Cluster b personality disorders

CLUSTER B
PERSONALITY DISORDERS
Presented By: Priya Singh
Chair Person:
Dr. L.N. Suman

PSYCHOSOCIAL THEORIES FOR
CLUSTER B PERSONALITY
DISORDERS

PSYCHODYNAMIC PERSPECTIVE
• Theory of Personality Organization - Otto Kernberg (1975,
1984, 1996)
• Proposed a continuum of pathology, from chronically
psychotic levels of functioning, through borderline functioning
through neurotic to normal functioning
• Borderline functioning- entails severe personality disorders
including
– Maladaptive modes of regulating emotions including reality
distorting defenses such as denial and projection (primitive
defenses)
– Difficulty in forming mature, multifaceted representations of
themselves and significant others (identity diffusion)

• Previous studies have demonstrated that insecure attachment
patterns and a trait disposition toward negative affect and
impulsivity are both associated with borderline personality
disorder (BPD) features. According to attachment theory,
insecure attachment patterns impart greater risk for the
maladaptive personality traits underlying BPD. Hence,
insecure attachment might be indirectly related to BPD
through its association with these traits.
• A study by Lori N. Scott, Kenneth N. Levy, and Aaron L. Pincus,
favoured a model in which the relationship between adult
attachment anxiety and BPD features is fully mediated by trait
negative affect and impulsivity.

• results extend upon the research reported by King-Casas et al.
(2008) by showing that the failure of BPDs to restore ruptured
cooperation can most likely be explained by a particularly
detrimental combination of personality traits. The joint presence of
high N and low A, a combination typical to BPD patients, predicted
failure to rebuild ruptured cooperation in exactly the same way as
did the BPD diagnosis in the study by King- Casas et al. (2008).
Furthermore, as other Cluster B disorders, such as Narcissistic PD or
Antisocial PD, may to some, albeit lesser extent also be
characterized by high N and low A (Saulsman & Page, 2004), a
similar failure to repair cooperation could be predicted to occur in
these groups. Although our results suggest that at least this
particular behavioral consequence of BPD can be predicted in terms
of the personality dimensions identified by the five-factor model,
the necessity to consider combinations of the five dimensions to
appreciate the consequences of BPD highlights one of the
advantages of the categorical approach: The category label is a
much more economic means of description than the delineation of
interactions between dimensions.

 Narcissistic Personality Disorder(NPD)
• According to Freud (1914), parental over evaluation, erratic,
unreliable caretaking in early life disrupts the development of
object love in the child, due to fixation in narcissistic phase of
development, they are unable to form lasting relationships
• In Kernberg’s view, individuals with NPD need to construct a
grossly inflated view of themselves to maintain self-esteem,
and may appear grandiose, sensitive to the slightest attacks
on their self-esteem (and hence vulnerable to rage or
depression), or both.
• Not only are the conscious self-representations of narcissistic
patients inflated, but so, too, are the representations that
constitute their ideal self.

• Actual and ideal self representations stand in dynamic relation
to one another. Thus, one reason narcissistic patients must
maintain an idealized view of self is that they have a
correspondingly grandiose view of who they should be,
divergence from which leads to tremendous feelings of shame,
failure, and humiliation.
• According to Kohut, results from faulty self development. The
“self” in its particular Kohutian meaning refers to the nucleus of
a person’s central ambitions and ideals, and the talents and skills
used to actualize them (Kohut 1971; Kohut 1977; Wolf 1988).
• It develops through two pathways (in Kohut’s language,
“poles”), which provide the basis for self esteem.
• The first is what he calls the grandiose self—an idealized
representation of self that emerges in children through empathic
mirroring by their parents (“mommy, watch!”) and provides the
nucleus for later ambitions and strivings.

