5.07 Cluster B Personality Disorders

Psychiatry review for USMLE Step 1 Exam

• Cluster B personality disorders are the highest yield among all personality disorders.
• The cluster B disorders include borderline personality disorder, histrionic personality disorder, narcissistic personality disorder, and antisocial personality disorder.
• Substance abuse and comorbid mood disorders, particularly major depressive disorder (MDD), are commonly associated with cluster B disorders.
• Personality disorders are distinguished from normal personality traits by their negative impact on daily life, lack of awareness of the problem, and deviation from cultural expectations.
• Borderline personality disorder is characterized by unstable emotions, impulsivity, disturbed relationships, and potential psychotic features.
• Criteria for diagnosing borderline personality disorder include frantic efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, recurrent suicidal behavior, affective instability, chronic feelings of emptiness, inappropriate anger, and paranoid ideation or dissociative symptoms under stress.
• Borderline personality disorder has a high risk of suicide, especially in women, and is often treated with dialectical behavior therapy (DBT).
• Histrionic personality disorder involves excessive attention-seeking, inappropriate sexually seductive behavior, shallow emotional expression, and self-dramatization.
• Diagnostic criteria for histrionic personality disorder include discomfort when not the center of attention, sexually provocative behavior, emotional instability, attention to physical appearance, impressionistic speech, self-dramatization, and susceptibility to influence.
• Histrionic personality disorder is more common in women and is associated with the defense mechanism of regression.
• Narcissistic personality disorder is characterized by grandiosity, a need for admiration, lack of empathy, and a sense of entitlement.
• Diagnostic criteria for narcissistic personality disorder include a grandiose self-importance, fantasies of unlimited success, a belief in being unique, excessive need for admiration, sense of entitlement, exploitation of others, lack of empathy, envy, and arrogant behavior.
• Narcissistic personality disorder is exemplified by individuals who exhibit characteristics similar to a former president (not mentioned by name), including being grandiose, preoccupied with success, and envious of others.
• Antisocial personality disorder, often referred to as sociopathy, involves a disregard for others' rights, lack of remorse, criminal behavior, hostility, and manipulation.
• Antisocial personality disorder is more common in males, has a high prevalence in incarcerated individuals, and is usually preceded by childhood conduct disorder.
• Diagnostic criteria for antisocial personality disorder include failure to conform to social norms, deceitfulness, impulsivity, aggressiveness, disregard for safety, irresponsibility, and lack of remorse.