Personality Disorders Cluster B Psychiatry Authors Shebani SETHI

Personality Disorders: Cluster B (Psychiatry) Author(s): Shebani SETHI 1 Swapna Kamal Verma 2 Academic Affiliation: 1 Duke-NUS Graduate Medical School, Medical Student 2 Duke-NUS Graduate Medical School, Associate Professor Level: Basic Version No: 1. 0 Submitted: Sep. 2012 Editors’ Review:

2 Learning Objectives • Understand the difference between personality trait and personality disorder. • To learn to recognize personality disorders. • To learn the characteristics and personality disorders in Cluster B. • To understand the general treatment options for Cluster B personality disorders.

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4 Financial Disclosures (past 3 years) No Disclosures

5 Outline • Personality Trait vs. Disorder • Recognizing Personality Disorders • Personality Disorders: Cluster A, B, and C Grouping • Cluster B Personality Disorders • Cluster B Key Characteristics • Treatment • Summary

6 Personality Trait vs Disorder • Personality trait: an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself. • Personality disorder: inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning; person is usually not aware of the problem. Usually presents by early adulthood. • The estimated international prevalence of personality disorders is 6 percent.

7 Recognizing Personality Disorders • Frequent mood swings • Angry outbursts • Anxiety sufficient to cause difficulty making friends • Need to be the center of attention • Feeling of being widely cheated or taken advantage of • Difficulty delaying gratification • Not feeling there is anything wrong with their behavior (egosyntonic symptoms) • Externalizing and blaming the world for their behaviors and feelings

8 Personality Disorders: Clusters • “Weird” --- Cluster A • “Wild”---- Cluster B • “Worried”-- Cluster C

9 Cluster B Disorders Cluster B characteristics: individuals often appear dramatic, emotional, or erratic in their emotions and behavior (impulsive) • • Histrionic Narcissistic Borderline Antisocial

10 Cluster B: Antisocial Key Characteristics Antisocial • Pervasive pattern of disregard for and violating the rights of others occurring since the age of 15 years as indicated by” − − − Lying, stealing, defaulting on debts. Neglect of children or other dependents Impulsivity and failure to plan ahead Aggressiveness Lack of remorse

11 Cluster B: Borderline Key Characteristics Borderline • A pervasive pattern of instability of interpersonal relationships alternating between extremes of idealization and devaluation that is characterized by: − − − Unstable self-image Chronic sense of emptiness and fear of abandonment Lack of control over impulses Recurrent suicidal behavior Affective instability

12 Cluster B: Histrionic Key Characteristics Histrionic • Excessive emotionality and attention seeking − − Inappropriate sexual or seductive behaviour Shallow expressions of emotion Uses physical appearance to draw attention Theatrical, over-dramatic

13 Cluster B: Narcissistic Key Characteristics Narcissistic • Grandiosity (in fantasy or behavior), need for admiration, and lack of empathy as indicated by: − − − Exaggerates achievements and talents Believes that he or she is special Has sense of entitlement Is interpersonally exploitative Lacks empathy

14 Treatment • No specific FDA approved medication for treatment of personality disorders • Studies suggest that it is more useful to target specific behavioral difficulties (eg, self-destructiveness, impulsivity, anger control) through psychodynamic therapy. • Selective serotonin reuptake inhibitors (SSRIs) are often thought of as first-line medical therapy for personality disorders. • Mood stabilizers may help stabilize mood and reduce irritability or aggression.

15 Summary • A personality disorder arises when an individual's personality traits are so inflexible and maladaptive across a wide range of situations that they cause significant impairment and distress. • Personality disorders are defined by specified DSM-IV-R criteria and specific types of personality disorders are grouped in three clusters and defined separately. • Cluster B personality disorders are grouped into the dramatic, emotional, and erratic group. Treatment can include psychotherapy and/or psychopharmacotherapy. • Patients with personality disorder may benefit from early referral to a mental health professional. Patients with personality disorders are at increased risk for adverse outcomes related to physical trauma, suicide, substance abuse, and concurrent psychiatric disorders. Additionally, patients often have difficulty understanding their condition and establishing rapport with their clinician.

16 Key References • Diagnostic and Statistical Manual of Mental Disorders, 4 th ed, Text revision (DSM-IV-TR). American Psychiatric Association, Washington, DC, 2000 • Langbehn DR, Pfohl BM, Reynolds S, et al. The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview. J Pers Disord 1999; 13: 75. • Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. AUGrant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJSOJ Clin Psychiatry. 2008; 69(4): 533. • Up. To. Date 2012 • Le Tao, Bhushan Vikas, Bagga, Herman. First Aid for USMLE Step 1 Clinical Knowledge 7 th edition. Student to Student Guide. 2011

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