CLUSTER B: PERSONALITY

DISORDER
I. TITLE: Cluster B: Personality Disorder

II. INTRODUCTION
In this session, you will learn about personality disorder, the signs and symptoms and
risk factors. You will also learn the different type of personality disorder under cluster b.
You will also know how to deal or manage that type of disorder. This module will help
you have a better health education to the patient and have a healthy outcome after you
undergo a patient with this kind of illness.

Learning Objectives:
At the end of this self-instructional module, you should be able to:
1. Review the characteristics of cluster B: personality disorders
2. Explore the functions of every symptoms
3. Identify what may cause these symptoms to develop
4. Explore the effects of these symptoms on significant others
5. Identify interventions to help the person more effectively manage
emotions and relationship
6. Learn specific treatment for each personality disorders

III. INSTRUCTION TO THE USERS

This self-instructional module about personality disorder will help you understand the
appropriate knowledge, skills and attitudes towards this topic. It is important to go
through the module in a simple way. The module consist of a pre-test, discussion of the
topic and some learning activities. You will also see a summary of this topic and a visual
presentation to guide you through. A self-check test and evaluation are also included in
this module for self-assessment of your learning.

IV. PRE-TEST
1. Give 3 characteristics of cluster b: personality disorder.
2. What are the four types of cluster b: personality disorder?
3. What type of personality disorder that a person does not usually show remorse
or feel sorry for the way they are acting?
4. What age is the onset of antisocial personality disorder?
5. Borderline personality disorder is more common in what gender?
 6. Seductive behaviour is common in what personality disorder?
7. It characterized by heightened sense of self-importance and grandiose feelings
of uniqueness?

V. DISCUSSION OF TOPICS
Reviewing the anatomy and physiology of the brain
The adult brain weighs about three pounds. It connects to the spinal cord through the
brain stem, which contains bundles of nerve cells, or
neurons. In the treatment of borderline personality disorder,
the most significant parts of the brain are the amygdala, an
almond-shaped group of neurons deep inside each
hemisphere of the brain, and the prefrontal cortex (PFC), the
part of each of the brain’s two hemispheres located right
behind the forehead and responsible for controlling
executive functions.

How do you defined personality?

Personality defined as the characteristics pattern of behaviour or modes of thinking that
determine a person’s adjustment to environment.

What is personality disorder?

- According to WHO, personality disorder can be defined as deeply ingrained
maladaptive pattern of behaviour, continuing throughout the most adult life,
although often becoming less obvious in middle or old age.
- Maladaptive behaviour results in loneliness, suspiciousness and withdrawn
behaviour.
- Personality disorder falls somewhere within maladaptive range. The degree of
maladaptiveness depends on the type of disorder and its severity of symptoms.
- Personality disorder is different from mental illness because the symptoms of
personality disorder are continuous and start from adolescence or even before.

Characteristics of personality disorder

- It is not mental illness
 - It is a maladaptive behaviour
- It is long lasting, most of a time lifelong problems
- It causes significant impairment in social or occupational functioning
- It produce distress to the individual and to others.

There are three (3) types of personality disorder:

❖ Cluster A: Personality disorder
❖ Cluster B: Personality disorder
❖ Cluster C: Personality disorder

CLUSTER B: PERSONALITY DISORDER

A person with a cluster B personality disorder may have trouble controlling their
emotions and display seemingly irrational behaviours.
Cluster B personality disorders are a group of mental health conditions that affect a
person’s emotions and interpersonal relations.
Cluster b personality disorder characterized as dramatic, emotional and erratic.

There are four (4) types of cluster b personality disorder:

A. antisocial personality disorder
B. borderline personality disorder
C. histrionic personality disorder
D. narcissistic personality disorder

ANTISOCIAL PERSONALITY DISORDER (APD)

Antisocial personality disorder is characterized by chronic antisocial behaviour that
violates other rights or social norms which predisposes the affected person to the
criminal behaviour.
The person is unable to maintain the consistent, responsible functioning at work, school
or as a parent.

