disorder
Antisocial Personality disorder defined by the absence of concern for
others’ feelings or social norms and a pervasive pattern of rule
Key features
breaking.
• Failure to conform to social or legal code
• Lack of anxiety and guilt
• Irresponsible behaviors
 DSM 5 criteria for ASPD
A. A pervasive pattern of disregard for and violation of the rights of
others, occurring since age 15 years, as indicated by three (or more) of
the following:
1. Failure to conform to social norms with respect to lawful
behaviors, as indicated by repeatedly performing acts that are
grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or
conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical
fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain
consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing
having hurt, mistreated, or stolen from another.
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the
course of schizophrenia or bipolar disorder
 Etiology
• Genetic factors: Genetic predisposition appears to play a
significant role in the development of ASPD. Studies have shown
that individuals with a family history of ASPD or related
conditions, such as conduct disorder, are more likely to develop
the disorder themselves.
• Environmental factors: Many environmental factors have
also been implicated in the development of antisocial personality
disorder.
 A Developmental Perspective
• ASPD has its roots in childhood, especially for boys.
• Prospective studies have shown that it is children with an early
history of oppositional defiant disorder characterized by a pattern
of hostile and defiant behavior toward authority figures that usually
begins by the age of 6 years, followed by early-onset conduct
disorder around age 9-who are most likely to develop ASPD as
adults.
• ADHD is characterized by restless, inattentive, and impulsive
behavior, a short attention span, and high distractibility.
• When ADHD co-occurs with conduct disorder, this leads to a high
likelihood that the person will develop a severely aggressive form
of ASPD.
 Differential diagnosis
• Substance use disorder
• Schizophrenia and bipolar disorder
• Narcissistic personality disorder
• Histrionic personality disorder
• Borderline personality disorder
• Paranoid personality disorder
• Criminal behavior not associated with Personality disorder
 Treatment
• Cognitive behavioral therapy (CBT)
• Risk need Responsivity ( RNR)
• Contingency management
• Schema therapy
• Mentalization based therapy
 Case Study
• Alec, a 40-year-old man, was court-ordered to take part in a
psychological assessment after being charged with manufacturing
counterfeit bills. He described his history of three divorces with no
remorse. His first marriage had ended in a rancorous divorce after he
was discovered having two simultaneous extramarital affairs. His
second marriage ended within 3 months, and he bragged about
emptying her large savings account, stating, “A fool and her money
are easily parted.” His third wife divorced him after discovering that
he had been trafficking in stolen furniture.
• He had a long history of petty financial and drug-related crimes,
and despite his frequent drug dealing, he was deeply in debt. He
was estranged from all family members, and his friends consisted
of the regulars at his neighborhood bar.
 Borderline Personality
Disorder
Borderline Personality disorder defined by impulsiveness and
Keyself-image,
unpredictability, an uncertain features intense and unstable social
relationships, and extreme
• Intense fluctuations swings of mood.
in mood
• Unstable Self-image
• Unstable Interpersonal relationships
 DSM 5 criteria for BPD
• A pervasive pattern of instability of interpersonal relationships,
self-image, and affects, and marked impulsivity, beginning by early
adulthood and present in a variety of contexts as indicated by five
(or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do
not include suicidal or self-mutilating behavior covered in
Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or
sense of self.Impulsivity in at least two areas that are potentially self-
damaging (e.g., spending, sex, substance abuse, reckless driving, binge
eating). (Note: Do not include suicidal or self- mutilating behavior
covered in Criterion 5.).
4. Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior.
5. Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours
and only rarely more than a few days).
6. Chronic feelings of emptiness.
7. Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical
fights).
8. Transient, stress-related paranoid ideation or severe dissociative
symptoms.
 Etiology
• Genetic factors: There is evidence to suggest a genetic
predisposition to BPD. Studies have shown that individuals with a
family history of the disorders are at a higher risk of developing it
themselves.
• Environmental factors: That genes influence sensitivity to
environmental stressors. It is likely that such experiences well as
other environmental influences interact with genes to determine
who will develop problems at a later point.
• Neurobiological factors: Neuroimaging studies suggest that BPD is
associated with increased amygdala activation in emotion-inducing
situations, as well as with reduced prefrontal regulation. Dysregulation
of neurotransmitters, such as serotonin, norepinephrine, and dopamine,
may play a role in the emotional instability seen in BPD.
