Cluster B Personality DisordersSymptoms, Diagnosis, and Treatment

What are cluster B personality disorders?

Cluster B personality disorders are a group of disorders that involve a pattern of intense emotions and erratic behavior. People with these disorders often have a hard time maintaining close or healthy relationships with others. There are four personality disorders that are classified as cluster B:

Narcissistic Personality Disorder (NPD)

Narcissistic personality disorder involves low empathy, an intense desire for admiration, and a tendency to exploit others. The mood or attitude of someone with NPD towards you can fluctuate depending on how well you feed their ego. They might be selfish, demanding, and seem entitled or self-important.

Borderline Personality Disorder (BPD)

Borderline personality disorder consists of a pattern of unstable moods, intense reactions, and impulsive decision-making. A person with BPD can be extremely sensitive, and their emotional volatility can blow seemingly small issues up into crises. Underneath all of this are feelings of emptiness and a fear of abandonment.

Antisocial Personality Disorder (ASPD)

Antisocial personality disorder, sometimes called sociopathy, involves a pattern of reckless, impulsive behavior and disregard for the well-being of others. A sociopath may steal, lie, or put others in danger, seemingly without remorse.

Histrionic Personality Disorder (HPD)

Histrionic personality disorder follows a pattern of extreme attention-seeking, self-centeredness, and overly dramatic displays of emotion. A person with HPD might come off as shallow and easily influenced. HPD has sometimes been referred to as “BPD-light,” because of how similar the conditions may appear on the surface.

If you think you or someone you know has one of these conditions, learn more about the symptoms and causes. Then, you can find ways to manage the disorder.

Symptoms of cluster B personality disorders

It might be useful to think of personality disorder symptoms as inflexible and extreme versions of otherwise ordinary traits. Everyone can be a little vain from time to time, but narcissism involves an unhealthy—sometimes even self-destructive—degree of vanity. No one likes to be ignored, but people with histrionic personality disorder have a chronic and problematic need to be the center of attention.

Exact symptoms will vary depending on the specific disorder; however, people with cluster B personality disorders typically experience the following:

Emotional instability. If you have a cluster B personality disorder, you might experience rapidly changing emotions. For example, your sense of self-worth may skyrocket or plummet based on small events, such as a work colleague receiving attention or praise instead of you. People around you may have a hard time keeping up with these sudden mood shifts.

Impulsive behavior. Others may point out that you tend to act without thinking. Suddenly breaking up with romantic partners, for example, or undertaking reckless spending sprees could make your life chaotic.

Interpersonal Issues. You may swing from idealizing someone to feeling resentful toward them because they’ve offended you by offering feedback or setting a boundary. Friends, family, and other loved ones can feel confused or overwhelmed by your reactions.

Cluster B vs. clusters A and C personality disorders

Personality disorders are grouped together based on similarities in their symptoms. The disorders in cluster B involve a tendency for dramatic or erratic behaviors and often a lack of empathy for others.

In contrast, cluster A personality disorders, such as schizoid or paranoid personality disorders, involve more withdrawn and odd behavior. People with these disorders may have limited expressiveness. Meanwhile, cluster C personality disorders, like avoidant or dependent personality disorders, feature intense anxiety and fear.

Causes and risk factors of cluster B personality disorders

Studies of families and twins reveal that cluster B personality disorders are at least partially hereditary. For instance, differences in genes may affect levels of serotonin, a brain chemical that regulates mood. These differences in brain chemistry may contribute to personality disorder symptoms.

However, environmental factors, such as parental role-modeling, childhood abuse, or neglect, can also be risk factors. Cluster B personality disorders are associated with insecure attachment styles. Insecure attachment is the result of having a caregiver who was unable to provide consistent comfort during infancy.

The interplay between all these factors might make personality disorders more or less likely to develop. For example, you might inherit a temperament that predisposes you to develop one of these disorders when you experience neglect or traumatic stress.

Diagnosing cluster B personality disorders

Getting an early and accurate diagnosis is important because it allows you to find the right resources and begin managing your condition. A mental health professional can make a personality disorder diagnosis by comparing your behavioral patterns to criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Personality disorders can often overlap in symptoms and co-occur with other mental health conditions, including depression, anxiety, eating disorders, and substance-use disorders. A thorough evaluation helps avoid a misdiagnosis and ensures co-occurring conditions are identified as well.

An evaluation will likely involve a look at your medical and mental health history. Structured clinical interviews allow an expert to gain more information and get a firsthand impression. Self-report inventories, such as the McLean Screening Instrument for BPD or Psychopathy Personality Inventory, might also be used.

