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Have you ever thought that someone around you might be narcissistic, borderline, or antisocial? Furthermore, have you encountered any social media content that mentions how these traits are? You might say, yes, because these terms have become very popular on social media lately. Besides the real meaning of these concepts, everyone has more or less a template of a narcissistic or antisocial personality. However, these terms are more than a character type or traits; these are known as personality disorders in the mental health field. Narcissistic disorder, borderline disorder, histrionic disorder, and antisocial disorder all come under Personality Disorders, Cluster B specifically. People with Cluster B personality disorder have difficulty controlling their emotions and impulsive behaviors. In fact, Cluster B is one of the most mediatic and popular personality disorders (APA, 2013). When one prioritizes themselves first, others might say that “This is narcissistic,” or in a dysfunctional relationship, one side might think the other is a narcissistic person directly. Similarly, someone who has a breakup recently might be thought to have borderline personality if they can’t get over it shortly. Or, one of the more well-known assumptions is that if someone can’t show their emotions or behave manipulatively, they might be antisocial. However, much more is needed to define a personality disorder than just the term itself. Personality disorders are long-term, rigid patterns of behavior that begin in childhood and significantly impact a person’s social, occupational, and relational functioning. In this therapy sketch, we will explore Cluster B personality disorders and the features that unite them into a common cluster.

A Brief Look at Personality and Personality Disorders:

In the last two therapy sketches, we explained how personality disorders developed over time. Before we go deeper, here’s a simple starting point.
 

  • Personality: Personality is basically the way we think, feel, and act. It refers to patterns that make us “us.” These patterns are usually steady, flexible, and help us move through life in a predictable way (Kring et al., 2018).
  • Personality disorders: Personality Disorders show up when these patterns become too rigid. Instead of helping the person adapt to life, the patterns start to get in the way. A person may struggle with their sense of self, their emotions, their goals, or their relationships. Life feels heavier, more confusing, and harder to navigate. While most people can adjust their reactions depending on the situation, people with personality disorders often feel stuck in the same emotional loops or behaviors (Kring et al., 2018).

According to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM – 5), personality disorders are divided into three groups (APA, 2013):

  • Cluster A is categorized by bizarre, eccentric, and unusual behaviors or beliefs that are not typical of the general population.
  • Cluster B is characterized by difficulty controlling emotions and by impulsivity.
  • Cluster C is classified by predominant feelings of anxiety and fear.

All the personality disorders listed above have a long and complicated historical background. The way we name them, group them, and even what we think they mean has changed many times over the years. We will specifically focus on Cluster B Personality Disorders (Borderline, Narcissistic, Antisocial, and Histrionic) in this therapy sketch. But instead of focusing just on symptoms, we’ll focus on how these terms developed, where the language came from, and how our understanding evolved into what we use today. Because each term carries traces of the period in which it was developed. Let’s explore together.


The term “borderline”

While “borderline” may sound like a modern idea, the term actually dates back to the 1960s. At that time, psychoanalysis was the main approach, and diagnostic manuals like the DSM did not exist yet and personality patterns had been considered under two broad categories: Neurotic and Psychotic (McWilliams, 2011). 

  • Neurotic: It refers to a way that a person organizes their inner world that is based on healthier coping styles and is more aware of the cause of the problems they have been dealing with (McWilliams, 2011). 
  • Psychotic: It refers to a way that a person organizes their inner world that is based on maladaptive coping skills and limited self-awareness. For example, they might believe the problem came from a distorted outside world all the time, not from within themselves. We can say that their sense of reality is more “fragile”(McWilliams, 2011).


After a while, mental health professionals have realized that there is a broader group in this spectrum that does not fit either group. They are mostly grounded in reality checks; however, their relationships with others often exhibit an “all or nothing” mentality, making relationships unstable. Likewise, their sense of identity and emotions can fluctuate. As a result, researchers have begun to describe the term “borderline” as the organization of the intermediate zone. At that time, the concept of borderline organization described a state where a person’s inner world is somewhat not in place but not entirely broken down (McWilliams, 2011).

With the introduction of the DSM system, borderline shifted from being understood as a personality organization to being defined as a personality disorder with specific symptoms. Today, according to the DSM-5, it is defined as a long-standing pattern of instability that affects nearly every area of a person’s life, including relationships, sense of self, emotions, and impulses (APA, 2013). DSM-5 describes the following key features for borderline personality disorder:

  • Instability in Self: Individuals may experience an unstable self-image that changes from one moment to the next.
  • Instability In Relationships: Individuals may show intense fears of abandonment, rapidly shifting perceptions of others,
  • Impulsivity: Emotional reactions tend to be sharp and short-term, often accompanied by impulsive or self-damaging behaviors. 
  • Emotion Dysregulation: Individuals might experience feelings of emptiness, difficulty managing anger, and brief episodes of suspiciousness or dissociation (Köroğlu, 2018).

The term “Narcissistic”

Narcissism is perhaps one of the most common psychological terms we encounter in daily life. We often hear this word on social media, in conversations with friends, or in many materials in popular culture. The term is often associated with people who are only in love with themselves, just like Narcissus from Greek mythology. However, when the concept of narcissism first emerged in psychoanalytic theory, its meaning was quite different.

In the context of psychoanalytic theories, narcissistic personality organization refers to a person’s excessive dependence on external approval, admiration, or acceptance in order to maintain their self-esteem. In other words, it was not about the person being “in love” with themselves; it was about their constant need for external feedback to balance their fragility. According to McWilliams, people with this pattern don’t easily feel their own worth internally; even a small criticism can hit them hard, while a bit of praise can lift them quickly. What might look like confidence or superiority from the outside is often just a way of protecting a very sensitive sense of self. This description aligns more closely with what we now call vulnerable narcissism(McWilliams, 2011).

But as time went on, clinicians noticed that there was more to this pattern. The behavioral patterns of these individuals were not limited to fragile or grandiose self-esteem. It also includes a consistent pattern of seeking superiority in relationships, a marked lack of empathy, excessive sensitivity to criticism, and an outward presentation of self. Mental health professionals began to realize that these characteristics were not just a set of maladaptive coping mechanisms, but pointed to a more structural personality pattern. After that, the narcissistic structure gradually became a more distinct clinical category and, with the development of modern diagnostic systems, began to be addressed as a separate personality disorder within the DSM system (McWilliams, 2011; Kernberg, 198).

According to the DSM-5, Narcissistic Personality Disorder is a persistent pattern characterized by a person’s exaggeration of their own importance, constant need for admiration, indifference to the needs of others, and often using relationships as a means to regulate their own value (APA, 2013). DSM-5 describes the following key features of narcissistic personality disorder :

  • Grandiose Self: These individuals may appear confident or self-assured on the outside; however, they often carry intense fragility within, and their sense of self can quickly unravel at the slightest criticism
  • Interpersonal Dominance: It includes prioritizing oneself in relationships and being unable to empathize with others. 
  • Defensive Impulsivity: Quick reactions such as dismissing criticism, seeking immediate reassurance, or shifting blame can appear impulsive. These behaviors often aim to protect their self-image.

The term “antisocial” 

Antisocial personality disorder is actually a more recent term compared to “borderline” and “narcissistic.” For many years, people more commonly used words like “psychopath” or “sociopath.” In everyday language, these words were often linked with ideas like being dangerous, breaking rules, not caring about others, or having no empathy. But in the psychoanalytic writings from the 1960s and earlier, “psychopathic” didn’t just mean someone who might commit a crime. It described a much broader personality pattern, someone who struggled with empathy, boundaries, and relationships in general, not just with the law (McWilliams, 2011).

 As McWilliams points out, psychopathic organizations encompassed both individuals with severe, sadistic tendencies and those who appeared extremely attractive, social, and even successful from the outside, but who experienced serious difficulties in forming relationships, developing a sense of guilt, and respecting the boundaries of others. Thus, the concept of “psychopathic” initially referred not to crime, but to impairments in more fundamental internal processes such as attachment, empathy, impulse control, and moral functioning. However, these concepts have come to encompass a very broad spectrum over time (McWilliams, 2011). 

