Cluster B - Dramatic, emotional, erratic - Chapter 9

What four disorders fall into cluster B - dramatic, emotional, erratic

• WHAT

• WHAT

• WHAT

• WHAT

What four disorders fall into cluster B - dramatic, emotional, erratic

• Antisocial personality disorder

• Narcissistic personality disorder

• Borderline personality disorder

• Histrionic personality disorder

Antisocial personality disorder DSM-5 Criteria

• Pervasive WHAT for & WHAT of others' rights

• Failure to WHAT to social/legal norms

• Deceitfulness and manipulation

• WHAT; failure to plan ahead

• Irritability and WHAT

• Reckless disregard for WHAT of self or others

• Consistent irresponsibility

• Lack of WHAT

• Must be ≥ WHAT; evidence of conduct disorder before WHAT

Antisocial personality disorder DSM-5 Criteria

• Pervasive DISREGARD for & VIOLATION of others' rights

• Failure to CONFORM to social/legal norms

• Deceitfulness and manipulation

• IMPULSIVITY; failure to plan ahead

• Irritability and AGGRESSIVENESS

• Reckless disregard for SAFETY of self or others

• Consistent irresponsibility

• Lack of REMORSE

• Must be ≥ 18; evidence of conduct disorder before 15

Antisocial personality disorder: Key Clinical Notes

• Most common in WHAT (~3:1 sex ratio)

• 'WHAT' and 'WHAT' are colloquial — ASPD is the clinical term

• WHAT threshold for emotional and physical pain (seen in prisons as well)

• Comorbid substance use disorders are extremely common

• Treatment is WHAT — patients rarely self- refer

Antisocial personality disorder: Key Clinical Notes

• Most common in MALES (~3:1 sex ratio)

• 'PSYCHOPATH' and 'SOCIOPATH' are colloquial — ASPD is the clinical term

• HIGH threshold for emotional and physical pain (seen in prisons as well)

• Comorbid substance use disorders are extremely common

• Treatment is CHALLENGING — patients rarely self- refer

Narcissistic personality disorder DSM-5 Criteria

• Grandiose sense of WHAT

• Preoccupation with fantasies of unlimited success, power, brilliance

• Belief in being 'WHAT' or WHAT

• Need for excessive WHAT

• Sense of entitlement

• Interpersonally exploitative

• Lack of WHAT

• Envious of others or believes others are envious

• Arrogant, haughty behaviours and attitudes

Narcissistic personality disorder DSM-5 Criteria

• Grandiose sense of SELF-IMPORTANCE

• Preoccupation with fantasies of unlimited success, power, brilliance

• Belief in being 'SPECIAL' or UNIQUE

• Need for excessive ADMIRATION

• Sense of entitlement

• Interpersonally exploitative

• Lack of EMPATHY

• Envious of others or believes others are envious

• Arrogant, haughty behaviours and attitudes

Narcissistic personality disorder: Key Clinical Notes

• Grandiosity masks profound WHAT — narcissistic injury can trigger rage or collapse

• Distinguish: confidence and self-belief vs. clinical NPD

• The 'dating game': someone who is self- absorbed vs. meeting full diagnostic criteria

• WHAT is impaired — not absent — but functionally they struggle to sustain it

• Pop culture overuses 'narcissist' — clinical NPD is more impairing and more specific

Narcissistic personality disorder: Key Clinical Notes

• Grandiosity masks profound FRAGILITY — narcissistic injury can trigger rage or collapse

• Distinguish: confidence and self-belief vs. clinical NPD

• The 'dating game': someone who is self- absorbed vs. meeting full diagnostic criteria

• EMPATHY is impaired — not absent — but functionally they struggle to sustain it

• Pop culture overuses 'narcissist' — clinical NPD is more impairing and more specific

