There are four cluster B personality disorders: antisocial, borderline, histrionic, and narcissistic.

Personality disorders are deeply ingrained, distressful ways of thinking, feeling, and acting that stray from standard cultural expectations of how people typically think, feel, and act. And folks who live with them experience unique challenges when it comes to navigating relationships, work, and life in general.

The cluster B personality disorders are grouped together because they share traits, including behaviors that others consider dramatic or overly emotional, trouble maintaining relationships, and significant distress.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) categorizes the 10 personality disorders into three clusters:

  • cluster A: paranoid, schizoid, schizotypal
  • cluster B: antisocial, borderline, histrionic, narcissistic
  • cluster C: avoidant, dependent, obsessive-compulsive

The National Institute of Mental Health (NIMH) notes that personality disorders affect 9.1% of people. And according to the DSM-5, cluster B personality disorders are the rarest of the three, with a prevalence of 1.5%.

Learning the similarities and differences between the cluster B conditions can help us destigmatize these often misunderstood mental health conditions and better understand those who live with them.

Each cluster of personality disorders features similar characteristics.

The main traits shared among cluster B personality disorders are:

  • dramatic, overly emotional, or erratic behaviors
  • difficulty maintaining healthy, stable relationships
  • traits that cause distress and impairments among those affected
  • impulsive behaviors or self-destructive tendencies
  • challenges finding effective treatment options
  • possible co-occurring mental health conditions

According to the NIMH, race or sex doesn’t have any impact on the prevalence of personality disorders.

Antisocial personality disorder is characterized by persistent disregard for or violation of other people that begins in childhood and lasts throughout life.

This condition has also been informally called or known as:

Psychopathy and sociopathy are unofficial and often misunderstood terms. Referring to the official diagnosis instead — antisocial personality disorder — affords a clearer and less stigmatizing understanding of the condition.

According to the DSM-5, you must be over 18 years old to receive an official diagnosis, but have a history of displaying related behaviors before age 15.

Signs and symptoms

Common antisocial personality disorder symptoms include:

  • deceitful and manipulative tendencies
  • aggression toward animals and people
  • destruction of properties or belongings
  • frequent breaking of rules and laws
  • tendency to lie or con others
  • irritability or argumentativeness
  • disregard for safety
  • lack of responsibility
  • placing blame on others for your actions
  • lack of empathy for others

The DSM-5 notes that people with antisocial personality disorder may also have the following co-occurring mental health conditions:

Potential causes

Many folks who receive a diagnosis of antisocial personality disorder also have a parent with the condition. Men are among the most commonly affected.

A 2019 study suggests that people with adverse childhood experiences (ACEs), like abuse or neglect, were more likely to develop antisocial personality disorder.

Socioeconomic or sociocultural factors, like poverty or migration, can increase the likelihood of someone developing this condition as well.

“There are both genetic and environmental influences on developing this disorder, but it’s important to remember that behaviors may mimic those in individuals who use antisocial behavior as a protective strategy for survival,” says Elinor Bawnik, LMFT, who works with people with personality disorders in Los Angeles, California.

According to the DSM-5, borderline personality disorder (BPD) is typically characterized by a pattern of unstable relationships, self-image, and impulsivity.

A 2018 study notes that the rate of BPD within the general population is 1.7%. Women are more commonly diagnosed with this condition compared to other identities.

Signs and symptoms

The most common symptoms of BPD include:

  • intense fears of abandonment (either real or imagined)
  • impulsive tendencies that can be harmful or damaging
  • sensitivity to environmental circumstances
  • unstable and intense relationships
  • unstable sense of self or identity issues
  • feelings of emptiness
  • angry outbursts and difficulty managing anger
  • anxiety or depressive symptoms
  • severe dissociative symptoms
  • dramatic shifts in perception of situations and people
  • recurring self-harm and suicide attempts

Self-harm is very common among people who live with BPD. A 2019 study reports that up to 10% of people with BPD will die by suicide, despite treatment efforts.

Potential causes

According to Bawnik, BPD is typically associated with a traumatic, invalidating, dismissive, or unstable upbringing.

It’s commonly diagnosed among people with childhood histories of:

  • physical and sexual abuse
  • neglect
  • hostile conflict
  • early parental loss

BPD can also occur alongside other mental health conditions, like:

Histrionic personality disorder (HPD), sometimes called dramatic personality disorder, features a pattern of excessive attention seeking and high emotions that present in various ways.