• The second he calls the idealized parent imago—an idealized
representation of the parents, which provides the foundation
for ideals and standards for the self.
• Parental mirroring allows the child to see his reflection in the
eyes of a loving and admiring parent; idealizing a parent or
parents allows the child to identify with and become like
them.
• In the absence of adequate experiences with parents who can
mirror the child or serve as appropriate targets of her
idealization (for example, when the parents are self-involved
or abusive), the child’s self structure cannot develop,
preventing the achievement of cohesion, vigour, and normal
self-esteem (which Kohut describes as “healthy narcissism”).
• As a result, the child develops a disorder of the self, of which
pathological narcissism is a prototypic example.

• Millon (1981) proposes a social learning theory of narcissism.
This view sees narcissism developing not as a response to
parental devaluation but rather as a consequence of parental
overvaluation. The child is treated as a special person,
provided much attention, and led to believe he or she is
lovable and perfect. According to Millon (1981), such
unrealistic overvaluation will lead to self-illusions that .cannot
be sustained in the outer world.

ATTACHMENT THEORIES
 Histrionic Personality Disorder (HPD)
 HPD is characterized by Preoccupied Attachment Style i.e.,
positive mental model of others but negative model of self
(Hart et al, 2001). Also have strong relational needs & are
hyper vigilant.
 Premature perception of relationships as intimate
(Westen,2008), difficulty in achieving emotional intimacy in
romantic or sexual relationships, these difficulties speculated
to originate from problematic relationships with parental
figures (Benjamin, 1996)

 Narcissistic Personality Disorder (NPD)
 Narcissism is the result of an insecure attachment style
between child & caretaker Bowlby(1973, 79)
 Parental devaluation hypothesis-
cold & rejecting parents lead to withdrawal in child, child
forms pathological grandiose self- representation (aspects of
real child, fantasized self, ideal parent). However rejects
negative self- representation, hence split- off leads to
emptiness, hunger for admiration.

 Antisocial Personality Disorder
 According to a study of ‘juvenile thieves’, separation of a
young child from its mother could lead to antisocial behavior
& failure to form close relationships (Bowlby 1944,1946).
Marital disharmony partly accounts for the association
between separation & antisocial disorder in sons (Rutter;
1972).
 Chodorow (1978, 1989) and Baker-Miller, Jordan, Kaplan,
Stiver, and Surrey (1991) consider the fact that the primary
attachment person in children’s lives is usually a woman—
their mother—as an important factor for sex differences in
autonomy development.
• Because daughters are of the same sex, mothers would
unconsciously experience a daughter as very similar to them,
and a son (i.e., a child of the opposite sex) as different. These
differences in the way the mother experiences children of the
two sexes would strongly affect the relationships of girls and
boys with her.

• The early, preoedipal “symbiosis” between mother and
daughter, a phase in which children do not experience clear
boundaries between themselves and their mothers, would be
more intense and longer lasting than the mother-son
symbiosis.
• Girls’ early relational experiences would contribute to their
greater potential for, and need for, functioning in intimate
relationships in adulthood their later “ego-boundaries” (sense
of personal, psychological division from the rest of the world)
would be vague, or, in positive terms (Chodorow, 1989), more
flexible.
• When the primary caregiver of boys is a woman, they might
on the contrary likely turn away from the mother earlier and
identify with the father, who is usually less available.

• As a result, boys define their masculine identity as the
absence of femininity, a relative denial of attachment, and
“separation.”
• Chodorow’s descriptions refer to “normal” feminine and
masculine personality development, sex-bound
psychopathologies from her perspective are extreme forms of
these “normal” pictures.
• Mental disorders, those with a higher prevalence in men, for
example, antisocial behaviour, might be affected by extreme
tendencies toward more masculine attachment styles, such as
detachment and separation.