Know the signs and symptoms of APD:

 ✔ Failure to sustain the relationship
✔ Impulsive actions
✔ Low tolerance to frustrations
✔ Tendency to cause violence
✔ Lack of guilt
✔ Inability to maintain close personal or sexual relationship
A person who has an antisocial personality disorder does not usually show remorse or
feel sorry for the way they are acting. If they do not get treatment, their behaviour may
cause problems with law enforcement.

BORDERLINE PERSONALITY DISORDER (BPD)

Borderline personality disorder is marked by a pattern of instability in interpersonal
relationship, mood, behaviour, and self-image.
A person with borderline personality disorder may have low self-esteem and a fragile
sense of self.

BPD has four main categories of signs and symptoms:

✔ Unstable relationship
✔ Unstable self-image
✔ Unstable emotions
✔ Impulsivity

Other signs and symptoms includes:

✔ Lack of control of anger
✔ Recurrent suicidal threats or behaviour
✔ Uncertainty about personal identity’
✔ Chronic feeling of emptiness

HISTRIONIC PERSONALITY DISORDER (HPD)

Patient with this disorder is characteristically have a pervasive pattern of excessive
emotionality and attention seeking behaviour and are drawn to momentary excitement
and fleeting adventure.
This disorder is most common in females than in males
People with this disorder need to be the center of attention at all time
The signs and symptoms of HPD, includes;
✔ Dramatic emotionality
✔ Attention seeking behaviour
✔ Lack of considerations for other
✔ Self-dramatization

NARCISSISTIC PERSONALITY DISORDER (NPD)

Patient with narcissistic personality disorder is self-centered, self-absorbed and lacking
in empathy for others.
They typically takes advantages of people to achieve his own ends, and uses them
without regards to their feelings

Assess the signs and symptoms that includes:

✔ Attention seeking
✔ Dramatic behaviour
✔ Unable to face criticism
✔ Lack of empathy
✔ Arrogances
✔ Exploitative behaviour

What could be the cause of these personality disorder?

Personality is the combination of thoughts, emotions and behaviours that makes you
unique. It's the way you view, understand and relate to the outside world, as well as
how you see yourself. Personality forms during childhood, shaped through an
interaction of:
● Your genes. Certain personality traits may be passed on to you by your parents
through inherited genes. These traits are sometimes called your temperament.
● Your environment. This involves the surroundings you grew up in, events that
occurred, and relationships with family members and others.
Personality disorders are thought to be caused by a combination of these genetic and
environmental influences. Your genes may make you vulnerable to developing a
personality disorder, and a life situation may trigger the actual development.
Some situation that may cause or trigger personality disorder:
● Sexual trauma
● Verbal abuse

What will be the risk factor?

Although the precise cause of personality disorders is not known, certain factors seem
to increase the risk of developing or triggering personality disorders, including:

● Family history of personality disorders or other mental illness

● Abusive, unstable or chaotic family life during childhood
● Being diagnosed with childhood conduct disorder
● Variations in brain chemistry and structure

What nursing diagnosis can we formulated?

1. Risk For Self-Mutilation

2. Chronic Low Self-Esteem

3. Impaired Social Interaction

4. Ineffective Coping

Based on the nursing diagnosis, what intervention must be done?

1. Risk for self-mutilation
- Assess client’s history of self-mutilation
- Identify feelings experienced before and around the act of self-mutilation
- Secure a written or verbal no harm contract with the client
- Set and maintain limits on acceptable behaviour and make clear clients
responsibilities
- Be consistent in maintaining and enforcing the limits, using a non-punitive
approach
- Avoid criticizing or giving sympathy when self-mutilation occurs

2. Chronic low self-esteem

 - Assess clients self-perception
- Maintain a neutral, calm and respectful manner
- Review with the client the types of cognitive distortions that affect self-
esteem
- Teach client to reframe and dispute cognitive distortions
- Work with client to recognize cognitive distortions
- Keep in mind clients with personality disorders might defend against feeling
of low self-esteem through blaming, projection, anger, passivity and
demanding behaviours
- Discourage client from making repetitive self-blaming and negative remarks
- Discourage client from dwelling on and relieving past mistakes
- Discuss with client his or her plans for the future
- Focus on questions in positive and active light
- Give the client honest and genuine feedback regarding your observations as
his or her strength
- Do not flatter or be dishonest in your appraisals
- Set goals realistically