Signs and symptoms

A person might have histrionic personality disorder if they display five or more of the following symptoms:

  • feeling uncomfortable or unappreciated when they’re not the center of attention
  • interacting in inappropriate sexual or provocative ways with others based on the cultural context, such as at work
  • having rapid shifts and a shallow expression of emotions
  • using their appearance to attract attention
  • exaggerating and dramatizing expressions
  • being easily influenced by people and circumstances
  • believing their relationships are more personal or intimate than they truly are

People with this condition are often flirtatious, seductive, enthusiastic, and charming. And when they’re not the center of attention, they tend to do whatever it takes to get the focus back on them.

These attention-seeking behaviors can include:

  • making up stories
  • crying uncontrollably
  • lashing out

Potential causes

HPD is more commonly diagnosed in women. However, this may be partly because it’s less socially acceptable for women to be sexually forward.

Experts believe the causes of histrionic personality disorder may be learned, inherited, or both. Underlying factors can be trauma related, leading to HPD symptoms as adaptive coping mechanisms.

Parenting styles can also play a major role in someone developing this personality disorder. A person may be more likely to develop it if their parents:

  • lacked boundaries
  • modeled dramatic, volatile, or inappropriate sexual behavior
  • have a history of personality disorders or other mental health conditions

Narcissistic personality disorder (NPD) is typically characterized by grandiose behaviors, a need for admiration, and a lack of empathy for others.

Although narcissism is a buzzword nowadays, NPD is actually very rare. According to the DSM-5, estimates of NPD in the U.S. population are anywhere from 0 to 6.2%, with 50–75% of those diagnoses in males. This data is older, though, and based on DSM-4 criteria.

Signs and symptoms

The most common signs and symptoms of narcissistic personality disorder include:

  • grandiosity or exaggeration
  • preoccupation with fantasies of great love, power, or success
  • a sense of entitlement
  • a need for excessive admiration from others
  • beliefs of being “special” and needing to only associate with other high-status people
  • exploitation of others
  • a lack of empathy
  • envy of others
  • arrogant behaviors or attitudes
  • an overestimation of achievements and abilities

“They can be very vulnerable, as their self-esteem is extremely low and will be reactive and sensitive to real or perceived criticism or defeat,” adds Bawnik.

Folks with NPD are often very charming and engaging, too. They want you in their world, so you can make them feel good about themselves.

It’s common for people with NPD to hurt others. This is because the person with the diagnosis doesn’t have the capacity for empathy or compassion for those around them.

Potential causes

Research from 2021 suggests that causes of NPD are multifaceted, including:

  • genetic predisposition
  • aggressive traits
  • negative developmental experiences, such as trauma or abuse
  • being rejected as a child
  • having a fragile or hurt ego during childhood
  • excessive praise from caregivers

Research is limited on effective treatments for cluster B personality disorders. But there are many options that can help you cope and manage the symptoms.

Some ways to manage Cluster B personality disorder include:

You may also find relief by treating other symptoms and co-conditions, like anxiety, depression, or substance use disorder.

Bawnik offers the following tips and reminders to consider

  • Be patient and remember your positive qualities.
  • Improve your communication skills.
  • Address your needs.
  • Create boundaries as necessary.
  • Try different treatment methods and coping mechanisms.

“Make sure you have a good support network to talk to when it’s been a rough day or just [need] a breather, including family, friends, therapists, neighbors, spiritual community, etc.,” she says.

Bawnik believes the secret to treating BPD lies in:

  • building skills
  • changing patterns
  • communicating effectively
  • regulating emotions

She says that the road to addressing these symptoms can be long and challenging, but it’s possible to find relief and heal.

A treatment option that works for one person may not be right for someone else, so consider working with a mental health professional or treatment team to figure out a good treatment plan for you.

If you ever feel suicidal or at risk of harm, remember that help and support are available. You can reach out to advocates and mental health professionals at a suicide hotline.

The cluster B personality disorders include the following four conditions:

  • antisocial personality disorder
  • borderline personality disorder
  • histrionic personality disorder
  • narcissistic personality disorder

They all share similar traits, but each have their own unique set of symptoms.

If you live with a cluster B personality disorder, trust that you can find relief and manage your condition. Treatment options like psychotherapy and medication may help you find more stability in your life and achieve healthier relationships.

It may take time to heal and overcome challenges related to these conditions. But healing is possible, support is available, and you’re never alone.