The 4 Types of Cluster B Personality Disorders

A personality disorder is a mental health condition that involves long-lasting unhealthy patterns of inner experience and behavior. These fixed patterns often have a negative effect on someone’s ability to function in work, school, relationships, and other aspects of daily life. 

According to the National Institute of Mental Health (NIMH), over 9% of U.S. adults meet the diagnostic criteria for a personality disorder. People with cluster B personality disorders—the most common type—tend to exhibit dramatic, emotional, and/or erratic behavior.

The four types of cluster B personality disorders, including histrionic personality disorder (HPD), antisocial personality disorder (ASPD), borderline personality disorder (BPD), and narcissistic personality disorder (NPD). This article will discuss these types, including their traits, causes, diagnosis, and treatment.

Types

There are four types of cluster B (dramatic/emotional) personality disorders: borderline personality disorder (BPD), histrionic personality disorder (HPD), narcissistic personality disorder (NPD), and antisocial personality disorder (ASPD). 

Borderline Personality Disorder

Borderline personality disorder involves a pattern of unstable relationships and self-image, overwhelming emotions, and impulsivity. BPD affects approximately 1.4% of the U.S. adult population, although some estimates are much higher. About 75% of the people diagnosed with BPD are women.

Some of the signs and symptoms of BPD include:

• Intense fear of abandonment
• Chronic feelings of emptiness 
• Inappropriate anger
• Self-sabotage
• Unstable, intense interpersonal relationships
• Difficulties in forming a consistent self-image
• Impulsive behavior, including substance abuse or other reckless behaviors
• Self-harm and/or a history of suicide attempts

Histrionic Personality Disorder

Histrionic personality disorder involves excessive attention-seeking and emotional behavior. Estimates of the prevalence of HPD are around 1.8%. It is more common among women than men. 

Some of the signs and symptoms of HPD include:

• Demands to be the center of attention
• Dramatic or attention-seeking behavior, appearance, or emotional expression
• Overly seductive behavior
• Impressionistic speech (lacks details and emphasizes emotions, such as simply saying an event was "wonderful" without saying why)
• Rapid shifts in shallow emotions
• Chronic boredom, unless stimulated by excitement or short-term gratification
• Hyperfocus on appearance to gain attention

Narcissistic Personality Disorder

Narcissistic personality disorder involves an inflated sense of self-importance, extreme self-centeredness, and a lack of empathy for other people. Although estimates can vary considerably, one study found about 4% of the population studied had NPD. Between 50% to 75% of the people diagnosed with NPD are men.

Some of the signs and symptoms of NPD include:

• Willingness to exploit or take advantage of other people for personal gain
• An exaggerated sense of self-worth
• Preoccupation with grandiose ideas of beauty, power, talent, intelligence, success, or importance
• Selfish goals and behavior
• Lack of empathy for others
• Difficulty accepting criticism 
• Feelings of entitlement to special treatment
• Requires excessive admiration

Antisocial Personality Disorder

Antisocial personality disorder involves long-lasting disregard for the rights, feelings, needs, and safety of others. About 3% to 5% of the general population meets the criteria for ASPD at some point during their lifetime, and it is more common among men than women. It is the most common psychiatric diagnosis among incarcerated people.

Some of the signs and symptoms of ASPD include:

• Breaking the law and/or rules (at work, school, etc.) repeatedly
• Manipulativeness
• Superficial charm and flattery
• Lying, cheating, and/or stealing
• Substance abuse
• Physical aggression
• Reckless behavior
• Willingness to exploit others and put them in danger
• Lack of remorse, guilt, compassion, and empathy
• Chronic irresponsibility

Traits

Each of the four cluster B personality disorders is different. However, they tend to share certain maladaptive personality traits—traits that tend to affect someone’s ability to function, typically in work, school, relationships, and other parts of daily life—in common.

Cluster B personality disorders are associated with the following traits:

• Emotional dysregulation (difficulty managing one’s emotions and emotional responses)
• Dramatic or attention-seeking behavior
• Hypersensitivity
• Impulsivity
• Unpredictability
• Lack of inhibition
• Externalizing behaviors (difficulties with respecting authority, following rules, and fitting in with cultural norms) 

Regardless of diagnosis, maladaptive cluster B personality traits are associated with higher rates of physical health issues, divorce, and unemployment. They have also been linked to a higher risk of emotional distress, substance abuse, social isolation, hospitalization, and suicide.

