Personality disorders are persistent but can still wax and wane in severity due to life circumstances, phases of life, social support, and various 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 people who meet the criteria for a personality disorder will meet the requirements for at least one other personality disorder. The development of personality disorders has genetic and environmental components, meaning that individuals likely have an underlying genetic predisposition that combines with childhood stressors and trauma to cause their symptoms. The personality traits that individuals develop are often a way of coping with stressors and trauma.
There are three clusters of personality disorders (Cluster A, Cluster B, and Cluster C). Cluster B is known as the dramatic and emotional cluster. The personality disorders in this cluster involve emotional reactivity, poor impulse control, a hazy sense of identity, aggression, stormy and problematic relationships, and self-destructive behavior. Cluster B includes antisocial personality disorder, borderline personality disorder (BPD), histrionic personality disorder, and narcissistic personality disorder. Learn more about antisocial personality disorder and BPD here in a separate post.
Histrionic personality disorder involves dramatic and attention-seeking behavior. It affects about 2% of the population. It is diagnosed more in women but is equal in both sexes. Affected individuals often feel the need to be the center of attention; without the attention they require, they can become depressed. They will frequently use their appearance with lively, flirtatious, and enthusiastic behavior to gain attention. They often appear to have rapid shifts of dramatic emotion. Affected individuals tend to be sexually provocative and seductive and may often consider relationships to be more intimate than they are. They strive to be the "life of the party" and fish for compliments to help their self-esteem. Like most personality disorders in Cluster B, they tend to become bored with their usual routine and prefer new, exciting relationships to older ones. Some of these behaviors can overlap with symptoms of manic episodes in bipolar disorder. However, a personality disorder involves behavior that persists instead of only occurring during isolated episodes.
Histrionic personality disorder has the best prognosis of disorders in Cluster B. Most associated personality traits are limited to intimacy, but individuals often have a retained capacity to create stable and meaningful relationships. In severe cases, their behavior can impair their professional and interpersonal functioning. Substance use, major depressive disorder, anxiety, somatic symptom disorder, and functional neurological disorder can be concurrent in these individuals and further complicate their functioning. Individuals often do well with long-term psychodynamic psychotherapy.
Narcissistic personality disorder affects about 6% of the population and is more common in men. It involves a feeling of entitlement, an elevated sense of self, frequent fantasies of success and power, and an excessive need for admiration from others. It is one of the most misunderstood personality disorders. It is important to note again that individuals develop personality disorders often in response to trauma and stressors. The traits they develop are maladaptive coping responses. Affected individuals may have underlying feelings of inferiority and envy, known as the covert type, which often presents along with chronic depression. Individuals with this type may have a sense of moral superiority due to perceived suffering, bolstering their self-esteem.
Individuals with narcissistic personality disorder often appear boastful, pretentious, self-centered, arrogant, and exploitative. They see themselves as unique and superior. Because of this, they may only want to associate with others they view as gifted. Individuals often fish for compliments, lack empathy, and tolerate criticism poorly. Criticism can lead to either emotional collapse with depression or rage. They may be unwilling to take a risk when failure is possible. Affected individuals are vulnerable to depression, and this risk increases as they age. This personality disorder is also associated with anorexia nervosa and substance use disorders (e.g., cocaine).
Individuals with narcissistic personality disorder usually do not seek help because doing so may make them feel inferior. When they engage in treatment, they typically do not tolerate treatment well because they struggle to acknowledge their flaws.
Gain a deeper understanding of these two heavily stigmatized disorders in the First Line episode on this topic. Here are related episodes: