Cluster B Traits

For those of you fortunate enough to have no clue what that title means, either

a).  Enjoy your final moments of bliss, or

b).  Stop reading and continue such bliss (perhaps at your peril).

For those of you who do know what the title at least could mean,

a).  Just wanted to let somebody on this planet know that if I read that phrase one more time, I’m going to start smashing windows, and

b).   Given that I will most likely read that phrase at least one more time before noon today, I am going to start a multi-day rant instead.  Be warned.

Or how about this:  I’ll rant for a while, then I’ll get serious.  Again, be warned.  About both.

(And for related thoughts, see my June 30, 2012 post, Quite the Handful, and my July 7, 2012 post, Saint Crispin’s Kindergarteners)

Back to those of you without a clue . . .

Let me reveal some dirty little secrets of my profession.  First, about our Sacred Scripture in psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (known far more lovingly as DSM-IV-TR):

First sub one:  Have no fear.  The Fifth Edition cometh, brought to you by the most august group of scholars assembled since the translators of the King James.  Thy redemption draweth nigh.

First sub two:  Until that glorious day, you–and, yes, I–are stuck with Edition Four.

Sub three:  We must consult it day and night, without ceasing, for within it are powerful truths.

Sub four:  Many of us (if not most) in mental health basically ignore DSM-IV our every breathing moment except  when we have to submit a bill; determine a disability payment; talk to a lawyer; try to impress our teachers/colleagues who are so-much-smarter-than-we-are (probably the most common reason); or want to send out a secret code to other clinicians, kind of like those fires set from hill to hill by the beseiged Men in Lord of the Rings.

Second:  it is to this code that I wish turn our attention.

One of the deep truths (and fun facts to know and tell) of the DSM is that our emotional lives can usefully (and in the view of some, definitively) be categorized into two groups:  Axis I disorders and Axis II disorders.  These two groups may easily be differentiated from each other as follows:

Axis I:   Poor Souls

Axis II:  Losers

Fleshed out a bit more:  in the view of many, the Axis I Disorders are the real psychiatric disorders, ones such as schizophrenia, depression, substance dependence, eating disorders, Alzheimer’s, you get the drift; stuff you don’t want to have, but for which you do not necessarily have to tred the walk of shame every time you darken the door of a mental health clinic.

In contrast, the Axis II Disorders are (for our present purposes, essentially exclusively) the Personality Disorders.  And indeed, that’s as bad as it sounds.  In the view of many, your whole personality is screwed up–understandably, of course, and with neurobiologic underpinnings, have no fear, and with our deepest respect for the complexities of the human spirit, naturellement.  But I repeat:  you’re screwed up–again, at least according to many.

Funny thing is:  many of these many clinicians are loathe to actually make an Axis II diagnosis.  It’s as if the very act of naming itself is somehow the height of impoliteness, akin to taking the last roll in the bread dish without asking permission.

Fear not, though, for there are traits!!  In other words, the patient doesn’t actually have to have a personality disorder, but rather can merely have personality traits.  It’s an ingenious device, truth be told.  Now one can warn all comers (remember the fires?) that “this person ain’t no picnic to deal with” without having really to put one’s money where one’s mouth is.

Even more fun:  you have different kinds of traits to choose from.  You can choose Cluster A traits, the traits of those whom some might call a bit “different.”  You can choose Cluster C traits, the traits of those whom some might call a bit “uptight.”  Or, best yet, you can choose Cluster B traits, the traits of those whom some might call a bit  “over-the-top pains-in-the-neck.”

The fun continues:  Cluster B traits come in four varieties, all of which can be mixed and matched at will:

1.)  Borderline Traits, or “Good Lord, man/woman, can’t you pull your life together?” or

2).  Histrionic Traits, or “Cut the drama, will ya?” or

3).  Narcissistic Traits, or “You’re a jerk and I want to slap you,” or

4).  Antisocial Traits, or “You’re a jerk and you make me want to check my wallet.”

And finally,  most fun of all:  today, somewhere in the great land of ours, who knows how many times, some combat veteran is going to get the diagnosis of Cluster B Traits.

Time to get serious.

Personality disorders are real, and they can be quite devastating, often to the patients themselves, almost always to the persons around the individuals with the personality disorder.  Borderline personality disorder, for example, is an extremely emotionally-painful condition in which individuals, usually who have suffered severe trauma as youngsters, struggle with tremendous emotional upheavals in the context of their closest relationships.  Personality disorders are not something to take lightly.

