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Cluster B Personality Disorders are evidenced by dramatic, erratic behaviors and include
Borderline Disorder, Antisocial Personality Disorder, Narcissistic Personality Disorder and Histrionic Personality Disorder.



Borderline Personality Disorder
Historically, BPD has been thought to be a set of symptoms that include both mood problems (neuroses) and distortions of reality (psychosis), and therefore was thought to be on the borderline between mood problems and schizophrenia. However, it is now understood that while the symptoms of BPD may straddle those symptom complexes, this illness is more closely related to other personality disorders in terms of how it may develop and occur within families. This is why it is characterized as a Cluster B illness, for its effects on the personality of someone who suffers from it. According to the DSM-TR-IV, BPD interferes with an individual's ability to regulate emotion. Like other personality disorders, it is characterized by a consistent pattern of thinking, feeling, and interacting with others and with the world that tends to cause significant problems for the sufferer. http://www.medicinenet.com/borderline_personality_disorder/article.htm The characteristic emotional instability results in dramatic and abrupt shifts in mood, impulsivity, poor self-image and tumultuous interpersonal relationships. People with this disorder are prone to unpredictable outbursts of anger, which sometimes manifests in self-injurious behavior. These emotional outbursts may last anywhere from a few hours to a day, but rarely any longer than that (NIMH). BPD sufferers are highly sensitive to rejection, and fear of abandonment may result in frantic efforts to avoid being left alone, such a suicide threats and attempts (Friedham 2004, Oldham 2004), as it says at http://personalitydisorders.suite101.com/article.cfm/cluster_b_personality_disorders People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly [[#|bipolar disorder]], depression, anxiety disorders, substance abuse, and other personality disorders. http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml


Borderlines are the patients psychologists fear most. As many as 75% hurt themselves, and approximately 10% commit suicide — an extraordinarily high suicide rate (by comparison, the suicide rate for [[#|mood disorders]] is about 6%). Borderline patients seem to have no internal governor; they are capable of deep love and profound rage almost simultaneously. They are powerfully connected to the people close to them and terrified by the possibility of losing them — yet attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead. Many therapists have no clue how to treat borderlines. And yet diagnosis of the condition appears to be on the rise.


Read more: http://www.time.com/time/magazine/article/0,9171,1870491,00.html#ixzz1HEmdM0bM

Symptoms
  • Impulsive
  • Self-damaging behavior
  • Extreme anger
  • Erratic emotions
  • Unpredictable aggressive and sexual behavior, such as unsafe sex and reckless driving
  • Monophobia
  • A pattern of intense and stormy relationships with loved ones
  • Chronic feelings of emptiness and/or boredom
  • Wide mood swings
  • Short but intense episodes of anxiety or [[#|depression]]
  • Fear of abandonment
  • Black and white thinking
  • Idealization and devaluation
  • Transient, stress-related paranoid thoughts or severe dissociative symptoms
  • Unstable self image

Causes
Most experts believe that BPD develops as a result of biological, genetic and environmental factors. Exact causes aren't known yet.
Environmental - distressing childhood experiences (physical and sexual abuse, early separation from [[#|caregivers]], emotional or physical neglect, emotional abuse, and parental insensitivity)
Genetic and Biological - studies have shown that a variation in a gene which controls the way the brain uses serotonin (a natural chemical in the brain) may be related to BPD. Individual is more likely to develop BPD if all these factors add up.

In addition, a number of studies have shown that people with BPD have differences in both the structure of their brain and in brain function. BPD has been associated with excessive activity in parts of the brain that control the experience and expression of emotion. For example, people with BPD have more activation of the limbic system, an area in the brain that controls fear, anger, and aggression, than people without BPD. This may be related to the emotional instability symptoms of BPD.
As in http://bpd.about.com/od/causesofbpd/a/CausesBPD.htm

Treatment
BPD is difficult to treat because symptoms of borderline personality disorder and criteria for diagnosis of BPD often indicate that a long history of unstable relationships is a hallmark of the disorder. The primary component of treatment for BPD is psychotherapy, but the combination of therapy and medication is often used. Since a large part of the treatment of BPD stems on a healthy relationship with a therapist, treatment can be difficult. However, once a treatment program is established, and the Borderline starts treatment, many of BPD’s damaging behaviors can be controlled, and a degree of recovery can even be observed. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones.