• According to Benjamin (1993) developmental histories of
harsh, neglectful parenting leads to an adult who is neglectful
& insensitive to the needs of others & exploits others.
 Social Learning in childhood leads to ASPD by following four
ways(Scott, 1960):
1. Antisocial family
2. Lack of rules
3. Overcoming another problem
4. Poor ability to sustain attention, inherently deficient in
acquiring learned responses

Cognitive-Behavioral Perspective
• Early life experiences, including family routines and
relationships, traumatic events, formation of
assumptions about the world and in inter-personal
relationships automatic thoughts emotional
reactions and behavioral reactions
• Such rigid cognitive schemata develop over time, each of
which governs behavior and reduces adaptability and
responsiveness to the environment

 Histrionic Personality Disorder
Dysfunctional Schemas-strong dependency & rejection
sensitivity tendencies as a child
Core belief “I am basically unattractive”
Reinforcement history “I need others to admire me in order to
be happy”
Individual compensates “I am lovable, entertaining” “I am
entitled to admiration”
Thus, deserve unfaltering attention & view others positively
as long as they provide it, conceals underlying anxiety &
rejection sensitivity

 Narcissistic Personality Disorder
Cognitive-behavioral theorists propose that narcissistic
personality disorder may develop when people are treated too
positively rather than too negatively in early life
Those with the disorder have been taught to “overvalue their
self-worth”

 Antisocial Personality Disorder
Following are the dysfunctional cognitions in an antisocial
personality disorder:
Self- loners, autonomous & strong
Life- cruel & harsh
Others- exploitative & manipulative or as weak & vulnerable

TRAIT THEORY
• Gordon Allport (1937)
• Traits are emotional, cognitive, and behavioral tendencies on which
the individual varies
• Most common approach is Five Factor Model of Personality (FFM)
Costa and McCrae (1992)
• FFM consists of five broad dimensions of personality, namely
Openness to experience, Conscientiousness, Extraversion,
Agreeableness and Neuroticism
• Personality profile is represented by a culmination of each of these
5 factors and a number of lower order sub factors.
• PD reflects extreme versions of normal personality and so a same
system can be used to diagnose normal and pathological
personality

HISTRIONIC PERSONALITY DISORDER(HPD)
•19 experts on HPD rated prototypical person with HPD
on a scale of 1 to 5( Lynam & Widiger ;2001)
•Ratings for 5 broad domains: OCEAN
•On average, clinicians rated HPD as low on self-
consciousness & high on impulsiveness (N domain)
•High on gregariousness, activity, excitement seeking &
positive emotions (E domain)
• High on fantasy, feelings & actions (O)
•Low on self- discipline & deliberation (C)

NARCISSISTIC PERSONALITY DISORDER(NPD)
• Practising clinicians rated a prototypic case of NPD on
the Five Factor Model (Samuel & Widiger; 2004)
• High scores on Extraversion (e.g., assertiveness,
excitement seeking)
• Very low scores on Agreeableness (e.g.,
straightforwardness, compliance, modesty)
• High levels of externally- directed negative affect (angry
hostility)
• low levels of internally- directed negative affect (self
consciousness)

ANTISOCIAL PERSONALITY DISORDER(ASPD)
• A Five-Factor-based re-interpretation of the
Psychopathy Checklist-Revised factor structure shows
that:
• The “Aggressive Narcissism” factor taps into facets of
low agreeableness (with some contribution of facets of
neuroticism and extraversion),
• And the “Socially deviant lifestyle” factor represents
facets of low conscientiousness and low agreeableness.

INTEGRATIVE THOERIES
Millon’s Evolutionary Social Learning Model
• Based on social learning concepts
• Describes personality in 4 polarities
 Pleasure- pain: nature of reinforcement that controls
one’s behavior
 Self- other: sources that provide reinforcement
 Passive- active: behavior & coping strategies
 Thinking- feeling- extent of abstract thinking or intuition
Identified 14 personality prototypes based on these polarities

• 4 evolutionary principles (based on 4 polarities)-
 Aims of existence- life enhancement or preservation
(pleasure/pain)
 Modes of adaptation- accommodation or modification of
environment (passive/active)
 Strategies of replication/reproduction- extent to which
focus on individuation/nurturance of others (self/others)
 Process of abstraction- ability for symbolic thought
(thinking/feeling)
• Patients with histrionic personality disorder are pleasure
seeking, interpersonally focused(although in a self-centered
way), highly active, and short on abstract thinking.

