Personality disorders are persistent but can still wax and wane in severity due to life circumstances, social support, and stressors. Many people with personality disorders are either unaware of their personality traits or, if they are aware, they do not view them as a problem. About half of the individuals who meet the criteria for a personality disorder will also meet the requirements for at least one other personality disorder. People with personality disorders are likely to have other conditions, including mood disorders, anxiety, eating disorders, and substance use. The development of personality disorders has genetic and environmental components, like childhood stressors and trauma.
Antisocial personality disorder and borderline personality disorder are two personality disorders in Cluster B. Cluster B is the dramatic and emotional cluster with emotional reactivity, poor impulse control, a hazy sense of identity, and possible aggression. Individuals with a Cluster B disorder have lives marked with stormy and problematic relationships, and affected individuals are also at risk for self-destructive behavior. Individuals affected by personality disorders often do not realize there is a problem; they frequently shift the blame onto external sources, including their situation, their environment, or other people. Additionally, these disorders are unfortunately often misunderstood and excessively stigmatized.
The word "antisocial" is commonly used in a casual sense to describe someone who is excessively introverted and does not want to socialize with others. Choosing to stay home to stream a show instead of going out to a party may be called "antisocial." However, antisocial personality disorder is very different than this meaning.
An antisocial personality disorder is a disorder that is usually referred to when someone uses the term "sociopath" or "psychopath." It involves a lack of remorse and a disregard for and violation of the rights of others.
Antisocial personality disorder affects about 2% of the population and is more common in men. It disproportionately affects individuals who have encountered poverty. People with antisocial personality disorder are more likely than the general population to participate in illegal, impulsive, and aggressive acts and develop substance use disorders.
Some people with antisocial personality disorder appear arrogant, opinionated, cocky, and irritable. Others may have a more subtle presentation and can be charming, clever, and seductive. They characteristically engage in frequent lying and have a general lack of concern for consequences.
Out of all the personality disorders in Cluster B, antisocial personality disorder has the poorest prognosis. Some individuals can function professionally while others have poor function, especially if they have violent tendencies. The disorder often starts as conduct disorder in childhood or adolescence and can then be diagnosed as antisocial personality disorder after the age of 18. As affected individuals age, they typically become less aggressive and impulsive with age. Like most personality disorders, treatment consists of therapy, such as cognitive behavioral therapy (CBT).
The casual use of the term "bipolar" to describe someone moody with frequent changes between highs and lows from minute to minute or hour to hour is a more accurate description of borderline personality disorder (BPD) than bipolar disorder. BPD affects about 2% of the population and is equal in men and women, though women are more likely to seek treatment. It involves emotional instability and dysregulation with rapid and wide swings of emotion, impulsivity, and an unstable sense of self. Many affected individuals engage in self-destructive behavior, used to cope with disruption or threat of disruption of a relationship, to deal with their emotions, or to punish themselves.
Much of the characteristic behavior in BPD revolves around the efforts to avoid abandonment. People with BPD report that they are easily bored and have difficulty controlling anger, which is often followed by shame and guilt. Affected individuals are prone to self-sabotage when they are close to their goals or when they finally find themselves in a stable relationship. In their relationships, people with BPD can often transition quickly from clingy behavior with idealization to hatred, which is referred to as splitting. They can also split themselves; one moment they can feel special, and then the next moment they can switch to feeling worthless.
People with BPD are more likely than the general population to experience drug and alcohol abuse, eating disorders (especially bulimia nervosa), and feelings of emptiness. Anxiety, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder commonly occur in individuals diagnosed with BPD. They are also more likely to gamble, binge eat, engage in unsafe sex, and drive recklessly. Up to 10% of affected individuals die from suicide, but most of them will live long enough to no longer meet the criteria for BPD. Individuals benefit from psychodynamic therapy (especially dialectical behavioral therapy) and CBT along with medical management.
For more information about antisocial personality disorder and borderline personality disorder, listen to the episode of First Line here: https://open.spotify.com/episode/1wiNW28cM45tQ2rml42bWT