Causes

There is no single known cause of cluster B personality disorders. However, there are several possible factors that increase the risk of developing a cluster B personality disorder, including: 

• Genetics: Research suggests that family history and certain genetic variations may contribute to the risk of developing a cluster B personality disorder. People with at least one immediate family member with HPD, NPD, BPD, or ASPD are significantly more likely to meet the diagnostic criteria for the same disorder.
• Brain structure: A growing body of research suggests that differences in brain structure and chemistry may play a role in the development and severity of cluster B personality disorders. For example, many people with ASPD have impaired function in the prefrontal cortex—an area of the brain involved in complex thinking and decision-making.
• Environmental factors: Certain early childhood events, experiences, and parenting styles may increase the risk of developing a cluster B personality disorder. Studies have shown, for example, that children whose parents are slow to display affection and who excessively praise them are more likely to develop narcissistic traits and/or NPD. Some researchers believe that people with HPD craved attention from neglectful or distracted caregivers as children. 
• Trauma: Experiencing trauma, such as physical, emotional, and/or sexual abuse (especially during childhood), significantly increases the risk of developing a personality disorder. For example, studies have found a significant percentage of people with BPD experienced severe childhood abuse or neglect. Children with at least one parent with a substance use disorder (SUD), such as alcohol use disorder (AUD), are significantly more likely to develop ASPD later in life.
  

Diagnosis

Most people are not diagnosed with personality disorders until 18 years old or older. A mental health professional can diagnose you with a cluster B personality disorder using the criteria in the DSM-5. 

To be diagnosed with a personality disorder, your symptoms must have lasted for an extended period. They must also negatively affect your functioning and quality of life in at least one major area, such as work, school, family life, or romantic relationships. 

With your permission, your healthcare provider may also gain insights into your behavior by talking to your spouse, family members, or other loved ones.

Treatment

Treatment for HPD, ASPD, BPD, and NPD typically involves psychotherapy as a first-line approach. If you have a cluster B personality disorder, here are some of the possible treatment approaches that may help:

• Dialectical behavior therapy (DBT): DBT is a specialized form of psychotherapy that helps to reduce self-harm, suicidal impulses, and emotional instability. It is especially effective in treating BPD.
• Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that can help people recognize and change maladaptive thinking and behavior. It has been shown to improve social functioning and emotional expression among people with personality disorders.
• Couples or family counseling: Many people with cluster B personality disorders have difficulty maintaining healthy, long-lasting connections with loved ones. Couples counseling, family counseling, and educating family members about your diagnosis may help reduce conflict and improve relationships.
• Psychoeducation: Recent research suggests that psychoeducation—which involves improving a person's understanding of their condition—may help reduce harmful drug and alcohol use among people with ASPD.
• Medication: There are no medications specifically approved by the Food and Drug Administration (FDA) for the treatment of personality disorders. However, some prescribed medications, including anti-anxiety medication, antidepressants, and antipsychotics, may reduce certain symptoms of comorbid mental health conditions.
• Treatment of comorbid mental health conditions: Nearly 85% of people with a personality disorder meet the criteria for at least one other mental health condition. If you have a personality disorder, it’s important to seek treatment for any other conditions you may have, such as substance abuse or depression.

Evidence-based therapies are more widely available for certain cluster B personality disorders than others. For example, there are currently no known, reliably effective treatments for ASPD.

People with ASPD are also unlikely to seek treatment on their own. They often only receive a diagnosis and treatment once they are required to do so, such as in an inpatient setting or as required by a court of law. 

By contrast, many people with BPD who receive treatment are able to achieve full remission of their symptoms for a year or more.

When to Talk to a Healthcare Provider

Talk to your healthcare provider if you are experiencing any of the following possible signs of a cluster B personality disorder:

• Relationship difficulties
• Frequent conflicts with others
• Out-of-control emotions, such as anger, hopelessness, or emptiness
• Difficulty connecting and relating to other people
  
• Impulsivity or chronic boredom
• Problems at work or school
• Putting yourself in risky situations
• Excessive drug or alcohol use
• Conflicts with the law

If you or someone else is thinking about self-harm, suicide, or harming someone else, seek immediate medical help.

Summary

Cluster B personality disorders are chronic mental health conditions that involve long-term patterns of dramatic, emotional, and/or erratic thinking and behavior. The four types of cluster B personality disorders are borderline personality disorder (BPD), histrionic personality disorder (HPD), narcissistic personality disorder (NPD), and antisocial personality disorder (ASPD).

BPD involves emotional instability, turbulent relationships, inconsistent self-image, and an intense fear of abandonment. People with HPD exhibit dramatic, attention-seeking behaviors, such as excessive seductiveness.

NPD involves an inflated sense of self-worth, extreme feelings of entitlement, hypersensitivity to criticism, and a lack of empathy. ASPD refers to a long-standing pattern of disregarding the rights, needs, and feelings of others and a lack of empathy, remorse, and guilt.

There are many possible factors that contribute to the development of cluster B personality disorders, including genetics, environmental factors, childhood trauma, and brain structure.

The first-line treatment for cluster B personality disorders is psychotherapy. In some cases, medication may be prescribed to help with certain symptoms.

A Word From Verywell

Some people with personality disorders may feel ashamed or unwilling to seek diagnosis or treatment. Don’t be afraid to talk to your healthcare provider about your symptoms. Treatment can help you improve your emotional health, relationships, quality of life, and overall well-being.