 On one side were individuals with severe sadistic tendencies, high impulsivity, and a propensity for criminal behavior; on the other side were individuals who appeared extremely compliant, attractive, and social on the outside but who, deep down, were incapable of empathy, instrumentalized others, and felt no guilt. Thus, a single concept had to explain very different profiles. With the DSM-III, Antisocial Personality Disorder became the formal clinical diagnosis, and today these older labels are mostly used in popular culture rather than the mental health field (McWilliams, 2011; Coolidge et al., 1998). 

According to DSM-5, antisocial personality disorder includes key features as follows (APA, 2013):

  • Egocentric Self: These individuals may experience a sense of self centered on personal gain, power, and immediate needs. 
  • Superficial Relationships: They may have trouble recognizing others’ limits or understanding how their behavior affects people. This can lead to patterns like stretching rules, bending honesty, or using shortcuts in relationships.
  • Impulsivity and Risk Taking: They may have a tendency to act on impulse, seek excitement, or make decisions without much planning. This can show up in finances, work, or daily responsibilities.
  • Emotional Insensitivity: It may be hard for them to reflect on the emotional impact of their actions, feel guilt in the way others typically do, or recognize the harm caused in close relationships.

The term “histrionic”

Although histrionic personality disorder is often associated with traits that most people today recognize as “attention-seeking,” “exaggerated emotions,” or “dramatic behavior,” the concept’s origins date back much further, even before modern psychology. The term “hysteria” was a word used in Ancient Greece and was used for many years to describe emotional distress manifested through physical symptoms. In Freud and Breuer’s famous work, Studies on Hysteria, hysteria was explained as the suppression of intense emotions into the unconscious and their expression through the body (Breuer & Freud, 1895/2000). In other words, in the early use of hysteria, the issue was not that the person just wanted attention; instead, when they could not regulate their emotional experiences, these took dramatic, theatrical, or intense forms of expression (McWilliams, 2011.


Mental health professionals eventually recognized that hysterical tendencies were not limited to temporary crises or physical symptoms; For some people, these patterns showed up again and again in their relationships. Their emotions could rise and fade quickly; they often paid close attention to how others responded to them, and they sometimes connected with people through lively or expressive behavior. Instead of seeing this as a reaction to an external event, mental health professionals categorized it as a consistent way some people relate to and cope with the world (McWilliams, 2011). As this understanding grew, this broad concept of hysteria took on a more behavior-based and measurable form and was classified as Histrionic Personality Disorder. According to the DSM-5, the histrionic personality pattern is defined by (APA, 2013; Coolidge et al., 1998) :

  • Expressive Self: Individuals may naturally express themselves in lively, energetic, or attention-drawing ways. Their sense of self can feel most steady when they feel seen, heard, or appreciated by others.
  • Seeking Engagement in Relationships: They tend to connect with others through warmth, expressiveness, and enthusiasm. At times, relationships may feel more intense or closer to them than they actually are, because they seek emotional connection and responsiveness.
  • Attention-Seeking Behaviors: They may want to be noticed or stay emotionally connected more often, leading to behaviors that look dramatic or flirtatious. s
  • Rapid Shifting Emotions: Emotions can rise and fall quickly and may be expressed in big, visible ways. These emotional shifts can reflect a strong sensitivity to the social environment and how others respond to them.

Why are they under the same umbrella?

The reason borderline, narcissistic, antisocial, and histrionic personality patterns are grouped together is that they share core themes across four areas: how a person relates to themselves, how they connect with others, how they manage impulses, and how they regulate their emotions. Across these patterns, we often see emotional instability, impulsive or highly expressive behaviors, shifts or inconsistencies in relationships, and a reliance on external feedback to maintain a sense of self-worth. In other words, although each of these four personality disorders may appear different, they all progress in the form of excessive sensitivity to feedback from the outside world, fragile self-esteem, difficulty controlling impulses, and fluctuations in close relationships (APA, 2013; Coolidge et al., 1998).

Is it as much as we think?

