Rethinking Cluster B Personality Disorders and Abuse
There is a disconnect when it comes to psychological and emotional abuse by those with personality disorders. In the educational setting it is taught that those meeting the criteria of the Cluster B Personality Disorders in the DSM-5 are clinically abnormal and therefore have a mental illness. Those who meet the criteria after diagnostic assessment are then given the associated diagnosis. Most clinicians then tend to view these persons as disordered and perhaps somewhat due to stigma causes the idea that these people (without treatment) are powerless over their distorted thinking. This distorted thinking in turn produces abusive behaviors. Clinicians focus on therapies that are intended to change the distorted thinking in effort to stop the associated behaviors. It is known, however, that some of the Personality Disorders in Cluster B are resistant to change. Specifically, Narcissistic Personality Disorder and Antisocial Personality Disorder have been resistant to treatment (van den Bosch, et al., 2018) (Caligor & Petrini, 2018). So then, the resulting conclusion would appear that these persons are doomed to be abusive because their distorted thinking is mostly unchangeable. This leads us to feel empathy for them as it would seem this is not the abusive person’s fault.
I propose, however, that those with Cluster B Personality Disorders – especially Narcissistic and Antisocial PD, are not mentally ill and instead make poor choices. While persons with the clinical diagnosis of the Cluster B Personality Disorders may indeed have distorted thinking processes, their abusive behaviors are typically targeted towards certain victims thus displaying the person’s ability to turn on and off abusive behaviors at will. This not only seems to confirm that the person is able to control their behavior, but also that they have awareness about when it is appropriate to abuse. While distorted thinking is most definitely at play, the person appears able to determine where and when they can get away with abusive behavior.
This is unlike any other diagnosis in the DSM. For example, without medication those with Schizophrenia do not have control over when and where a hallucination might occur, those with bipolar disorder cannot regulate when they will cycle from mania to depression, and those with anxiety cannot turn off the ability to have a panic attack.
I suggest that those with Cluster B Personality Disorders are not mentally ill. Instead I propose that these persons have learned to manipulate as a maladaptive coping skill. This maladaptive coping may have arisen from other underlying disability, such as an anxiety or mood disorder, but most persons with these Cluster B disorders have a history of childhood maltreatment. Perhaps the person would benefit from trauma therapy or treatment for underlying disorders. This, however, would do nothing to curb abusive behavior because the behaviors currently get the person’s needs and desires met, even if maladaptively.
This is possibly why the National Domestic Violence Hotline does not recommend couples counseling for victims of domestic abuse (NDVH, 2011). Couples counseling requires both parties to be willing to compromise and change. Those who have developed effective coping skills are going to resist change, regardless how dysfunctional those coping skills are.
It is high time we revisit these disorders and consider them as behavioral. It is an injustice to victims to treat abusers as incapable and ill. Those who psychologically and emotionally abuse know quite well what they do. And those in the Cluster B Personality Disorder category are quite good at it.
I propose, however, that those with Cluster B Personality Disorders – especially Narcissistic and Antisocial PD, are not mentally ill and instead make poor choices. While persons with the clinical diagnosis of the Cluster B Personality Disorders may indeed have distorted thinking processes, their abusive behaviors are typically targeted towards certain victims thus displaying the person’s ability to turn on and off abusive behaviors at will. This not only seems to confirm that the person is able to control their behavior, but also that they have awareness about when it is appropriate to abuse. While distorted thinking is most definitely at play, the person appears able to determine where and when they can get away with abusive behavior.
This is unlike any other diagnosis in the DSM. For example, without medication those with Schizophrenia do not have control over when and where a hallucination might occur, those with bipolar disorder cannot regulate when they will cycle from mania to depression, and those with anxiety cannot turn off the ability to have a panic attack.
I suggest that those with Cluster B Personality Disorders are not mentally ill. Instead I propose that these persons have learned to manipulate as a maladaptive coping skill. This maladaptive coping may have arisen from other underlying disability, such as an anxiety or mood disorder, but most persons with these Cluster B disorders have a history of childhood maltreatment. Perhaps the person would benefit from trauma therapy or treatment for underlying disorders. This, however, would do nothing to curb abusive behavior because the behaviors currently get the person’s needs and desires met, even if maladaptively.
This is possibly why the National Domestic Violence Hotline does not recommend couples counseling for victims of domestic abuse (NDVH, 2011). Couples counseling requires both parties to be willing to compromise and change. Those who have developed effective coping skills are going to resist change, regardless how dysfunctional those coping skills are.
It is high time we revisit these disorders and consider them as behavioral. It is an injustice to victims to treat abusers as incapable and ill. Those who psychologically and emotionally abuse know quite well what they do. And those in the Cluster B Personality Disorder category are quite good at it.
Caligor, MD., E. &
Petrini, MD., M. J. (2018) Treatment of narcissistic personality
disorder,
from
https://www.uptodate.com/contents/treatment-of-narcissistic-personality-disorder/print
https://www.uptodate.com/contents/treatment-of-narcissistic-personality-disorder/print
van den Bosch,
L.M.C., Rijckmans, M.J.N., Decoene S. & Chapman, A.L. (2018)
Treatment of antisocial personality disorder: Development of a
practice focused framework, from
https://www.sciencedirect.com/science/article/abs/pii/S0160252718300086
The National
Domestic Violence Hotline (2011) RHOBH Recap: Taylor’s Therapy &
Why We Don’t Recommend It, from
https://www.thehotline.org/2011/12/01/rhobh-recap-taylors-therapy-why-we-dont-recommend-it/