Treatment options for cluster B personality disorders

While cluster B personality disorders come with significant challenges, it’s possible to manage symptoms and lead a fulfilling life with consistent treatment and support. Professional treatment for personality disorder typically includes some form of psychotherapy. Medication may also be used to help manage specific symptoms.

Therapy approaches for cluster B personality disorders

Recommended therapy approaches will vary depending on your disorder and particular needs. Some possibilities include:

Cognitive Behavioral Therapy (CBT): Cognitive behavioral therapy involves examining and changing unhelpful thought patterns and the resulting feelings and behaviors. Someone with NPD, for instance, may examine how the ingrained belief, “I must always be the best,” ultimately leads to feelings of anger, envy, and distress. Those feelings then lead to problematic behaviors, such as gloating, to protect their own fragile self-esteem.

Dialectical Behavior Therapy (DBT): Dialectical behavior therapy helps a person build mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation skills. These skills may be especially useful for people with BPD.

Mentalization-based treatment. Mentalization-based treatment aims to enhance a skill known as mentalizing—understanding another person’s internal state. This treatment was initially developed to treat borderline personality disorder because people with BPD seem to have trouble understanding the mental states of others. However, it might also potentially help with other conditions, such as antisocial personality disorder.

Medication management for cluster B personality disorders

Medication won’t “cure” a cluster B personality disorder. However, certain drugs can help a person manage specific symptoms. Some examples:

• Antidepressants for co-occurring depression that people with borderline and histrionic personality disorders often struggle with.
• Mood stabilizers for emotional dysregulation and mood swings that are generally associated with cluster B personality disorders.
• Antipsychotics for aggression in people with ASPD.

Self-help tips for treating cluster B personality disorders

In many cases, people with personality disorders don’t see their behavioral patterns as problematic. So, by recognizing that your actions are unhealthy for you, you’ve already cleared an initial hurdle.

Personality disorder symptoms can be complex, intense, and, by definition, inflexible and resistant to change. Despite that, it’s possible to escape unhealthy patterns and live a fulfilling life. A combination of self-help strategies and professional treatment can help you manage your condition.

Tip 1: Cope with the stigma surrounding cluster B personality disorders

Social stigma follows personality disorders in general. Some research indicates that those with personality disorders are seen as less sympathetic than people with other types of mental illness. This might be especially true for people with cluster B disorders. For example, messages in the media often associate labels like narcissistic and antisocial with villainy. People with borderline personality disorder are often stigmatized as “out of control” or “dangerous.”

Self-stigma, seeing yourself as “broken” or “inferior,” can drag down your self-esteem or lead you to isolate yourself from others. Shame can keep you from looking for support and treatment.

Resist the urge to self-isolate. Believe that you’re worthy of community and have plenty to offer other people. Engage in peer support groups, spend time with friends and family, and look for ways to help those around you.

Educate yourself and others. Research your condition and seek out books, articles, and other types of media created by other people with the disorder. Share what you learn with your loved ones.

Get involved in an advocacy group. Look for opportunities to share your story and participate in groups that work to reduce the stigma associated with personality disorder.

Practice self-compassion. Remember that you are more than your diagnosis. Consider the many ways in which you enrich the lives of those around you, and know that having a personality disorder does not reduce your worth.

Tip 2: Reach out for support

People with personality disorders often feel lonely and disconnected from others. Some research suggests that loneliness may increase the severity of personality disorder symptoms, resulting in a loop of increased isolation and worsening mental health.

Ensure you have the right social support. Trusted individuals can make you feel heard and seen, offer guidance, and create a sense of community.

Explore support groups. If you ever get the feeling that people around you simply don’t understand what you’re dealing with, support groups can be a useful resource. Look for in-person and online support groups that focus on your specific cluster B personality disorder, if possible.

Connect with people with secure attachment styles. Whether they are friends or romantic partners, seek out people who know how to communicate effectively, set appropriate boundaries, and demonstrate reliability. They can model the types of behaviors that lead to healthy and fulfilling relationships.

Volunteer. Volunteering allows you to meet other people who share your values and interests. It’s also a way to feel like you’re part of something that’s bigger than yourself.

Tip 3: Manage co-occurring disorders and comorbidities

Personality disorders often go hand-in-hand with other mental health conditions, which can complicate diagnosis and treatment. In general, cluster B personality disorders are often associated with substance abuse and addiction. Depression and anxiety are also common comorbidities.

