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A PSA: Please Stop Using Cluster B Terms; They're Not the Own You Think They Are



Ready to call your ex-whatever borderline, a narcissist, or a sociopath? Think twice. Put simply, the person calling someone a sociopath or a narcissist is more likely to be a sociopath or a narcissist themself.


And no one knows what it's like

To be hated

To be fated to telling only lies


But my dreams they aren't as empty

As my conscience seems to be


-"Behind Blue Eyes" by the Who


Cluster B diagnoses refer to a group of so-called personality disorders, including Narcissistic Personality Disorder (NPD), Antisocial Personality Disorder (ASPD), Histrionic Personality Disorder (HPD), and Borderline Personality Disorder (BPD), which involve persistent, pernicious problems with how affected individuals emote, self-regulate, express themselves, and navigate relationships. 




Embellished Cluster B terms like malignant narcissist are the ADD / ADHD of the current epoch; they have been so grossly misconstrued and overapplied that they risk becoming meaningless. 


The first thing that you should know about this group of disorders is that their very existence is still challenged by some psychologists and psychiatrists. Moreover, these disorders tend to co-occur with each other, leading some mental health experts to question whether they are in fact a single disorder on a spectrum (this same concern is manifesting in many important subfields of psych at the moment; it is an emerging theme in our understanding of the human brain). 


There are specific concerns that some of the disorders, especially ASPD, have tautological definitions (in the case of ASPD, involving criminal behavior as a key criterion). There are cultural factors and issues related to gender that can impact diagnosis, as well. These disorders are frequently confused with other mental health diagnoses; Bipolar Disorder and Borderline Personality Disorder, for example, can be comorbid but are frequently mistaken for each other. The simple fact is that when leading mental health experts advance Cluster B diagnoses - even for famous cases such as Jeffrey Dahmer's, for which abundant information is available - they do not assign them in a standardized, replicable way, as science demands. 


I decided to write this post after reflecting on a recent conversation with a friend. She is a smart, socially adept art dealer who works for a small gallery in the City. We have known each other for over 10 years, during which time I have observed that her friendships and romantic relationships tend toward the passionate - some would even say turbulent. For what it's worth, she's 33 and has been engaged twice but never married. 


This friend, who has a sum total of one course of psychological knowledge, launched into a forensic exposition on her ex-fiancé, who she classified as a covert narcissist. (As bestsellers get written and careers get made over yet another area of psychiatry that has captured the public imagination, terms like covert and malignant are used to embellish the general diagnostic labels). 


"It was all there; I just couldn't see it," she declared. "The love-bombing, then the devaluation, then the discarding, then starting the cycle all over again." 





I wish I were kidding when I say that I have heard no fewer than half a dozen virtually identical psychological indictments of ex-boyfriends and ex-husbands during the past few years. It's no longer enough to say "Hey, we both had our issues, and it didn't work out; we're focusing on co-parenting"; there seems to be an impulse to utterly character assassinate exes using clinical terms that by their definitions involve lifelong traits that are hard to change or manage. On the surface, this clinical terminology lends a certain sterile appeal, perhaps even an apparent air of detachment, but it carries a powerful riptide: Clinical-izing in this manner is actually crueler and more condescending than simply laying out someone's traits and actions in straightforwardly moralistic terms. 


The issue with this type of "reading" of someone’s personality is that it depends entirely on one heavily biased, typically ex post facto assessment of the other party's intentions, motivations, and personal qualities. It isn't hard for me to imagine how a very typical, mid-twenties relationship - which begins with ardent, worshipful love and ends six months later when the happy chemicals wear off and reality sets in - would create a trajectory that could be inadvertently or intentionally misinterpreted as reflective of narcissistic abuse by one of the parties who is feeling hurt and abandoned afterward. The crux of the issue in this scenario seems to be whether the "love bombing" and other phases are sincere or manipulative, and it is easy to envision a scenario in which initial passion is overrated by one or both parties, leading to a steep drop-off and a long, cold denouement afterward. 


Another important consideration is that we all express Cluster B traits to some degree; for this reason, these diagnoses depend on questions of extent, persistence, and level of disruption of daily life. 


My recommendation is that unless you have a PhD in psych with a specialty in personality disorders or an MD / DO / MBBS with a psychiatry specialization, stop using these terms. Diagnosing these disorders is nuanced, difficult, and debatable even for the experts; it requires a thorough knowledge of every single alternative diagnosis from outside of the personality disorder realm, and it involves ruling out physical disorders such as hyperthyroidism that can create all of the symptoms of a personality disorder (in that case, Borderline Personality Disorder or Histrionic Personality Disorder). 


There is another level on which people inclined to refer to exes as borderline or narcissistic should be wary. Any mental health provider with experience with these disorders will tell you that, despite them being fairly rare at a population level, it is absolutely shocking how people afflicted by them tend to end up in each other's lives; affected individuals are like magnets for each other.


Moreover, the heritability of these disorders, which refers to the percentage of variation in a population that is attributable to genetics, is very high, meaning that if mom was borderline or narcissistic, there is a very high chance that you are, as well. Using these terms suggests that the person applying them has Cluster B characteristics just as strongly as it says anything at all about whomever is being discussed


I know that some of you will read this and question how else you should describe a borderline- or narcissistic-seeming ex who "fits all the criteria perfectly," and my answer is simple: Just describe traits and behavior without the clinical overlay. It's perfectly fine - in fact, vastly preferable - to say that your ex was emotionally volatile, frequently manipulative, and lied a lot. If you are absolutely sure that he or she demonstrated these qualities for long enough and in enough different relationships and areas of life for them to qualify as essential, feel free to call him or her a liar or a manipulator straight out.


I tend to keep my assessments of other people's characters as rooted in their behavior and as limited to a certain context or relationship as possible, and I find that this tends to increase the weight that people assign to my judgments about others, but this is certainly not required or appropriate in every case. 


The one exception to all of the above is when the person in question has been creditably diagnosed with a Cluster B disorder, preferably by at least two doctoral-level psych professionals rendering independent assessments. Please note the "creditably" and forego this damaging, demeaning clinical terminology if you are not absolutely sure that it is being justly applied. 


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