Cluster B Personality Disorders: High Drama
Though there are nine different types of Personality Disorder described in the book that mental health professionals use to categorize and diagnose mental illness, the Diagnostic Statistics Manual, it is the grouping called ‘Cluster B’ that often have the largest, most dramatic, and negative impact on society at large, as well as creating devastation to anyone who has gotten into relationship with a Cluster B Personality Disorder. The societal costs of the common crimes that people with this disorder cluster commit, in terms of human devastation and trauma, as well as the economic impact of their crimes, trials, and incarceration is in the multiple billons, if not trillions of dollars.
Many of the nine recognized personality disorders have overlapping, and even common characteristics. There are several overriding characteristics that cover all nine, including that the symptoms of the disorder can be traced far back into the history of the individual; there is a sense when these people are children or teens that ‘something is not quite right’ with them. The symptoms that they have also tend to affect every aspect of their lives, from home life and private relationships to things like school and work, as well as their ability to function in an average fashion in the larger community and society.
Those personality disorders that make up ‘Cluster B’ are: Histrionic, Borderline, Narcissistic, and Antisocial. Generally, here are the major identifying characteristic of each: Histrionic: a pervasive pattern of emotionality and attention seeking. Borderline: a pervasive pattern of instability of interpersonal relationships and self-image, with marked impulsivity. Narcissistic: a persistent pattern of grandiosity, need for admiration, and lack of empathy. Antisocial: a persistent pattern of disregard for the rights of others.
To the layperson, these diagnostic criteria will seem to be quite clear cut, but mental health professionals often note that most individuals who have personality disorders that fit into the Cluster B category may have overlapping, or even most all of the above noted major characteristics. In a very real sense, all of them can be described as ‘antisocial’ in the sense that all of them result in countless damaged relationships and collateral damage due to the behaviors of the disorders. All can be seen to have a high degree of the self-centeredness common in narcissism; for a Cluster B personality disorder, everything is always about themselves and what they want. Each of the Cluster B disorders also demonstrate a high degree of interpersonal dysfunction, impulsivity, and (often negative) attention seeking behaviors.
The Cluster B Personality Disorders might then be described as a ‘spectrum’ of varying symptoms and intensity of symptoms. On one end of the spectrum might be the teased and bullied ‘oddball’, while in the middle are con-men, petty criminals, and self-imagined kings of their own domains, and at the other far end, stone-cold killers with no conscience whatsoever. When we add in any particular case’s level of intelligence, learned skills, balancing influences, and life experiences, we have a potent mix that creates a range from the benign eccentric to the psychopathic killer.
So, it is important to understand that if someone has a Cluster B Personality Disorder, it does not mean that they are on par with say, Charles Manson, or that they will become someone like him. There are countless factors that shape every human being, including those with personality disorders. While estimated worldwide percentages of the population with Cluster B disorders stands at around 1.5%, and of those, only a very small portion are represented by say, serial killers, this till represents that a bit more than one on one hundred people are in this category.
How Do You Get Personality Disorder?
So how do people with these disorders get them? The jury is still out on definitive answers to this question, though there is good scientific evidence pointing to a genetic link. Case studies also support a genetic link in that review of the individual’s history can often trace to a personality disordered parent as well as many, many varieties of dysfunctional environmental issues. By environmental issues, we mean the social, developmental, educational, disciplinary, and nurturing environment that children grow up in.
A handy way to understand this is to compare the effects of personality disorder on children to another disorder like addiction. While some of the children of an addict may inherit the gene that predisposes them to addiction, not all will. In addition, if the parent addict is clean and sober and the child never lives in an active addiction environment, the child has a lower chance of becoming an addict themselves (if they choose never to use). But if the parent addict is still in active addiction, the child is being exposed to a lifestyle and level of damaged parenting that likely will impact the child in a negative manner.
Most mental health professionals are very hesitant to give a diagnosis of personality disorder to someone under the age of eighteen, as it is felt that personality is still forming during the teen years. There are some studies though, that demonstrate that personality disorder traits can be observed in children and teens that later turn out to be full-blown personality disorder in adulthood. Many confirmed adult personality disordered people have a history of childhood diagnoses such as ADHD, oppositional defiant disorder, and conduct disorder. Though it should be noted that note every individual with these childhood diagnoses will grow into an adult with personality disorder.
Can It Be Treated?
There is good evidence that people with personality disorder will likely have it for their entire lives. The truth is, some get worse, some get slightly better when they reach their fifth decade, and some get far worse as they age. Personality disorder is underdiagnosed and undertreated. This may be due to the fact that most people with these disorders do net see themselves in any way needing treatment; they are blind to their own issues and the fact that they create their own problems.
In addition, the mental health field has been quite inadequate in designing interventions for people with the disorder, especially Cluster B disorders. Many Cluster B personality disorders only get some form of treatment when they get caught by law enforcement and end up in jail, if we can call what is offered there ‘treatment’. Often, people with Cluster B personality disorders get a multitude of other diagnoses like depression, anxiety, bipolar disorder, and even psychosis. In many cases, the individual would far rather be mentally ill in this sense, and gain access to psychotropic drugs, than to face the truth about their own participation in their disorder.
A discussion currently in the field of mental health is to begin to identify children and teens with behavioral signs of developing personality disorder as early as possible so that appropriate interventions can be made. The recognition that children show early signs, let alone the design of effective treatment for these children and teens is essentially in its infancy.
Another part of the difficulty in discovering adequate and effective treatments for people with Cluster B personality disorders is that due to the characteristics of the disorder. It can be quite difficult to find professionals who are willing and able to tolerate the often offensive behaviors and expressed sentiments that these people have, as well as the real potential dangers of working with a highly volatile, vindictive, and deceitful group of of people. While people with personality disorder need compassion and good treatment, these are often difficult to deliver.
In order for diagnosis and treatment to take place, the individual with a Cluster C personality disorder first has to admit to themselves that they are the one with the problem, and it is they who need to change, and this is no small task or miracle when it happens. Much like an addict, it really only genuinely happens when the person ‘hits bottom’. Even then, if properly diagnosed and committed to therapy, progress is slow, and intensive treatment is usually needed. If the person invests in treatment and works hard, their life can get better.
It should be noted that while successful treatment for a diagnosed Cluster B Personality Disorder is relatively rare, but what is not rare is the need for treatment of the victims of them. There is often a very wide path of damaged people when looking at a Cluster B individual’s history, and many of these victims remain ignorant of what exactly it was that happened to them, and the cause. Victims can benefit from education about the particular disorder that they were victimized by, and how to construct limits and boundaries to manage the person with personality disorder in their life.