The different kinds of therapy involved in the treatment of BPD are:
  • Cognitive Behavioral Therapy
  • Dialectical Behavioral Therapy
  • Psychodynamic Therapy
  • Support Groups or Group Therapy
  • Pharmaceutical Support
  • Mentalization-Based Therapy
  • Schema-Focused Therapy
  • Transference-Focused Therapy

The most common medications used to treat BPD are:
  • Antidepressants
  • Antipsychotics
  • Mood Stabilizers
  • Anxiety Medication

From http://borderline-personality.suite101.com/article.cfm/treatment_of_bpd

Case Study​

**http://www.buzzle.com/articles/borderline-patient-case-study.html**

http://www.bpdfamily.com/bpdresources/nk_a102.htm

Videos


Addendum:
A Feminist Perspective

The criteria that define patients with borderline personality disorder are stereotypically feminine traits. Emotional instability, fragmented sense of self, and troubled interpersonal relationships are all portrayed as typical extremes of a woman’s character. This portrait of woman is echoed in literature and more currently the media.
So, how is it possible to explain the unequal ratio of women suffering with BPD? One explanation points to the fact that women are more commonly victims of sexual abuse and are therefore more likely to develop behaviors consistent with those covered in the DSM-IV. There has been a push from feminists to diagnose those affected by sexual abuse with PTSD rather than with BPD and the stigma that it entails. Lenore Walker, a psychologist who pioneered the study of battered woman syndrome, suggests that disorders such as BPD should come under a different category all together entitled “abuse disorders.”


ANTISOCIAL PERSONALITY DISORDER
Antisocial personality disorder is a psychiatric condition in which a person manipulates, exploits, or violates the rights of others. A person exhibits a lack of conscience, and their behavior is often criminal.

Nickname: Con Artist

CAUSES
There is no definite explanation for these sociopathic tendencies, however it is believed that environment plays a major role. There is a strong correlation between sociopaths and the lack of maternal affection during the first five years of their life, however this has not been stated as a cause. Child abuse or major trauma in childhood are said to have made an impact on people with this disorder. Also, the cause of genetics has yet to be ruled out. Those with antisocial relatives are at increase risk. Overall, this disorder is caused by a combination of both nature and nurture.

SYMPTOMS
  • For Adults
    • Disregard for rights of others
    • Considerable superficial charm
    • Above average intelligence
    • Inflated sense of self that convinces a sociopath that whatever he does is his right.
    • Manipulative
    • Disregard for the law
    • Lacks empathy
    • Feels little fear
    • Failure to relate emotionally
    • Promiscuous behavior.
    • Have no guilt or shame
    • Violent
    • Pathologically ego centric and self centered.
    • Impulsive
    • Addiction to drugs and alcohol.
    • Unreliable and irresponsible.
    • There is evidence of a Conduct Disorder (aggressive & destructive activities), onset before the age of 15
    • The individual is at least 18 years old
  • For Children
    • Bedwetting
    • Speech and learning disabilities
    • Irresponsible behavior
    • Poor self control
    • Inability to develop relationships with peers
    • Argumentative and manipulative
    • Violent behavior (Juvenile delinquency)


TREATMENT
Antisocial personality disorder is one of the most difficult personality disorders to treat. People with this condition rarely seek treatment on their own. They may only start therapy when required to by a court. The effectiveness of treatment for antisocial personality disorder is not known.
https://health.google.com/health/ref/Antisocial+personality+disorder




CASE STUDIES
Charles Manson is a well-known serial killer who has been diagnosed with antisocial personality disorder. He endured a loveless child hood, constantly switching from home-to-home among his relatives. His mother was an alcoholic prostitute who sold him for a pitcher of beer. By the time he was 33, he had spent more than half of his life in institutions for crimes ranging from robbery to rape. Over time he gained followers, a group called "The Family," made up of mostly troubled young women, who served as his army of executioners. It was this group that he ordered to perform the infamous Sharon Tate and LaBianca murders. These two killing sprees alone left over 35 people dead, including an 8-and-a-half-month pregnant woman.
http://serialkillercalendar.com/Brief-Bio-of-Charles-Manson.html
Richard Ramirez

