PDs: Cluster B

Question 1

What characterises the Cluster B of personality disorders?

Answer 1

They are the ‘dramatic’ and ‘emotional’ disorders.

Question 2

Which personality disorders fall within cluster B?

Answer 2

• Antisocial PD.
• Borderline PD.
• Histrionic PD.
• Narcissistic PD.

Question 3

What is Histrionic Personality Disorder?

Answer 3

The MOST dramatic disorder. It is characterised by attention seeking, overly dramatic displays of emotion in an exaggerated manner.

Question 4

What does ‘Histrionic’ mean? How does it relate to the disorder?

Answer 4

Histrionic = theatrical in manner.

It seems as though they are acting, living on stage the whole time.

Question 5

In Histrionic Personality Disorder, what is the attention given to appearance?

Answer 5

They are seductive in appearance (with a focus on grooming).

Question 6

What emotions do people with Histrionic Personality Disorder often deny?

Answer 6

They often deny anger and hostility.

Question 7

People with Histrionic Personality Disorder use their emotions to… what?

Answer 7

Manipulate others. They can be flirtatious, gregarious.

Question 8

People who have Histrionic Personality Disorder can be what in their interpersonal relationships?

Answer 8

Dramatic but also superficial.

Question 9

What other disorders is Histrionic Personality Disorder comorbid with?

Answer 9

Narcissistic, Borderline, Anti-Social PDs.

Psychoactive substance abuse.

Question 10

The Histrionic Personality Disorder mode model explains why people may behave the way they do. The model involves a ‘Punitive Parent’ and a ‘Vulnerable Child’ - explain these constructs.

Answer 10

• ‘Vulnerable Child’ - felt unloved, lonely, unseen, needing attention and love.
• ‘Punitive Parent’ - (actual or perceived messages from caregiver or outside world) ‘you are not lovable, you screw things up, no one will put up with you.’
  The person will develop strategies to overcome the feeling of being unloved.

Question 11

In Histrionic Personality Disorder mode model, what are the strategies a person will develop to overcome the feeling of being unloved?

Answer 11

They will go into ‘attention-seeking mode’ (drama queen mode).
Although these emotions are hollow, they learn that this is the way to get attention and be in touch with others.

Question 12

What are the three key characteristics of Borderline Personality Disorder?

Answer 12

• Emotional instability/affective dysregulation when reacting to environmental and interpersonal situations.
• Poor impulse control.
• Unstable identity and insecure attachments.

Question 13

People with Borderline Personality Disorder are high on what personality dimensions?

Answer 13

High on emotional sensitivity and reactivity.

Question 14

For people with Borderline Personality Disorder, they are quick to - what? And slow to - what?

Answer 14

They are quick to overreact (heat up) and slow to reach emotional base line (cool down).

Question 15

People with Borderline Personality Disorder have poor impulse control and often self-harm or attempt suicide out of a need for attention. While deep down, most do not intend to kill themselves, how many accidentally do?

Answer 15

About 10%

Question 16

The poor impulse control and dissociative feelings in Borderline Personality Disorder are linked with what behaviours?

Answer 16

Promiscuity, self-harm, spending, binge eating, poor limit setting, suicidal behaviour.

Question 17

The Borderline Personality Disorder mode model explains why people may behave the way they do. The model involves a ‘Punitive Parent’, an ‘Abandoned/Abused Child’ and an ‘Angry/Impulsive Child’ - explain these constructs.

Answer 17

• Punitive Parent: abusive, neglectful.
• Abandoned/Abused Child: intense fear of abandonment, fears being abused.
• Angry/Impulsive Child: undisciplined, fulfilling needs, without control, doesn’t care about consequences.
  To deal with these feelings the child develops coping strategies. They push the emotions as far away as possible and become a ‘Detached Protector’.

Question 18

In Borderline Personality Disorder mode model, a person will develop strategies as a ‘Detached Protector’ to protect themselves from the emotions related to child modes, what are they? (6)

Answer 18

Detached Protector:

1. Social withdrawal.
2. Avoidance.
3. Substance use.
4. Medication abuse.
5. Binge-eating.
6. Non-suicidal self-injury.

Question 19

There is an extreme feeling of emptiness in Borderline Personality Disorder, often linked with dissociative feelings. What will they do in order to feel something?

Answer 19

Often harm themselves.

Question 20

People with Borderline Personality Disorder often have unstable relationships, they desperately want to be with someone but find it difficult to maintain a stable relationship, why?

Answer 20

Because they form intense and unstable relationships. They will idealise the person and then hate them.
They can become possessive and resentful if the partner is paying attention to others, isolate the person from their friends and family.

Question 21

Why is there a high prevalence of people with Borderline Personality Disorder in a clinical setting?

Answer 21

Because someone who is emotionally unstable and threatening to kill themselves will lead them to psychiatric help.

Question 22

Borderline Personality Disorder is the most prevalent PD in clinical settings. Out of all PD, what is the percentage of outpatients and inpatients that have Borderline PD?

