Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) identifies ten (10) Personality Disorders. These are then divided into clusters. The second cluster involves Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders. Patients are often characterized as having dramatic, emotional, and erratic behaviors. 

Antisocial Personality Disorder

Individuals with Antisocial Personality Disorder are described as a having a pattern of disregard for and violation of the rights of other.

The patient with Antisocial Personality Disorder often fails to conform to social norms regarding lawful behavior and usually shows a disregard for the wishes, rights, and feelings of others. The patient is frequently deceitful and manipulative. Patients tend to be irritable and aggressive and often display a reckless disregard for the safely of themselves and others. The patient shows little remorse for the consequences of his acts and then tends to minimize the harmful consequences of his actions or is completely indifferent; furthermore, the patient generally fails to compensate for his behavior.

Patients with Antisocial Personality Disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feeling, rights, and suffering of others. The patient may be excessively opinionated and seem cocky. The patient tends to be irresponsible and exploitative. Not surprisingly, patients with Antisocial Personality Disorder are more likely to have criminal records and die prematurely by violent means than other people. 

Borderline Personality Disorder

Individuals with Borderline Personality Disorder often display a pattern of impulsivity and instability in personal, social and occupational environments.

The patient with Borderline Personality Disorder is hypersensitive to environmental circumstances and experiences intense abandonment fears and inappropriate anger when faced with separations or unavoidable changes in plans. In order to avoid abandonment, whether real or imagined, the patient may employ frantic efforts that often include impulsive actions such as self-mutilation or suicidal behaviors. The patient can empathize with and nurture other people, however, she expects that the other person will be available to her upon demand. The patient often seems to have an unstable self-image or sense of self which is characterized by shifting goals and values as well as sudden changes in opinions and plan regarding career, sexual identity, values, and types of friends. The patient displays recurrent suicidal behavior, gestures, or threats, or even self-mutilating behavior. The patient often experiences sudden mood changes and feelings of emptiness.

Patients with Borderline Personality Disorder have a pattern of undermining themselves just about the time a goal is to be achieved. The patient may feel more comfortable and secure with transitional objects, such as pets or inanimate objects, than he does in interpersonal relationships. Recurrent job losses, interrupted education, and broken marriages are common among patients diagnosed with Borderline Personality Disorder. 

Histrionic Personality Disorder

Individuals with Histrionic Personality Disorder are described as having a pattern of excessive emotionality and attention seeking.

The patient with Histrionic Personality Disorder seeks to constantly be the center of attention and often resorts to dramatics to draw the focus to her. The appearance and behavior of the patient is usually inappropriately sexually provocative or seductive and since her physical appearance is often used to draw attention to herself, she will spend excessive amounts of time, energy, and money on clothes and grooming. She often fishes for compliments from others and has trouble accepting critical comments from others. Her emotional expression often seems shallow and fake. She is often dramatic and theatrical in her everyday dealings. Furthermore, the patient is so highly suggestible and is easily influenced by other people and fads that she seems to be flaky.

Patients with Histrionic Personality Disorder often tries to controls other people with emotional manipulation and seductiveness; but, she also has a complete dependence on other people. Patients tend to alienate friends with demands for constant attention; patients also tend to alienate same-sex friends due to their sexually provocative interpersonal style. Patients crave new ideas and stimulations. 

Narcissistic Personality Disorder

Individuals with Narcissistic Personality Disorder are often described as having a grandiose need for admiration and lack of empathy.

The patient with Narcissistic Personality Disorder often has an inflated sense of self-importance. The patient believes that she is superior, special, or unique and even expects other people to recognize her as such. The patient with Narcissistic Personality Disorder has a very fragile sense of self and self-esteem and in order to keep this fragile self-esteem high, the patient requires constant admiration from others and expects to be catered to, no matter what it might mean to others. The patient generally has difficulty recognizing the needs and feelings of others; however, when these needs and feelings are recognized, the patient usually views them as being signs of weakness and vulnerability.

Patients with Narcissistic Personality Disorder often seem arrogant, haughty, snobbish, disdainful, and even patronizing. The patient’s low self-esteem leads to feelings of humiliation in regards to criticism from others. Interpersonal relationships are usually strained due to problems that arise from the patient’s constant need for attention and admiration.

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