592 CHAPTER 13
Dramatic/Erratic Personality Disorders
In her memoir, Rachel Reiland recalls an occasion when a minor matter set off an
escalating fi ght between her and her husband. She raged at him until she realized
that she might drive him away. Then, she decided to leave him before he had a
chance to leave her. She ran out of the house barefoot, then ran for miles through
the city on glass-strewn sidewalks. After several hours, her husband and children—
who had been searching for her—pulled up their car beside her and brought her
home (Reiland, 2004).
Reiland’s response to this fi ght with her husband exemplifi es the typical reac-
tions of people with Cluster B personality disorders—impulsive, dramatic, and er-
ratic behaviors, which arise because of diffi culty regulating their emotions. In fact,
emotional dysregulation and impulsive and dramatic behaviors are common to all
Cluster B (dramatic/erratic) personality disorders. This commonality can some-
times make it diffi cult to determine which specifi c Cluster B personality disorder a
given patient has; many of the symptoms specifi ed in the diagnostic criteria are not
unique to a single personality disorder in the cluster (Blais, Hilsenroth, & Fowler,
1999; Fosatti, Madeddu, & Maffei, 1999; Zanarini & Gunderson, 1997; Zittell &
Westen, 1998). People with a dramatic/erratic personality disorder also tend to have
certain types of Axis I disorders, namely substance-related disorders, mood disor-
ders, anxiety disorders, or eating disorders (Dolan-Sewell, Krueger, & Shea, 2001;
McGlashan et al., 2000; Oldham et al., 1995; Skodol, Oldham, & Gallaher, 1999;
Skodol et al., 1993; Tyrer et al., 1997; Zanarini, Gunderson, & Frankenburg, 1989;
Zanarini et al., 1998).
Let’s examine the four Cluster B (dramatic/erratic) personality disorders: anti-
social, borderline, histrionic, and narcissistic.Antisocial Personality Disorder
One day, Reiland was in a particularly angry mood and she put the following note
on the front door: “You need to pick up the kids. I’m upstairs in the attic. Don’t even
think of going up there if you know what’s good for you!” At the bottom
of the stairs to the attic, she taped another note: “Stay away! Don’t mess
with me! You don’t know what I might have up here!” The last note was
on the attic door, which was locked: “I might die
anyway, but if you dare come in here, you might all
be dead! You don’t know what I have up here!”
(Reiland, 2004, p. 148).
Some might say that Reiland’s behavior—and
her apparent lack of concern for how her husband
and children might respond to the notes—had ele-
ments of antisocial personality disorder, which in-
volves a persistent disregard for the rights of others.
As noted in Criterion A in Table 13.11, people with
antisocial personality disorder may violate rules or
laws (for example, by stealing) and may lie or act
aggressively, hurting others (American Psychiatric
Association, 2000). They may also act impulsively,
putting themselves or others at risk of harm. In ad-
dition to these behaviors, people with antisocial per-
sonality disorder shirk their responsibilities—they
don’t pay their bills or show up for work on time,
for instance. They may also exhibit a fundamental
lack of regret for or guilt about their antisocial be-
haviors, seeming to lack a conscience, a moral sense,
or a sense of empathy. In Reiland’s case, holing upTable 13.11 • DSM-IV-TR Diagnostic Criteria for
Antisocial Personality DisorderA. There is a pervasive pattern of disregard for and violation of the rights of others
occurring since age 15 years, as indicated by three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors as indicated by
repeatedly performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profi t or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fi ghts or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor fi nancial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
mistreated, or stolen from anotherB. The individual is at least age 18 yearsC. There is evidence of conduct disorder [Chapter 14] with onset before age 15 yearsD. The occurrence of antisocial behavior is not exclusively during the course of schizo-
phrenia [Chapter 12] or a manic episode [Chapter 6].Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,
Text Revision, Fourth Edition, (Copyright 2000) American Psychiatric Association.