3. Impaired social interaction

- Set limits on any manipulative behaviours
- Expand limits by clarifying expectations for clients
- In a respectful, neutral, manner, explain expected client behaviour, limits and
responsibilities during sessions
- Monitor own thoughts and feelings constantly regarding your response to the
client
- Collaborate with the client to establish a reward system for compliance with
clearly defined expectations
- Assess need for and encourage skills training workshop

4. Ineffective coping
- Assess for self-mutilating or suicide thoughts or behaviours
- Encourage client to explore feelings and concerns
- Be non-judgemental and respectful when listening to clients feelings,
thoughts or complaints
- Use assertiveness when setting limits on clients unreasonable demands for
attention and time
- Provide and encourage client to use professional in other disciplines such as
social services, vocational rehabilitation, social work
How will you diagnose the cluster b personality disorder?

If your doctor suspects you have a personality disorder, a diagnosis may be

determined by:

● Physical exam. The doctor may do a physical exam and ask in-depth questions
about your health. In some cases, your symptoms may be linked to an
underlying physical health problem. Your evaluation may include lab tests and a
screening test for alcohol and drugs.
● Psychiatric evaluation. This includes a discussion about your thoughts,
feelings and behavior and may include a questionnaire to help pinpoint a
diagnosis. With your permission, information from family members or others
may be helpful.
● Diagnostic criteria in the DSM-5. Your doctor may compare your symptoms to
the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
published by the American Psychiatric Association.

Diagnostic criteria
Each personality disorder has its own set of diagnostic criteria. However, according to
the DSM-5, generally the diagnosis of a personality disorder includes long-term marked
deviation from cultural expectations that leads to significant distress or impairment in at
least two of these areas:
● The way you perceive and interpret yourself, other people and events
● The appropriateness of your emotional responses
● How well you function when dealing with other people and in relationships
● Whether you can control your impulses

How personality disorder treated?

1. Anxiolytic drugs:
- To treat severe stress
● Alprazolam
● Ativan
● Librium
● Diazepam
2. Neuroleptic drugs: antipsychotic
- It can be useful in case of paranoid and schizotypal personality disorder
 ● Olanzapine
● Haloperidol
● Droperidol
3. Psychodynamic treatment
- It’s also known as the insight oriented therapy, focuses on unconscious
processes as they are manifested in a person’s present behaviour.
- The goal of psychodynamic therapy is a client’s self-awareness and
understanding of the influence of the past on present behaviours.
4. Cognitive and behaviour therapy
- Most cognitive behavioural approaches address specific aspects of thoughts,
feelings, behaviours, or attitudes and do not claim to treat the entire
personality disorder of the persons

Is there a way to prevent personality disorder?

At this time, there is no known way to prevent personality disorders, but many of the
related problems might be lessened with treatment. Seeking help as soon as symptoms
appear can help decrease the disruption to the person’s life, family, and friendships.

VI. LEARNING OUTCOMES

1) Does personality disorder affects our brain?

a. Yes
b. No
Answer: a
2) Dramatic, overly emotional, erratic is a characteristics of what cluster?
a. Cluster A
b. Cluster B
c. Cluster C
Answer: b
3) This is a drug that treat severe stress except.
a. Ativan
b. Diazepam
c. Haloperidol
Answer: c
 4) It affects person’s emotion and interpersonal relation?
a. Cluster b personality disorder
b. Personality disorder
c. Personality
Answer: a
5) BPD is common in what gender?
a. Male
b. Female
c. Children
Answer: b