Borderline personality disorder DSM-5 Criteria

• Frantic efforts to avoid real or imagined WHAT

• Pattern of WHAT, intense interpersonal relationships

• Unstable WHAT or sense of self

• Impulsivity in ≥ 2 self-damaging areas

• Recurrent WHAT behaviour, gestures, or WHAT

• Emotional WHAT — intense reactivity

• Chronic feelings of WHAT

• Inappropriate, intense anger

• Transient paranoid ideation or dissociation under stress

Borderline personality disorder DSM-5 Criteria

• Frantic efforts to avoid real or imagined ABANDONMENT

• Pattern of UNSTABLE, intense interpersonal relationships

• Unstable SELF-IMAGE or sense of self

• Impulsivity in ≥ 2 self-damaging areas

• Recurrent SUICIDAL behaviour, gestures, or SELF-HARM

• Emotional INSTABILITY — intense reactivity

• Chronic feelings of EMPTINESS

• Inappropriate, intense anger

• Transient paranoid ideation or dissociation under stress

Borderline personality disorder: Key Clinical Notes

• WHAT emotional regulation threshold. An emotional regulation disorder

• Think of BPD as 'emotional burn victims' — they feel everything more WHAT, with less skin

• WHAT (splitting) thinking: all good or all bad — no grey

• Fear of WHAT is the organizing terror — real or imagined

• SI must always be assessed — recurrent WHAT behaviour is a criterion

• High comorbidity: depression, PTSD, eating disorders, substance use

• WHAT (Dialectical Behaviour Therapy) is the gold- standard treatment

• 'Borderline to what?' — originally meant borderline psychosis; now its own entity

Borderline personality disorder: Key Clinical Notes

• LOW emotional regulation threshold. An emotional regulation disorder

• Think of BPD as 'emotional burn victims' — they feel everything more INTENSELY, with less skin

• BLACK-and-WHITE (splitting) thinking: all good or all bad — no grey

• Fear of ABANDONMENT is the organizing terror — real or imagined

• SI must always be assessed — recurrent SUICIDAL behaviour is a criterion

• High comorbidity: depression, PTSD, eating disorders, substance use

• DBT (Dialectical Behaviour Therapy) is the gold- standard treatment

• 'Borderline to what?' — originally meant borderline psychosis; now its own entity

Histrionic personality disorder DSM-5 Criteria

• Uncomfortable when not the centre of WHAT

• Inappropriate WHAT seductive or WHAT behaviour

• Rapidly shifting, shallow emotional expression

• Uses WHAT appearance to draw attention

• Speech impressionistic — lacks detail

• WHAT, theatrical emotional expression

• WHAT — easily influenced by others

• Perceives relationships as more intimate than they are

Histrionic personality disorder DSM-5 Criteria

• Uncomfortable when not the centre of ATTENTION

• Inappropriate SEXUALLY seductive or PROVOCATIVE behaviour

• Rapidly shifting, shallow emotional expression

• Uses PHYSICAL appearance to draw attention

• Speech impressionistic — lacks detail

• DRAMATIC, theatrical emotional expression

• SUGGESTIBLE — easily influenced by others

• Perceives relationships as more intimate than they are

Histrionic personality disorder: Key Clinical Notes

• Distinguish: enjoying attention vs. impaired functioning when denied it

• Does Hollywood foster histrionic traits? The entertainment industry rewards these patterns

• WHAT overlap with narcissistic PD — both seek attention, but histrionic is more WHAT vs. grandiose

• More commonly diagnosed in WHAT — but this reflects diagnostic bias as much as prevalence

• The key: WHAT or WHAT must be present — not just a dramatic personality

Histrionic personality disorder: Key Clinical Notes

• Distinguish: enjoying attention vs. impaired functioning when denied it

• Does Hollywood foster histrionic traits? The entertainment industry rewards these patterns

• HIGH overlap with narcissistic PD — both seek attention, but histrionic is more EMOTIONAL vs. grandiose

• More commonly diagnosed in FEMALES — but this reflects diagnostic bias as much as prevalence

• The key: DISTRESS or IMPAIRMENT must be present — not just a dramatic personality