Richard Ramirez is known as the Night Stalker. This interview shows his reactions to questions about his actions, including the charges and allegations that he is a serial killer. Some of the answers are genuine but most seem like they are being read right out of a script, showing the lack of emotions and/or inappropriate emotions.
http://www.youtube.com/watch?v=MC5huwZoPZA&feature=related

Sources: http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829/DSECTION=treatments-and-drugs, DSM IV

NARCISSISTIC PERSONALITY DISORDER
Narcissism is a class B disorder that is described as inordinate fascination with oneself-including excessive self-love, and erotic gratification derived from admiration of one's own physical or mental attributes, being a normal condition at the infantile level of personality development. Most narcissistic people look at themselves very highly, and look down on other people as if they are inferior. Ego-centrism is a one word description of the disorder.

Symptoms:
  • Extreme amounts of stress
  • Valued importance of self-image
  • Difficulty understanding others
  • Sense of entitlement
  • No regard (empathy) for others
  • Manipulative
  • Has trouble taking criticism
  • Need for constant praise; slightly "needy"
  • Perceiving that all are envious of you and simply out to get you
  • Consistently putting yourself before others

Causes: Typically nurtured causes
  • Low self esteem
  • Ignored in childhood
  • Permissive parents who give excessive praise to the child, thus fostering an unrealistic view of themselves
  • Overindulgence and spoiling by parents
  • Idealization of the child; or even of relationships
  • Learning manipulative behaviors from parents
  • Possibly caused by genetics

Effects:
  • Substance abuse
  • Alcohol abuse
  • Depression
  • Suicidal thoughts or behaviors
  • Eating disorders; especially anorexia nervousa but not excluding bulimia and others.
  • Relationship difficulties
  • Conflicts at school/work.

DSM IV Classification:
Diagnostic Criteria for Narcissistic Personality Disorder includes 5 or more of the following*:
  • Grandiose sense of self-importance
  • Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Believes that they are "special" and unique, and should only surround themselves with other equal to them
  • Requires excessive admiration
  • Has a sense of entitlement
  • Takes advantage of others to achieve own goals
  • Lacks any empathy towards others, does not understand/identify with feelings and needs of other people
  • Often envious of other people, or believes others are envious of him/her
  • Displays arrogant attitudes and behaviors

*It should be noted that although the criteria above has been shown to diagnose NPD (Narcissistic Personality Disorder), it is by no means restrictive to other criteria. The proper use of these criteria requires specialized clinical training that provides both a body of knowledge and clinical skills.

Information taken from: http://www.behavenet.com/capsules/disorders/narcissisticpd.htm

Treatments:
  • Psychotherapy
  • Brief Medical Treatment (hospitalization)
  • Psychosocial treatment
  • Group Therapy
  • Family Therapy
  • Cognitive Behavioral Therapy

Case Study:
  • Charles Manson is an example of someone with Narcissistic Personality Disorder, and the following is a video clip of him and some of the main symptoms of Narcissistic Personality Disorder shown through his behaviors:
  • Another real life example is Ted Bundy who not only suffered from narcissistic personality disorder but also antisocial personality disorder. (See APD section for more information and links to videos)


http://www.youtube.com/watch?v=M79RMlw__5Q&feature=related

Sources: http://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652

HISTRIONIC PERSONALITY DISORDER

Histrionic Personality Disorder (HPD) is personality disorder in which the individual displays an ongoing pattern of attention-seeking and excessively dramatic behaviors beginning in early adulthood and present across a broad range of situations.

Nickname: Stripper Disorder


Symptoms:
According to the DSM-IV-TR, HPD is indicated by five (or more) of the following symptoms:
(1) Is uncomfortable in situations in which he or she is not the center of attention.
(2) Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
(3) Displays rapidly shifting and shallow expression of emotions.
(4) Consistently uses physical appearance to draw attention to self.
(5) Has a style of speech that is excessively impressionistic and lacking in detail.
(6) Shows self-dramatization, theatricality, and exaggerated expression of emotion.
(7) Is suggestible, i.e., easily influenced by others or circumstances.
(8) Considers relationships to be more intimate than they actually are.