You may have noticed how prevalent certain personality disorders, such as narcissism and antisocial personality disorder, seem to be these days. However, we don’t actually have exact data on the prevalence of these concepts under the umbrella of personality disorders because the DSM-5 diagnostic system allows for many variations in personality disorders. Even for narcissism, one of the most commonly diagnosed personality disorders, the rate is between 0.5% and 5% of people in the U.S. This indicates that it is more of a tendency or a few observable symptoms rather than a diagnosis (Cleveland Clinic, 2023). Similarly, antisocial personality disorder has been well studied in community samples with estimates of its lifetime prevalence ranging from 1-4% of the general population (eCare Behavioral Health Institute, 2023). In short, what we generally notice in daily life (except in rare cases) is not the personality disorder itself, but rather behavioral traits associated with it that appear in milder forms, especially due to social media, competitive culture, individualistic culture, and modern communication styles (Fisher, 2024).

It’s also important to highlight that for every personality disorder in the DSM-5, a person must meet at least 5 out of 9 criteria to get a personality disorder diagnosis. Because there are multiple ways these criteria can be combined, two individuals with the same diagnosis can look very different. In addition to this, the intensity of symptoms and how much they affect daily functioning also vary widely. For this reason, creating a simple, one-size-fits-all image of any personality disorder is much harder than it seems. This complexity also impacts their prevalence (Köroğlu, 2018).

So what can be done?

Cluster B personality patterns impact core components of personality like self, relationships with others, emotion regulation, and coping styles. And because these patterns have been used for so many years, they don’t usually change on their own. If these patterns start to get in the way of someone’s daily life, professional support can make a difference. Therapy aims to help the individual develop flexibility by assisting them to understand their relational cycles, triggers, and emotional responses (Linehan, 1993). Approaches such as psychodynamic therapy, DBT, schema therapy, and mentalization-focused therapy can be effective in addressing the emotional and relational origins of Cluster B patterns (Kernberg, 1984; Linehan, 1993; Bateman & Fonagy, 2004).

Take-aways:

  • Personality disorders show up when these patterns become too rigid; instead of helping the person adapt to life, the patterns start to get in the way.
  • In this therapy sketch, we explored Cluster B personality disorders, which include Borderline, Narcissistic, Antisocial, and Histrionic patterns.
  • Instead of limiting them to DSM-5 symptoms, we examine them through their history, language, and the theories that influenced them, because understanding the origins of these terms can help make sense of them well beyond their diagnostic criteria.
  • The reason borderline, narcissistic, antisocial, and histrionic personality patterns are grouped together is that they share core themes across four areas: how a person relates to themselves, how they connect with others, how they manage impulses, and how they regulate their emotions.
  • If these patterns start to get in the way of someone’s daily life, professional support can make a difference.

References:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
  • Bateman, A. W., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization-based treatment. Oxford University Press.
  • Breuer, J., & Freud, S. (1895/2000). Studies on hysteria. Basic Books. (Original work published 1895)
  • Cleveland Clinic. (2023). Narcissistic personality disorder. Retrieved (2025), from https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder
  • Coolidge FL, Segal DL. Evolution of personality disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Clin Psychol Rev. 1998 Aug;18(5):585-99. doi: 10.1016/s0272-7358(98)00002-6. PMID: 9740979.
  • eCare Behavioral Health Institute. (2023, October 17). Antisocial personality disorder statistics: Prevalence & facts. https://www.ecarebehavioralinstitute.com/blog/antisocial-personality-disorder-statistics/
  • Fisher, H. (2024, February 7). Why narcissism is rising. Psychology Today.
  • https://www.psychologytoday.com/us/blog/the-human-beast/202402/why-narcissism-is-rising
  • Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. Yale University Press.
  • Köroğlu, E. (2018). Kişilik bozuklukları tanı ve tedavi rehberi. HYB Yayıncılık.
    (Metinde DSM-5 kriterlerinin Türkçe karşılığı olarak kullanıldı.)
  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  • McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.
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Whether you’re seeking guidance on a specific issue or need help navigating difficult emotions, we’re ready to assist you every step of the way.

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This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

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