Dramatic Personality Disorders

Antisocial, Borderline, Histrionic and Narcissistic

Individuals with these disorders have intense, unstable emotions, distorted self-perception, and/or behavioural impulsiveness.

Antisocial Personality Disorder

 Individuals with Antisocial Personality Disorder show a pervasive disregard, and violation of, the rights of others since aged 15 years, as indicated by three (or more) of the following (from the DSM IV, American Psychiatric Association, 1994):

  • Repeated acts that are grounds for arrest
  • Deceitfulness, i.e. repeated lying, use of aliases, or conning others for personal profit or pleasure
  • Impulsiveness or failure to plan ahead
  • Irritability and aggressiveness, such as repeated physical fights or assaults
  • Reckless disregard for the safety of self or others
  • Consistent irresponsibility, i.e. repeated failure to sustain consistent work behaviour, or honour financial obligations
  • Lack of remorse, as indicated by indifference to, or rationalising having hurt, mistreated, or stolen from another

To receive this diagnosis an individual also needs to be at least 18 years old, to show evidence of a conduct disorder (which begins before age 15), and to show antisocial behaviour that does not only occur during a Manic Episode or the course of Schizophrenia

Borderline Personality Disorder

Individuals with Borderline Personality Disorder show a generalized pattern of instability in interpersonal relationships, self-image and observable emotions and significant impulsiveness. This pattern begins by early adulthood, occurs in various contexts, and is indicated by five (or more) of the following:

  • Frantic efforts (excluding suicidal or self-inflicted cuts or burns) to avoid real or imagined abandonment
  • A pattern of intense and unstable interpersonal relationships that may quickly alternate between extremes of idealisation (the other person may be “put on a pedestal”) and devaluation (the other person’s negative qualities are now exaggerated)
  • Identity disturbance: sudden and dramatic shifts in self-image in terms of shift values (e.g. sexual identity, types of friends) and vocational goals
  • Impulsiveness in at least two areas that are potentially harmful (e.g., spending, sex, substance abuse, reckless driving, binge eating, excluding suicidal or self-mutilating  behaviour)
  • Repeated suicidal behaviour or threats, or self-inflicted cuts or burns (e.g., self-mutilating behaviours, repeated serious overdoses)
  • Significant, sudden changes in mood and observable emotion (e.g., intense periodic sadness, irritability, or anxiety, usually lasting a few hours and rarely lasting more than a few days; extreme reactivity to interpersonal stresses)
  • Chronic feelings of emptiness, also may be easily bored
  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  • Temporary, stress-related psychosis (symptoms such as paranoia or grossly distorted body image)

Read more about Borderline Personality Disorder

Histrionic Personality Disorder

Beginning in early adulthood, individuals with Histrionic Personality Disorder often display excessive emotionality and attention seeking in various contexts. They tend to overreact to other people and are often perceived as shallow and self-centred. This pattern is suggested by five (or more) of the following:

  • Discomfort in situations in which he or she is not the centre of attention
  • Frequent, inappropriate, seductive or provocative behaviour in interpersonal interactions
  • Rapid shifts of emotion, and shallow expression of emotion; emotions often appear to be “turned on and off too quickly” to be deeply felt
  • Consistent use of physical appearance to draw attention to self
  • Excessively dramatic style of speech that lacks detail, opinions are strongly presented, but underlying reasons may be vague, without supporting facts and details
  • Self-dramatic, theatrical, and exaggerated expression of emotion
  • Easily influenced by others or circumstances (e.g., fads)
  • Views relationships as more intimate than they actually are

Narcissistic Personality Disorder

Individuals with Narcissistic Personality Disorder often have a grandiose view of themselves, a need for admiration, and a lack of empathy that begins in early adulthood and is present in various situations. These individuals are very demanding in their relationships. This pattern is indicated by five (or more) of the following:

  • Has inflated sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognised as superior without corresponding achievements.
  • Is overly concerned with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special high-status people (or institutions)
  • Requires excessive admiration
  • Has a sense of entitlement, i.e. unreasonable expectations of very positive treatment or automatic compliance with his or her expectations
  • Takes advantage of others to achieve his or her own ends
  • Lacks empathy: is unwilling to identify with the feelings and needs of others
  • Is often jealous of others or believes that others are jealous of him or her
  • Shows arrogant or domineering behaviours or attitudes