• Early Childhood Experiences: Adverse childhood experiences,
particularly involving neglect, physical or sexual abuse, inconsistent
parenting, or early separations from caregivers, are significant risk factors
for BPD. Early trauma and disrupted attachment bonds can contribute to
emotional dysregulation and interpersonal difficulties later in life.
 Differential diagnosis
• Depressive and Bipolar disorders
• Histrionic personality disorder
• Narcissistic personality disorder
• Paranoid personality disorder
• Antisocial personality disorder
• Dependent personality disorder
• Identity problems
 Treatment
• Transference - focused therapy
• Mentalization therapy
• Dialectical behavior therapy
 Case Study
Mr. J is a 31-year-old unemployed male who was referred to the
hospital emergency room by his therapist at a community mental
health center after two days of sustained suicidal gestures. He
appeared to function adequately until his senior year in high school,
when he became preoccupied with transcendental Meditation. He had
considerable difficulty concentrating during his first semester of
college and seemed to focus most of his energies on finding a spiritual
guru.
At times, massive anxiety and feelings of emptiness swept over him,
which he found would suddenly vanish if he lightly cut his wrist
enough to draw blood. He had been in treatment with his current
therapist for 18 months and became increasingly hostile and
demanding as a patient, whereas earlier he had been quite captivated
with his therapist’s empathy and intuitive sense. Lately, his life seemed
to center on these twice weekly therapy sessions. Mr. J’s most recent
suicidal thoughts followed the therapist’s disclosure that he was
moving out of the area.
 Histrionic Personality
Disorder
• A psychological disorder marked by overblown emotions and
behavior that seeks attention.
• Individuals with HPD typically rely on external validation from
others instead of developing an internal sense of self-worth.
• They desperately crave attention and often gain it through
exaggerated or inappropriate behavior.
• Additionally, patients are often unaware that there may be a
 Key features
• Self-dramatization
• Exaggerated emotional expression, and seductive.
• Provocative or attention-seeking behaviors
 DSM 5 criteria for HPD
A pervasive pattern of excessive emotionality and attention seeking,
beginning by early adult-hood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. Is uncomfortable in situations in which he or she is not the center of
attention.
2. Interaction with others is often characterized by inappropriate
sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in
detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of
emotion.
7. Is suggestible (i.e., easily influenced by others or
circumstances).Consider relationships to be more intimate than they
actually are.
 Etiology
• Genetic factors: The development of HPD is significantly
influenced by genetic predisposition. There is strong evidence from
twin studies that personality disorder features, especially those
linked to HPD, are heritable.
• Neurobiological Factors: Abnormalities in neurotransmitter
systems, including those of the dopamine and serotonin
systems.The impulsivity and emotional instability that define the
illness are linked to these dysregulations.
• Psychological factors: Parenting practices and early life
experiences in particular have a big impact on psychological
variables that affect how HPD develops. Notable contributors
include early trauma, overindulgence, and inconsistent parenting.
• Cognitive dysfunction: Cognitive theorists emphasize the
importance of maladaptive schemas revolving around the need for
attention to validate self-worth.
 Differential diagnosis
• Borderline personality disorder
• Antisocial personality disorder
• Narcissistic personality disorder
• Dependent personality disorder
 Treatment
• Cognitive behavioral therapy
• Psychodynamic Therapy
• Group therapy
 Case study
Ms. P. is a 20-year-old female undergraduate student who requested
psychological counseling at the College Health Services for
“boyfriend problems.” Actually, she had taken a nonlethal overdose of
minor tranquilizers the day before coming to the Health Services. She
said she took the overdose in an attempt to kill herself because “life
wasn’t worth living”after her boyfriend had left the afternoon before.
She was an attractive, well dressed woman adorned with makeup and
nail polish, which contrasted sharply with the very casual fashion of
most coeds on campus.
During the initial interview she was warm and charming, maintained
good eye contact, yet was mildly seductive. At two points in the
interview she was emotionally labile, shifting from smiling elation to
tearful sadness. Her ex-boyfriend had accompanied her to the
evaluation session and asked to talk to the clinician.

He stated the reason he had left the patient was because she made
demands on him which he could not meet, and that he “hadn’t been
able to satisfy her emotionally or sexually.” Also, he noted that he
could not afford to “take her out every night and party.
 Narcissistic Personality
Disorder
• NPD is characterized by the personal features of unreasonably high
value of oneself, a great need for admiration and recognition from
others, and lack of empathy and caring of others.