But, then, that’s the point.  Because individuals with personality disorders are often challenging to deal with, clinicians can often be quite cavalier when discussing them, leaving one with the sense that in the hands of some, all the diagnosis of “personality disorder” or “personality traits” tells you is that the diagnostician didn’t feel treated well enough by the patient, darn it.

Even more importantly, emotional upheaval per se does not equal “personality disorder” or “Cluster B traits.”  Combat veterans have plenty of good reasons to be in emotional turmoil–and not necessarily be pleasant 24/7 about it, even with their I’m-here-for-you therapists or prescribers.  The fires in the lands of Men are often false alarms.  It is not the goblins who are coming.  It’s the men and women who are depending on somebody in this world to understand that sometimes it hurts too much to be nice.

Therefore, let’s next consider what “personality disorders” actually are.  Before then, though, I’ve got to sweep up some shards of glass.

17 responses

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  2. Pingback: Where Narcissicm Ends and Antisocial Personality Disorder Begins « Phoenix Rising

  3. Rod, great piece. Here is my nomination for the DSM-V Charismatic personality disorder: This disorder is manifested in a combination of traits that include dynamic attractive “magnetic” personality, strong leadership ability through inspiration, often physically attractive, hypersexual – has difficulty controlling sexuality, over time develops a weakened association with truthfulness. Individuals with this disorder include Franklin Roosevelt, Bill Clinton, Newt Gingrich, Dwight Eisenhower and several individuals each of us could name. While this is obviously tongue in cheek, I do believe it is a legitimate disorder.

    • Oh, Paul, there you go . . .

      I go back and forth on this post: as you can see, my tongue’s so far in my own cheek, I think my larynx’s not far behind! I’ve received some feedback about this one–and quite thoughtful and well-deserved feedback. Some have been concerned, for example, that I might not be taking seriously the struggles some individuals have. I hope that will never be the case. I do wonder, though, about the labels we choose. Granted, certain struggles individuals face will always, somehow be mislabeled by those who don’t want to deal with those struggles. Eventually, any naming is little more than a stalling technique. However, I still think it’s important periodically to question–vigorously–the names we choose for people’s sufferings. Keeps us all honest, and that is a good thing.

      Of course, that depends on what your definition of “is” is, does it not?

      Thanks so much.

  4. How can some idiot trainee psychiatrist diagnose me with cluster B trait, apsychotic and some other crap – when she only spoke to me for about 15 minutes? There were no tests done at all. I’m baffled, confused and worried. Is there hope for me that I will again be the old Ana (happy, confident, accepted back by family and friends etc etc) ??? Because if not – I will not keep going through this – I will end it, if somebody who really knows does not give me a promise of HOPE.

    • Ms. Lopes,

      Sorry it took me a couple days to get back to you. I do indeed hope that you will maintain “hope,” for you should. Even though clinicians can mean different things (obviously) when they use the phrase “Cluster B traits,” in my years I have found that most individuals who have “received” that diagnosis often find much help (and hope) from two books. The first is “I Hate You, Don’t Leave Me,” by Dr. Jerald Kreisman and Hal Straus. Although the book is allegedly written for those who have received the diagnosis of Borderline Personality Disorder, it is also an excellent book for any individual who finds himself or herself struggling with mood shifts that can complicate relationships. The second is a book that I personally have not read, but which always receives excellent reviews: “Get Me Out of Here: My Recovery from Borderline Personality Disorder,” by Rachel Reiland. This is a memoir that always receives the highest praise for its honesty–and its hope–about dealing with the ups and downs of emotional reactivity. I do hope these books might prove helpful and, even more, hopeful for you. My best wishes.

    • Ana – per Dr. Judith Herman (Harvard Med School professor) in her Trauma and Recovery, BPD, HPD, and even bipolar should not be the first diagnoses. PTSD should be. If treatment for PTSD doesn’t work, then go down the flow chart to other diagnoses.

      Unfortunately, many are misdiagnosed by the “experts” which causes compounding harm and another layer of trauma.

  5. I am a mental health counselor I went to a psychiatrist to get a definitive dx. of PTSD for some trauma I experienced as a child and adult in the military and just discovered I received a dx. of anxiety disorder NOS with ptsd traits and an axis II dx. of cluster B from a psychiatrist I saw once for less than an hour who after being unable to elicit a self-dx. as I have been in the medical profession for more than 20+ years stated he did not feel he had enough time with me to make a diagnosis, go figure. You can bet I will be having my medical records ammended!!!!!