Causes:
The exact cause of Histrionic Personality Disorder is unknown, but many mental health professionals believe that both learned and inherited factors play a role in its development. For example, the tendency for Histrionic Personality Disorder to run in families suggests that a genetic susceptibility for the disorder might be inherited. However, the child of a parent with this disorder might simply be repeating learned behavior. Other environmental factors that might be involved include a lack of criticism or punishment as a child, positive reinforcement that is given only when a child completes certain approved behaviors, and unpredictable attention given to a child by his or her parent(s), all leading to confusion about what types of behavior earn parental approval.

This disorder is also seen to be diagnosed more in women than men because attention seeking and sexual forwardness are less socially acceptable for women.

Treatments:
  • Psychodynamic therapy: HPD may require several years of therapy and may affect individuals throughout their lives. Some professionals believe that psychoanalytic therapy is a treatment of choice for HPD because it assists patients to become aware of their own feelings. Long-term psychodynamic therapy needs to target the underlying conflicts of individuals with HPD and to assist patients in decreasing their emotional reactivity. Therapists work with thematic dream material related to intimacy and recall. Individuals with HPD may have difficulty recalling because of their tendency to repress material.
  • Cognitive-behavioral therapy: Cognitive therapy is a treatment directed at reducing the dysfunctional thoughts of individuals with HPD. Such thoughts include themes about not being able to take care of oneself. Cognitive therapy for HPD focuses on a shift from global, suggestible thinking to a more methodical, systematic, and structured focus on problems. Cognitive-behavioral training in relaxation for an individual with HPD emphasizes challenging automatic thoughts about inferiority and not being able to handle one's life. Cognitive-behavioral therapy teaches individuals with HPD to identify automatic thoughts, to work on impulsive behavior, and to develop better problem-solving skills. Behavioral therapists employ assertiveness training to assist individuals with HPD to learn to cope using their own resources. Behavioral therapists use response cost to decrease the excessively dramatic behaviors of these individuals. Response cost is a behavioral technique that involves removing a stimulus from an individual's environment so that the response that directly precedes the removal is weakened. Behavioral therapy for HPD includes techniques such as modeling and behavioral rehearsal to teach patients about the effect of their theatrical behavior on others in a work setting.
  • Group therapy is suggested to assist individuals with HPD to work on interpersonal relationships. Psychodrama techniques or group role play can assist individuals with HPD to practice problems at work and to learn to decrease the display of excessively dramatic behaviors. Using role-playing, individuals with HPD can explore interpersonal relationships and outcomes to understand better the process associated with different scenarios. Group therapists need to monitor the group because individuals with HPD tend to take over and dominate others.
  • Family therapy: To teach assertion rather than avoidance of conflict, family therapists need to direct individuals with HPD to speak directly to other family members. Family therapy can support family members to meet their own needs without supporting the histrionic behavior of the individual with HPD who uses dramatic crises to keep the family closely connected. Family therapists employ behavioral contracts to support assertive behaviors rather than temper tantrums.
  • Medications: Pharmacotherapy is not a treatment of choice for individuals with HPD unless HPD occurs with another disorder. For example, if HPD occurs with depression, antidepressants may be prescribed. Medication needs to be monitored for abuse.
  • Alternative therapies: Meditation has been used to assist extroverted patients with HPD to relax and to focus on their own inner feelings. Some therapists employ hypnosis to assist individuals with HPD to relax when they experience a fast heart rate or palpitations during an expression of excessively dramatic, emotional, and excitable behavior.


    • P - Provocative (or seductive) behavior.
    • R - Relationships, considered more intimate than they are.
    • A - attention, must be at center of.
    • I - Influenced easily.
    • S - Speech (style) - wants to impress, lacks detail.
    • E - emotional lability, shallowness.
    • M - Make-up - physical appearance used to draw attention to self.
    • E - Exaggerated emotions - theatrical.
Effects:
  • Damages social and romantic relationships.
  • Effects patients ability to cope with loss or failure.
  • Job changes due to boredom or frustration.
  • Patient may put themselves in risky situations, this can lead to a greater risk of depression.
  • Over exaggerates relationships
  • Feels uncomfortable when not the center of attention

Case Study:

Regina George (Mean Girls)

http://www.youtube.com/watch?v=9lxk5IRLysI


Sources: http://www.behavenet.com/capsules/disorders/histrionicpd.htm, http://www.minddisorders.com/Flu-Inv/Histrionic-personality-disorder.html#ixzz0jh7WJBgu