• A person with NPD is likely to experience difficulties in all aspects
of one’s life, such as relationships, daily work and can even affect
everyone with whom one interacts.
 Key features
• Exaggerated sense of self-importance
• Exploitative behavior
• Lack of empathy
 Two subtypes of narcissism
• Grandiose
• Vulnerable narcissism

1. Grandiose narcissism - High extroversion and low neuroticism -

Causes more distress to friends and family than do the narcissist
themselves.
2. Vulnerable narcissism - High neuroticism -Causes more personal
distress to the narcissist.
 DSM 5 criteria for NPD
• A pervasive pattern of grandiosity (in fantasy or behavior), need
for admiration, and lack of empathy, beginning by early adulthood
and present in a variety of contexts, as indicatedby five (or more)
of the following:
1. Has a grandiose sense of self-importance (e.g., exaggerates
achievements and talents, expects to be recognized as superior
without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be
understood by, or should associate with, other special or high-
status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of
especially favorable treatment or automatic compliance with his
or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to
achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the
feelings and needs of others.
8. Is often envious of others or believes that others are envious of
him or her.
9. Shows arrogant, haughty behaviors or attitudes.
 Etiology
• Genetics: There is evidence to suggest a genetic predisposition to
personality disorders in general, including NPD.
• Grandiose narcissism is associated with parental overvaluation.
• Vulnerable narcissism has been associated with emotional, physical, and
sexual abuse as well parenting styles characterized as intrusive,
controlling and cold.
• Psychological Factors: Certain personality traits, such as high levels of
extraversion, low levels of empathy, and a fragile self-esteem, may make
individuals more susceptible to developing NPD.
 Differential diagnosis
• Borderline personality disorder
• Histrionic personality disorder
• Antisocial personality disorder
• Obsessive compulsive personality disorder
• Schizotypal/Paranoid personality disorder
• Mania or hypomania
 Treatment
• Transference focused therapy
• Schema therapy
• Meta cognitive Interpersonal therapy
• Mentalization based therapy
 Case study
• Mr. C. is a 41-year-old male who presented for therapy after his
wife of six years threatened to leave him and because his employer
was pressuring him to resign his position as a sales executive for a
condominium project. Apparently, Mrs. C. had told her husband
that he loved himself “a hundred times more than you love me.”
Mr. C. dismissed this by saying he needed to buy $600 suits
because his job demanded that he look his best at all times and that
he was “tall, dark, handsome, and sexy—all any woman could
want in a man.”
• Mr. C. denied that he used scare tactics, exaggerated claims, or
other pressure-selling techniques with customers. “Sure, I’m a bit
aggressive, but you don’t get into the ‘Millionaire’s Club’ by being
a wimp.” He added that his employer would “go belly-up without
me,” and that he was too important to be dismissed for such petty
reasons.
 Reference
• American Psychiatric Association. (2013). Diagnostic and Statistical
Manual of Mental Disorders (DSM-5). Washington, DC: American
Psychiatric Publishing.
• A, A. F., & Mishra, H. (2024). Persona Unveiled: Psychological Insights
into Histrionic Personality Disorder. International Journal for
Multidisciplinary Research, 6(4). https://doi.org/10.36948/ijfmr.2024.v0
6104.24484.
• Butcher, J. N., Hooley, J. M., & Mineka, S. M. (2015). Abnormal
Psychology. (16th ed.). Pearson Higher Education.
• Comer, R. J. (2015). Abnormal Psychology (9th ed.). New York, NY:
Macmillan
• Craighead, W. E., Miklowitz, D. J., & Craighead, L. W. (2013).
Psychopathology: History, Diagnosis, and Empirical Foundations. (3rd
ed.). John Wiley & Sons.
• Gahlot, M. P., & Biraje, M. Α. (2024). Antisocial Personality Disorder,
It's Risk Factors and Treatment.
• Narcissistic Personality Disorder: Understanding the origins and causes,
consequences, coping mechanisms, and therapeutic approaches. (2024).
In EC Psychology and Psychiatry (Vols. 13-1, pp. 01-21).
https://ecronicon. net/assets/ecpp/pdf/ECPP-13-01134.
• Yang, M. (2023). Overview on Histrionic personality Disorder.
Communications in Humanities Research, 7(1), 221-226. https://doi. org
10.54254/2753-7064/7/20230886
Thank You