Answer 22

• Outpatient: 10%

- Inpatient: 15-20%

Question 23

There is rarely a sole diagnosis of Borderline Personality Disorder as it is comorbid with other disorders. What are the most common comorbid diagnoses?

Answer 23

Mood disorders, eating disorders, substance-use disorders, anxiety disorders and PTSD.

Question 24

Compared to all other PDs, Borderline Personality Disorder is (arguably) seen as what?

Answer 24

The most debilitating PD.

Question 25

When is Antisocial Personality Disorder evident in a person? Before this age, what are they most likely to have?

Answer 25

It is evident around the age of 15, before they will likely have Conduct Disorder.

Question 26

How do people with Antisocial Personality Disorder behave toward others?

Answer 26

They have repeated reckless disregard for others.

They victimise and blame others for their inadequacies.

Question 27

What characterises the interpersonal relationships of people with Antisocial Personality Disorder?

Answer 27

Shallow and manipulative.

Question 28

What traits do people with Antisocial Personality Disorder tend to have?

Answer 28

Impulsive, aggressive, charismatic and deceitful traits.

Question 29

Someone who has Antisocial Personality Disorder may feel guilt and depression, so may seek help from a clinician. Why do they experience these things?

Answer 29

They cannot empathise and will be depressed because they felt betrayed by their victim.

Question 30

Although antisocial behaviours are linked with criminality, what is important to remember about Antisocial Personality Disorder?

Answer 30

That diagnosis is NOT dependant on the presence of criminal behaviours.

Question 31

People with Antisocial Personality Disorder cannot empathise with others, and do not understand what about their behaviour?

Answer 31

They do not understand the effect their behaviour has on others.

Question 32

What other disorders is Antisocial Personality Disorder comorbid with?

Answer 32

Borderline PD, Narcissistic PD, Histrionic PD & Schizotypal PD.

Question 33

What are some of the underlying assumptions of Antisocial Personality Disorder?

Answer 33

• ‘everybody is out to get for themselves.’
• ‘I need to protect myself, I need to defend myself.’
• ‘My needs are paramount and much more important than anyone else’s needs.’
• ‘Rules don’t apply to me. If you obey rules, you are not smart, you will loose in the end.’
• ‘Better to beat the system and get what you need.’
• ‘It’s me against everyone.’

They are self-centred and entitled, it is the callous and exploitative behaviour that leads to diagnosis.

Question 34

In the Antisocial PD mode model, the person experiences being a Vulnerable child and an Enraged Child, due to a Punitive Parent. Thus they compensate with three different modes: Predator, Bully/Attack, and Conning/Manipulative. Expand on these.

Answer 34

• Punitive Parent: abusive, abandonment.
• Vulnerable Child: abused/abandoned.
• Enraged Child: becomes aggressive when treated unfairly.
  In order to cope they go into:
• Predator: severely hurting/killing in a premeditated way in order to pursue their own interests.
• Bully/Attack: acting aggressively in a planned manner to accomplish their needs or meet their interests.
• Conning/Manipulative: lying and cheating but trying to make others believe that they are behaving well.

Question 35

In Narcissistic Personality Disorder, the personality is arranged around what?

Answer 35

Maintaining a high self-esteem by eliciting external admiration to compensate for internal sense of falseness.

Question 36

Although in Narcissistic Personality Disorder most people display a grandiose sense of self, in truth ‘image replaces substance’ being the person has, what?

Answer 36

A fragile self-esteem, envy, self-consciousness, vulnerability.

Question 37

To compensate for feeling of fragility and vulnerability, a person with Narcissistic Personality Disorder will what?

Answer 37

React with self-righteousness, pride, contempt, vanity, and superiority.

Question 38

What pervasive patterns do people with Narcissistic Personality Disorder display?

Answer 38

Grandiosity, entitlement, privilege, special treatment, exaggerated sense of self-importance, arrogant behaviour and attitudes.

Question 39

How might people with Narcissistic Personality Disorder act toward others?

Answer 39

They can be cold, disinterested, snobbish and patronising.

Question 40

What disorders is Narcissistic Personality Disorder comorbid with?

Answer 40

All the others in the same cluster: antisocial, histrionic and borderline, as well as substance abuse.

Question 41

In the Narcissistic Personality Disorder mode model, what is the ‘Demanding Parent’ and the ‘Vulnerable/Enraged Child’ modes? And what compensatory behaviour does this lead to?

Answer 41

• Demanding Parent: extremely high standards and expectations, believe that if the child shows emotions it means they are weak, anything less than perfect is not good enough.
• Vulnerable Child: feels like a failure, humiliated, powerless, unable to meet parental standards.
• Enraged Child: becomes aggressive when others address issues related to the vulnerable child mode.

Flips into the ‘Self-Aggrandizer’ mode:

• inflated sense of self-importance.
• unrealistic ideas about their professional success.
• devalues those who don’t admire them.
• demands recognition.