Cloninger’s Temperament and Character Model
(1993)
Neurobiological Model
Provided with 7 factor model of personality divided in 2 domains
• 4 Temperamental dimensions (automatic associative responses to
basic emotional stimuli)
• 3 Character dimensions (self-aware concepts that influence
voluntary intensions and attitudes
• Each domain is defined by a mode of learning and underlying neural
systems that are involved in that learning
Temperament Determinants
1. Novelty Seeking: Excited and exhilarated responses to novel
stimuli. Low novelty-seeking implies preference for routine, order,
details and social stability. Associated with Dopamine NS

2. Persistence (Happiness Seeking): Determination and tenacity
to achieve a goal, industrious, stable and resolute in the face
of frustration or fatigue. Associated with Serotonin and
Glutamate NS
3. Harm Avoidance: Intense response (fear, timidity, pessimism)
to aversive stimuli, avoiding behaviors that may expose them
to punishment or loss. Associated with Serotonin and GABA
NS
4. Reward Dependence (Security-Seeking, Social attachment,
openness): Responds to rewards of social approval or
sympathy. Low reward dependence implies introversion, self-
reliance and self-directedness. Associated with Serotonin and
nor-epinephrine NS
High novelty seeking is in the cluster B (Preiss & Klose 2001)

Character determinants
1. Self directedness- responsibility, purposefulness, self
acceptance. It is considered the major determinant for the
presence/absence of PD
2. Cooperativeness- empathy, compassion, helpfulness
3. Self transcendence- spirituality, idealism, enlightenment
All PDs are found to be low on self directedness and
cooperativeness (Cloninger,1998)

Stress Diathesis Model (Monroe &
Simons,1991)
• Non-reductionist and interactional theory
• Genes shape individual variability in temperament and traits
(diathesis)
• Traits become maladaptive only under certain environmental
conditions (stress)
• Interaction between the two is bidirectional

Sociobiological Model
• Psychopaths have a genotype that results in an “inborn
temperament or personality, coupled with a particular pattern
of autonomic hyper arousal that, together, design the child to
be selectively unresponsive to the cues necessary for normal
socialization and moral development” ( Mealey;1995).

Fearlessness Model
• Lykken (1957) has argued that psychopaths are relatively
fearless, a condition that makes it difficult for them to “learn
to avoid antisocial behaviors and to inhibit forbidden
impulses, through punishment and the conditioned fear it
leaves behind”.
• A consistent finding was that psychopaths showed relatively
small increases in palmar skin conductance in anticipation of
an unpleasant or painful event, a finding that implies they
experienced relatively little anticipatory fear and that helps to
explain their difficulty in learning to avoid punishment.

Other studies..
• Narcissism is increasingly recognised as a heterogeneous
construct, with two dimensions of narcissistic dysfunction
commonly accepted, Grandiose Narcissism and Vulnerable
Narcissism.
• Two distinct dimensions of Narcissism are increasingly
accepted (Cain, Pincus, & Ansell, 2008; Wink, 1991).
Grandiose Narcissism is characterised by overt grandiosity
and exhibitionism. Individuals with this grandiose expression
of Narcissism openly display a sense of entitlement and are
preoccupied with a need for admiring attention from others.
Vulnerable Narcissism is a more covert dimension of
Narcissism associated with hypersensitivity to criticism and a
tendency to withdraw from social interactions.

• Miller et al. (2011) found Grandiose Narcissism related
positively to Extraversion and negatively to Neuroticism, while
Vulnerable Narcissism related negatively to Extraversion and
positively to Neuroticism through factor and correlational
analysis using the Pathological Narcissism Inventory (PNI).
Also it was found that Grandiose Narcissism was unrelated to
psychological distress, whilst Vulnerable Narcissism was
positively related to psychological distress.

