Original article
The “a-b-c's” of the cluster b's: Identifying, understanding, and treating cluster b personality disorders

https://doi.org/10.1016/S0272-7358(99)00052-5Get rights and content

Abstract

This article is a summary of some of the more recent research on the diagnosis, etiology, and treatment of Cluster B personality disorders (antisocial, histrionic, borderline, and narcissistic). Research on psychological, psychosocial, and biological perspectives of these disorders is presented. Individual psychotherapy, group psychotherapy, and other forms of multiperson therapies are also discussed. Finally, perspectives on issues of countertransference when treating these personality-disordered patients are addressed.

Section snippets

A word about personality disorders and the cluster b group

Patients experiencing personality disorders have deeply ingrained and pathological patterns of thought, feeling, and behavior that can be traced back to adolescence or early adulthood. Outside the range of actions found in most people, those persons with a personality disorder create subjective distress and/or experience functional impairment because of their pervasive, maladaptive, and inflexible ways of interacting with others (DSM-IV; American Psychiatric Association. 1994) The pathology of

Diagnostic Picture

Because of the enormous implications on public safety and the economic well-being of our society, research on the antisocial personality has been more prevalent than on any other personality disorder. Prior to more careful differentiation among these terms, the antisocial personality had been referred to as the psychopathic, sociopathic, dyssocial, and criminal personality. This disorder is typified by a wanton disregard for and violation of the rights of others. Such eye-popping cinematic

Diagnostic Picture

Among all those diagnosed with a Cluster B personality disorder, patients with borderline personality disorder are believed to experience the greatest suffering. Almost always in a state of crisis, borderlines are so named because they were believed to stand on the border of a number of diagnoses, perhaps most poignantly on the border between a neurotic and psychotic personality organization (Hoch & Polatin, 1949). Patients with borderline personality disorder have significant impairments in

Diagnostic Picture

Derived from the Latin word for actor, the histrionic patient has a style of presentation that is excessively dramatic and emotionally exhibitionistic. Driven by an intense need for affection, histrionics are self-centered, seductive, and blatantly conspicuous in their shallow manipulation of others. Previously referred to as the hysterical personality, histrionic personality disorder is typified by a need to be the center of attention and an almost desperate kind of gregariousness in which the

Diagnostic Picture

The term narcissism is derived from the Greek myth of Narcissus. In this story, a handsome young man disobeyed his mother's warning never to look upon his own reflection. Gazing into a pool of water, he fell in love with himself and died vainly, unable to release his compelling stare.

According to the DSM-IV (American Psychiatric Association, 1994), persons with narcissistic personality disorder are interpersonally exploitative, exhibit a grandiose sense of their own self-importance, are

Concluding comments

The line between normal and abnormal or disordered personalities lacks a sharp divide (Millon, 1986). Although the authors of the DSM-IV (American Psychiatric Association, 1994) deemed a categorical system of clustering personality disorders to be the most appropriate at this time, they acknowledge the absence of distinct boundaries between the various personality disorders. Many of the personality disorders have been found to be strongly correlated with one another (Bell & Jackson, 1992), and

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