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Psychiatry 3 USMLE RX BRICKS
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an indepth notes for psychiatry usmle step 1
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Cluster B PersonalityDisorders
Last Updated: August 28, 2020
access_time19 min
Learning Objectives (4)
After completing this brick, you will be able to:
● Describe the etiology and epidemiology of the cluster B personality
disorders (antisocial, borderline, histrionic, narcissistic).
● 1
● Compare and contrast the DSM-5 diagnostic criteria for the cluster B
personality disorders.
● 2
● List the common differential diagnoses and comorbid conditions for
each cluster B personality disorder.
● 3
● Describe the evidence-based assessments and treatment approaches
for each.
● 4
CASE CONNECTION
You are doing a portion of your psychiatry rotation at the local prison
when your attending asks you to interview LD, a 32-year-old man
convicted of first-degree murder. LD has been in and out of prison for
felony charges since the age of 18. “I’m just fine,” LD reports. “I’m
not a fan of this place, but I can’t seem to get out. Wait. Why do you
look so nervous? Did they tell you I killed a guy? Listen, will it make
,it easier if I tell you I would do it again in a second for what he said
about my mother? Anyway, do me a favor. Come back tomorrow and
bring me a roast beef sandwich. The food here is unacceptable.” On
review of his record, you note that LD was charged with setting fires
at age 8 years, and he admitted to mutilating animals at that time.
What disorder will you discuss with LD and your attending? Consider
your answer as you read, and we’ll revisit at the end of the brick.
What Are Personality Disorders?
A personality disorder is a long-term pattern of thinking, feeling, and
behavior that deviates from expected norms and causes distress and
problems with daily functioning.
There are 10 specific types, each with a unique presentation. These
disorders are classified into three clusters:
● Cluster A (odd, bizarre, eccentric): Paranoid, schizoid, and
schizotypal
● Cluster B (dramatic, erratic): Antisocial, borderline, histrionic,
and narcissistic
● Cluster C (anxious, fearful): Avoidant, dependent, and
obsessive-compulsive
,In this brick, we’ll explore the nature of cluster B personality
disorders and how each is diagnosed and treated.
What Are the Cluster B Personality
Disorders?
Personality disorders generally present with symptoms first in
childhood or early adolescence (around the age of 14 years) and
persist throughout life. They tend to be stable and enduring,
regardless of context. However, they can improve in some adults over
the age of 55 years.
There are four distinct disorders (antisocial, borderline, histrionic, and
narcissistic), but all share certain similarities. Cluster B personality
disorders are characterized by dramatic, overly emotional, or
unpredictable thinking and behavior. Patients with these personality
disorders have difficulty understanding the emotions of others and
exhibit unpredictable patterns of behavior, especially in their
interactions with others.
How Common Are Cluster B
Personality Disorders?
, Overall, personality disorders (including all types) are estimated to
occur in about 11% of the US population. The worldwide and US
prevalence of cluster B disorders is shown in Table 1. Antisocial
personality disorder (also known as psychopathy) is much more
common in men than in women. Narcissistic personality disorder is
also more common in men, with a US male-to-female ratio of 2.5:1.
Disorder Global Prevalence US Prevalence
Antisocial 0.7%-3.6% Overall 3.6%
4.5% among men
0.8% among women
Borderline 0.7%-5.9% Overall 1.6%
(Three-fourths of cases occur
in women)
Histrionic 2.0% Overall 2.1%
(No significant difference in
rates between men and
women)
Narcissistic 0.8%-6.2% Overall 0.5%-1%
2.4% among men
0.3% among women
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