Descriptive Psychopathology: The Signs and Symptoms of ...

356 Section 3: Examination domainsTable 15.3. Cluster B observable behaviorsAntisocial Borderline Histrionic NarcissisticImpulsive Impulsive Rapid mood shifts Lack of empathyIrritable and aggressiveCold and callousLack of remorseand sympathySigns of vanity andself-indulgence 25Self-decoration 26Evasive historianAffectiveinstabilityIrritable andaggressiveSigns of self-injuryExaggerated emotionalexpressionSigns of vanity andself-indulgenceSelf-decorationFlirtatiousImpressionistichistorian 27Arrogant mannerSelf-absorbedManipulativeControlling andimpressionistichistoriandisorders, but paranoid personality disorder is also seen in some epileptics, in longtermheavy drinkers, and chronic abusers of inhalants. 28 Schizotypal personalitydisorder is also seen in some epileptics and in chronic abusers of hallucinogens.Bleuler considered schizoid personality to be an early sign of schizophrenia. It isalso associated with autistic spectrum disorders. 29Patient 15.3 meets DSM criteria for schizotypal personality disorder.Patient 15.3A 34-year-old man worked only several hours weekly in a transitional centerof a large community mental health system. He spoke in a soft voice andoften about being clairvoyant and seeing scurrying creatures from thecorners of his eyes. His speech was vague. He used few nouns and specificcontent, and it was difficult to follow his train of thought. He had no friends,lived alone, and interacted only with the center staff that he knew. He neverexperienced any psychotic symptoms, although he was prescribed antipsychoticmedication.Cluster BCluster B personality disorders represent two groupings: (1) narcissistic/antisocial/histrionic, and (2) borderline.The narcissistic/antisocial/histrionic group is characterized by egocentric andexcitable behavior, high behavioral activation and low inhibition. The narcissisticpersonality criteria are mostly interpretive and historical and may not be observedor clearly elicited during the examination.Histrionic personality disorder has the longest history, described originally ashysterical personality. Such persons were characterized as egocentric, affectivelylabile, exhibitionistic, dramatic, excitable, emotionally shallow, flirtatious but