VII. SUMMARY
Since everyone has a personality, but not everyone has a personality disorder, these
disorders are considered a variant form of normal, healthy personality. This group of
disorders is characterized by problematic thinking patterns, problems with emotional
regulation and difficulty achieving a balance between spontaneity and impulse control. 
However, the most significant and defining feature of personality disorders is the
negative effect these disorders have on interpersonal relationships. People with
personality disorders tend to respond to differing situations and demands with a
characteristically rigid constellation of thoughts, feelings, and behaviour.  This
inflexibility and difficulty forming nuanced responses, represents the primary difference
between healthy and disordered personalities.
The exact cause of personality disorders remains uncertain.  However, it is clear there
are both biological and psychosocial factors that influence the development of
personality and personality disorders. There are now several highly effective treatments
for personality disorders that could help patient with these disorder. Treatment includes
psychodynamic treatment, cognitive and behavioural therapy and also pharmacological
treatment.
We all have a personality traits integrated with each other. If one trait dominates on the
other traits then we have a personality disorder. This different types of personality
disorder under cluster b has almost the same symptoms which is in dramatic, emotional
and erratic that conclude the general symptoms of cluster b: personality disorder. If you
are experiencing any one this symptoms you should go see a doctor to prevent these
disorder to be worsen.
VIII. MATERIALS/VISUAL

NARCISSISTIC PERSONALITY DISORDER

 BORDERLINE PERSONALITY DISORDER

HISTRIONIC PERSONALITY DISORDER ANTISOCIAL PERSONALITY DISORDER

IX. SELF-CHECK AND EVALUATION
Now that you have completed this study session, you can assess how you will have
achieved its learning outcomes by answering the questions below.

1. According to DSM-IV-TR classification, antisocial personality disorders is classified

under

a. Cluster-A
b. Cluster-B
c. Cluster-C
d. Cluster-D

2. Narcissistic personality disorder is characterized by

a. Callous unconcern for feelings of others

b. Self-dramatization, theatricality
c. Ideas of grandiosity and inflated sense of self-importance
d. Significant and persistent disturbances of identity of self.

3. Incapacity to experience guilt and to profit from experience, particularly punishment

is seen in

a. Antisocial personality disorder

b. Schizotypal personality disorder
c. Schizoid personality disorder
d. Dependent personality disorder

4. Antisocial personality disorders are characterized by all, except.

a. Low frustration tolerance

b. Drug abuse
c. Learning from past experience
d. Criminal activities

5. Choose the best definition for Histrionic Personality Disorder.

a. A pattern of grandiosity, need for admiration, and lack of empathy

b. A pattern of instability in interpersonal relationships, self-image, and affects,
and marked impulsivity.
c. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation.
d. A pattern of excessive emotionality and attention seeking
 6. Choose the best definition for Antisocial Personality Disorder.

a. A pattern of instability in interpersonal relationships, self-image, and affects,

and marked impulsivity.
b. A pattern of disregard for, and violation of, the rights of others.
c. A pattern of grandiosity, need for admiration, and lack of empathy
d. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation.
7. To what region of the brain is the damage usually shown in APD?

a. Prefrontal cortex
b. Postfrontal cortex
c. Orbital cortex
d. Occipital lobe
 
8. Which of the following is not in Cluster B personality disorders?

a. Dependant Personality Disorder

b. Antisocial Personality Disorder
c. Borderline Personality Disorder
d. Narcissistic Personality Disorder

9. All are the main categories of signs and symptoms of BPD, except.

a. Unstable self-image
b. Unstable emotions
c. Impulsivity
d. Chronic feelings of emptiness

10. A person with this disorder have low self-esteem and a fragile sense of self.

a. Antisocial personality disorder

b. Borderline personality disorder
c. Narcissistic personality disorder
d. Histrionic personality disorder
X. REFERENCES

https://www.medicalnewstoday.com/articles/320508#causes
https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-
causes/syc-20354464
https://www.healthline.com/health/cluster-b-personality-disorders
https://nursingcrib.com/nursing-notes-reviewer/psychiatric-mental-health-
nursing/cluster-b-personality-disorders/
https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-
overview/prevention

ANSWERS TO SELF CHECK TEST:

1. b
2. c
3. a
4. c
5. d
6. a
7. a
8. a
9. d
10. b