  6. Is having no empathy a sign of a personality disorder? I try over and over again to communicate with my boyfriend/ex fiancee and he doesn’t get it. What he has done in the past. The cheating, dumping me for no reason etc. He is a recovering alcoholic. Two and a half years sober (and did the steps) and no pot for 7 months. He had been drinking and doing some kind of drug for 20 years. His father neglected him and he was spoiled so I wonder if he is a narcissist. His father was also a womanizer so he learned bad behavior from him. We are in counseling and the counselor believes he loves me. That he is just numb from years of substance abuse. I gave him a second chance after he broke our engagement and spent last summer “dating”,(has been with prostitutes before and “massage parlors”/happy endings) and traveling. He also stalked me. He said he did all that because he was desperate and lonely. He wanted me and no connections with women he was physical with. He had an emotional friend that he knew liked him and I believe he led her on and liked it. Writing all this is making me sick. What is my problem that I’m with him? I feel very sorry for him and believe he wants to be different. Is that possible? Can people change that much??? I’m a good example of the person trapped in their nasty web. Btw, if I leave, he won’t go away easily.

    • Mandy,

      Thank you for your sincere comment and questions. Given that I’ve never met your boyfriend, anything I say should be taken simply as a “possibility,” a hypothesis. Also, I would hope that your boyfriend would not feel any of this as a criticism, for i intend none of it to be such.

      When I hear a story like this, my first thought is that the individual (i.e., here, your bf) is struggling greatly with being to modulate/regulate his emotional changes, the changes that are part and parcel of life, the ones that all of us have to struggle with. Currently, many prominent, clinically-oriented neuroscientists believe that all we humans (and other mammals as well) have seven “core” emotions that will always be with us in one way or another (although to different degrees in different people): SEEKING (basically curiosity/intensity), RAGE, FEAR, LUST, CARE, PANIC/GRIEF, and PLAY (these are ideas from a man named Jaak Panskeep). These “core” emotions are quite raw, quite powerful, and the scientists believe that as we grow up, we (hopefully) learn to be able to modulate them, as well as experience all their various “flavors.”

      It does seem to me that individuals who had a rough time of it growing up often do find themselves at times when their, shall we say, “raw” emotions become so powerful, they cannot think clearly about them, and thus they act in ways that can be quite harmful both to themselves and others. They might even feel bad about such outbursts, but the underlying problem is that the emotion is too “core,” too strong, not modulated-enough to allow the individual to act more thoughtfully and successfully.

      Can people develop the capacity to think more clearly through their emotions? Absolutely. Do most/many achieve this goal? Sadly, from my experience, no. The problem is often not the underlying desire to change (although clearly there are individuals who have no plans at all to change, but will say anything to manipulate others). The problem is that the process of, if you will, better “attaching thoughts to emotions” is quite hard, especially when adults are experiencing such powerful emotions. Kids with powerful emotions can be managed (yes, lovingly) far more easily. Adults with such emotions wreak havoc–and you can’t just put them in a time-out!

      In other words, I do fear that both you and your boyfriend will need to come to grips with the old adage from St. Matthew’s Gospel: “the spirit is willing, but the flesh is weak.” As I read about your dilemma, I’m not at all hopeless. Yet, again sadly, I cannot also be strongly hopeful.

      I certainly have no problem believing you when you say that it will be hard to leave him, should you decide to do that. You will need a great deal of physical emotional, and spiritual support. Be sure you get it.

      So will he need such support, although I do fear that he may be less likely to seek it out. I am saddened to have to say that to you, but I believe I owe you my honest thoughts. I hope, for both your sakes, I’m wrong.

      My best to you and also my best to your boyfriend.

      • That’s really good and thoughtful advice. Struggling to understand why a person acts or treats others the way they do sometimes leads us to realize there may never be a concrete answer for any of it. And the hope for a solution/resolution is often an exercise in futility. It took a “team” of loving people to get me back to me after my life with a man who just wasn’t good for me in any sense of my understanding or other’s understanding of good.