• A study by Louise Houlcroft , Miles Bore, Don Munro provided
empirical support for the two dimensions of Narcissism, a
possible third dimension of Narcissism emerged which was
markedly aggressive and antisocial. Along with the
Pathological Narcissism Inventory (PNI) and the Narcissism
subscale of the Narcissism–Aloofness–Confidence–Empathy
(NACE), questionnaires assessing personality traits,
psychopathologies, and behavioural characteristics were
administered to Australian university students. This study
highlighted the phenomenological breadth of Narcissism and
the need for an improved understanding of Narcissism,
particularly given the imminent publication of DSM-5..

• A study by Marrie H. J. Bekker, Nathan Bachrach, and Marcel
A. Croon investigated the relationships among attachment
styles, autonomy-connectedness (self-awareness, sensitivity
to others, and capacity for managing new situations),
alexithymia, and antisocial behaviour among 202 college
students (67 men and 135 women).
• For men, anxious attachment had a stronger direct and
positive effect on antisocial behaviour than for women, and
the positive effect of anxious attachment on passive-
aggressive behaviour was smaller for women than for men.
Interestingly, capacity for managing new situations had a main
and mediating effect on antisocial behaviour. Sensitivity to
others appeared as a mediator between anxious attachment
style and passive-aggressive behaviour. Contrary to
expectations, fantasizing (a component of alexithymia) had a
strong, negative association with antisocial behaviour.

• Concerning the assumption that antisocial behaviour might be
affected by extreme tendencies toward detachment and
separation, several sources of support can be mentioned:
Allen and colleagues (2002) found that the acquisition of
autonomy forms a threat to preoccupied, insecurely attached
individuals and causes dysfunctional and angry behaviour.
• Second, various longitudinal studies found that antisocial
adolescents show specific affective-interpersonal
characteristics, such as superficial charm, emotional
insensitivity, callousness, and a lack of feelings of guilt and
empathy (Hare, 1993, 1999), in other words, low sensitivity to
others.
• Hare also found that antisocial individuals are often found to
be grandiose, egocentric, arrogant, and insensitive and to
show only superficial emotions. Hare thus states that
antisocial individuals fail to experience or appreciate the
emotional meaning of situations, in other words, they exhibit
low self-awareness (Hare, 1999).

References
1. American Psychiatric Association. (2013). Diagnostic And
Statistical Manual of Mental DIsorders-5. American
Psychiatric Publishing.
2. Bennett, P. (2006). Abnormal and Clinical Psychology. New
York: Open University Press.
3. Carr, A. (2001). Abnormal Psychology. USA: Psychology Press.
4. Cloninger, C. Robert - Biosocial Theory of Personality. (2008)
from wikidot.com: http://paei.wikidot.com/cloninger-c-
robert-biosocial-theory-of-personality
5. Davila, J., Ramsay, M., Stroud, C. B., & Steinberg, S. J. (n.d.).
Attachment as a Vulnerability to the development of
Psychopathology.

6. O'Donohue, W., Fowler, K. A., & Lilienfeld, S. O. (2007). Personality
Disorders: Towards the DSM 5. California: Sage Publications.
7. Paris, J. (2009). A Current Integrative Perspective on Personality
Disorders. In J. M. Oldham, A. E. Skodol, & D. S. Bende, Essentials of
Personality Disorders (pp. 119-128). American Psychiatric Publishing
Inc.
8. Preiss M., Klose J. (2001) Personality disorders diagnostics through
the C.R.Cloninger’s theory. Proceedings 37th IAMPS, Prague, 21-25
May 2001, 175-181
9. World Health Organization. (1992). ICD-10. Switzerland: World
Health Organization.

Cluster b personality disorders

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