Know your risks. Your specific type of cluster B personality disorder might put you at risk for certain co-occurring conditions. For example, some studies suggest that there’s a link between antisocial behavior and ADHD. Meanwhile, borderline personality disorder is often linked with bulimia nervosa.

Make lifestyle changes that help you manage co-occurring disorders. When possible, take self-help measures to reduce the severity of your symptoms. For example, regular exercise can be a simple way to rein in anxiety, alleviate depression symptoms, and boost your overall mental health.

Seek professional treatment. In some cases, the co-occurring conditions may be incredibly difficult for you to manage without help. By tackling those conditions through professional treatment—whether that comes in the form of medication, rehab, or therapy—you’re also taking steps to make your cluster B personality disorder easier to manage.

Tip 4: Recognize patterns and triggers

Self-awareness can go a long way in managing cluster B personality disorder symptoms. Part of that involves learning to predict your own behavior and understanding what situations lead to unhealthy reactions.

Connect behaviors with triggers. Perhaps criticism leads you to experience explosive bouts of anger, either because your ego is bruised or you feel rejected. Or maybe when your partner doesn’t give a certain amount of attention, you feel the urge to act out dramatically. Knowing your triggers can help you change your reactions.

Reflect on consequences. What usually happens after you lose your temper or dramatically act out? Do those around you put less trust in you? Does your partner push you further away? Recognize the specific ways in which your behavior affects your well-being. This can further motivate you to seek change.

Identify warning signs. Consider physical or mental signs that a problematic behavior is about to surface. You might feel your jaw clench or your shoulders go stiff when you feel slighted. Or you might experience looping thoughts or a fixation on one particular line of thought. Once you identify the signs, you can adopt coping strategies rather than engage in negative behavior.

Tip 5: Break destructive patterns in behavior

Entrenched habits, such as impulsivity, manipulation, or self-sabotage, are often barriers to success in work and relationships for people with a cluster B personality disorder. Developing more constructive ways of responding to your emotional distress can make a big difference in your life. The strategies you adopt moving forward will vary depending on your specific disorder and situation. However, here are a few to consider:

Slow down your decision-making. Impulsivity is a hallmark of these disorders, so delaying your actions might be generally helpful. Commit to journaling your thoughts before responding to someone in anger. If you have the sudden urge to quit your job, for example, take several days to think about other options.

Know how to calm yourself down. Quick stress relief techniques offer ways to self-soothe and ground yourself. Exploring deep breathing exercises may be a good place to start. They can be done anywhere, and they can help ease distress and improve emotional regulation.

Manage negative self-talk. Often, destructive behavior starts with negative internal dialogue (or cognitive distortions). You might convince yourself that others are looking down on you, for example, or tell yourself that you can’t trust your partner’s words of affirmation. Learning to identify and challenge negative assumptions can help curb counterproductive and self-sabotaging behavior.

Tip 6: Improve relationships

People with cluster B personality disorders often push loved ones away through emotional reactions and unpredictable actions. Here are a few interpersonal skills you can develop through consistent practice.

Ask for clarification. How often do you assume that another person is criticizing you, rejecting you, or belittling you? Rather than jump to negative assumptions about what someone else was saying, ask them to clarify.

Take responsibility for your words and actions. It’s not always easy to see your own faults, but reflect on how your behaviors may be affecting those around you. If you’re committed to improving your relationships, be ready to set aside your defensiveness and apologize when necessary.

Build emotional intelligence (EQ). Emotional intelligence refers to your ability to understand your own and others’ emotions to improve well-being and strengthen your relationships. When you’re better able to manage stress and strong emotions, you can communicate more effectively, overcome challenges, and build stronger ties.

Improve empathy. Empathy is your ability to see another person’s perspective and share their emotions. Even if you don’t see yourself as a highly empathetic person, you can build empathy by becoming a better listener, recognizing nonverbal cues, and embracing your own vulnerability.

Being in a relationship with someone with a cluster B personality disorder

Having a family member or loved one with a cluster B personality disorder can be extremely challenging. You may find it hard to be patient with a narcissistic father, for example, or feel like you’re walking on eggshells when dealing with a friend who has borderline personality disorder.

You might feel as if the relationship dynamic is unfair, as you’re often the one who is trying to keep the peace and initiate the difficult conversations. Still, you care about them, and you’re likely aware that your ongoing support is important. Here are tips for maintaining a healthy relationship through communication and boundary setting.