    • Hi Mandy I came across you statement on this site.. I honestly feel like you are telling my story.. I have been with my ex on and off for 14 years.. And he also is a recovering alcoholic 6 years sober.. He too would break up with me and date … I found out he was also with escorts.. His childhood was also a rough one where his father was not a great example and his mother was not there for.. Throughout these years I have been there for him as a girlfriend or as his friend because I loved him and I wanted our family to work.. We have two kids together.. He too has stalked me various times.. This last break up was bad because he believed I was pushing him away and was with someone else.. I was trying to set boundaries as per our couple therapist…he wanted to be with me every minute of the day but I felt suffocated .. I felt like he was doing it cause he didn’t trust me.. He began stalking me and I begged him to go see a therapist.. But he refused.. He ended up getting arrested because my child called the police.. He was then diagnosed with cluster band us now getting therapy because if dyfs .. But what hurts me now us he’s been again dating .. And claims he has changed.. This is what I wanted all along for us to get help.. So now I’m so confused and hurt cause I feel like he is stringing me along.. One day he says he loves me and wants our family and our days he tries to start fights with me saying I never knew how to take care if him…I so hurt and confused .. I see your post was from March 2013.. And I was wondering how your situation is today ..Mari

      • Hi Mari! Sadly, I married him a couple months ago with promises I believed and hidden lies from him I thought he was changed. I’m not in a good place today, (go figure that). He is a liar, a with holder of truth, a twister a reality, a blame shifter, an excuse maker and he is vindictive. When we talk about the past it’s as if I deserved it. I “was being a pill”. He was “at a bad place”, he dumped me giving me the chance to be sorry…. Blah blah blah. Now I’m ready to run. I feel it’s hopeless as much as before but worse as I allowed myself to be trapped with him. We are in counseling but I don’t think he has remorse or really cares/wants to work or change. I think he’s fed up and wants me fixed back to the quiet sucker he so preferred. I’m tired of explaining and really teaching a grown man how he should feel and or how to behave. It’s so twisted and I now must turn to myself and find out what’s wrong with ME! Why on earth would I allow myself to be treated so poorly. By poorly I mean I could list a thousand God awful nightmare things he has done only for me to forgive. I’m giving it a last shot because I said I would. I have zero hope and will try very hard to fix me and get strong enough to likely be on my own with him trashing me/telling lies which held me down in the past. Now I will tell about him. Who he is and the truth. He will say I dumped him over one lie or wouldn’t forgive him…. If he does, this time I’m not staying quiet. Get away from these men!!!! Good luck! :( Hugs Joan

  7. Reblogged this on Narc Raiders and commented:
    Food for thought…and it is in looking at the angles objectively…the first part is healing in that when mauled of course there are going to be very strong reactions; however, there comes a time when as we strive to get closer to our essence, our truth, our ‘compassion’ we seek not so much as to re-unite with one who has harmed us, but rather get to a place where perhaps we can call it a draw? (from a safe distance)…over time, continuing to fan flames about what they did, how evil they are, how disordered, WHATever…it becomes counter productive…at some point we experience our own mental, and emotional evolution, we experience ‘grace’ and if we continue to ‘delve’ into the issues we may begin to see that we even have a different view…one that does not deviate from the knowledge we’ve gained so far, but in some ways perhaps the closure comes in recognizing that they are in some respects just as powerless…they did not ask to be born this way, nor did they ask to experience things they were powerless over and hence disorder manifested…but it takes time and a lot of exploration and inner work to get there…see also:

  8. It’s easy to get frustrated with someone with PTSD and plop them in the personality disordered category or at the very least as you suggest, label them with have traits of those disorders. I’ll be honest, I get a little impatient with a few of my friends who suffer from PTSD and have worked really hard to find peace, then one day “Bam!” they’re back to being angry due to a trigger. Patience. It takes lots of patience and a desire to keep understanding. I sometimes just say to them, “I just want you to know that I don’t like seeing you hurt yourself by being so angry. I care about you and believe in you.” Ultimately, it’s up to the sufferer to decide which path to take. I’m not happy about how these personality traits often get confused with the disorder, either. Just another label to fight off and defend ourselves against.

  9. I just obtained some copies of my medical records, and found that I was diagnosed with “major depression, cluster B traits.” So, I Googled “cluster B traits” and the first result listed said something about a “dramatic personality.” Yes, I suppose I do have a bit of a dramatic personality, but I have good reason to be on edge 97% of the time.

    I find it interesting that a person who is diagnosed with “obsessive compulsive personality with avoidant and schizoid features” can be diagnosed with “narcissistic personality disorder” (or something to that effect) just a year later. Quite funny, really, since the former diagnosis describes someone who is so afraid of rejection that they avoid social situations, and feels as though they are hopelessly flawed to the point that there’s no sense in even attempting at a relationship, but the latter describes a person who thinks they have no flaws and even if they do make a mistake or something, there is always an excuse or justification. (By the way, those were the two different personality disorders I was diagnosed with several years ago; a year after the latter diagnosis, I was told I had NO personality disorders at all.)

    Psychologists are funny creatures.

  10. Pingback: Veterans’ Blogs Offer a Glimpse into Life on the Front Lines — Blog —

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