Navigating conflict and communication challenges

Know that timing is important when it comes to important conversations. If your loved one with ASPD or NPD is angry and defensive, you’ll have a hard time getting through to them. Consider your own emotions as well. If you’re distracted or upset, it’s best to delay the conversation.

When conflict arises, don’t take it all personally. Your loved one’s bursts of rage or manipulative behavior can be deeply distressing and painful. Keep in mind that their reactions are often due to their own internal pain and discomfort, not a sign that you’re doing anything wrong.

Know that not every battle is worth fighting. Give yourself permission to disengage from conflict that is too draining. Some arguments will likely be more draining than productive.

Setting boundaries and healthy relationship practices

Set strong boundaries. Boundaries help you maintain a sense of autonomy from your loved one and protect you from their more unhealthy behaviors. If a friend with NPD or ASPD seems to respond in anger to criticism, you might say, “When you yell at me, I feel disrespected. If it happens again, I will need to walk away.”

Enforce your boundaries. When boundaries are broken, be prepared to follow through on your stated consequences. It’s possible the other person will be upset, lash out, or attempt to manipulate you, but stand firm and find support if needed.

Recognize and escape abuse. Abuse, especially in the form of emotional abuse, such as blaming, shaming, and intimidating behavior, can be common in cluster B personality disorders. If you feel afraid of your loved one or know that you’re consistently being mistreated, it’s important to come up with an escape plan to protect your safety.

Supporting a loved one with a cluster B personality disorder

Always keep in mind that you’re not the cause of your loved one’s condition, nor can you cure it or control it. Here are a few things you can do.

Encourage treatment and seeking professional help

Encouraging your loved one to seek treatment is one of the most supportive steps you can take. However, know that many people with personality disorders refuse to acknowledge their condition, and you can’t force them to go if they refuse.

If they’re in denial about having a personality disorder, it might be wiser to draw their attention to specific behaviors. For example, they might be willing to admit they’re overly sensitive to rejection or too dismissive of others. Let them know that a therapist could help them overcome this.

If they decide to seek treatment, you can help them find the right therapist, support groups, or other resources.

Provide emotional support and understanding

Lend a sympathetic ear and make your loved one feel heard. Resist the urge to tell them that they’re being irrational or crazy. Make a habit out of asking, “Do you need advice or comfort from me right now?” Brush up on your active listening skills if necessary.

Gaining a deeper understanding of your loved one’s disorder can also be helpful. Research their condition and listen to accounts of other people who have similar personality disorders. Aim to get a fuller understanding of their wants, needs, and their views of themselves and the world.

Take care of yourself

If you neglect your own needs while supporting your loved one, you risk burning yourself out and feeling resentful. Make time for self-care by doing the following:

Nurture other relationships. Rather than make your loved one the center of your world, remember to spend time with other friends and family members.

Keep up with hobbies and interests. Whether they include playing sports or working on crafts, make time for the activities you love.

Have a list of ways to unwind. Yoga, a soothing bath, meditation—have a general idea of which practices ease your mind and release tension after a stressful day.

Set realistic expectations. Your loved one’s disorder won’t simply disappear overnight, or even after several therapy sessions. Rather than set yourself up for disappointment, be patient and know that setbacks will occur.

Research and developments in cluster B personality disorders

Researchers are still working to better understand the complexity of cluster B personality disorders. Current studies offer plenty of hope, as deeper insights may eventually lead to more effective treatment options.

Current studies and findings in cluster B personality disorders

Some studies aim to contribute to a neurological understanding of specific disorders. For instance, in 2023, researchers used imaging techniques to study what activity happens in the brain when people with BPD experience rejection.

Other studies explore potential treatment options, such as whether mentalization-based treatment will be effective in managing a wider range of personality disorders. Researchers also aim to understand what factors may worsen personality disorder symptoms. A 2024 study examined how psychedelic use negatively affects people with personality disorders.

Future directions in research and treatment

Mental health experts continue to debate how best to model personality disorders and categorize them. Some argue that the cluster framework should be replaced with a different model, perhaps one that focuses more on temperament or specific personality traits. Others suggest that certain diagnoses, such as histrionic personality disorder, should be removed or combined with commonly co-occurring disorders. These types of decisions will ultimately affect how personality disorders are researched and diagnosed.

Cluster B personality disorder help

Despite their complexity, cluster B personality disorders can be managed through consistent treatment and self-help steps. Social support is also a crucial part of the process. If you have a personality disorder, know that you don’t have to cope with the condition alone. And if you know someone with a personality disorder, know that your support can be life-changing.

Last updated or reviewed on March 24, 2025