Studies of adults with “dramatic” or cluster B personality disorders — e.g., antisocial, narcissistic, histrionic, and borderline personality disorders — document that the developmental trajectory leading to maladaptive patterns of coping and relating is shaped by an array of risk factors, including neurobiological vulnerabilities and adverse childhood experiences. Some of these individual’s minds and bodies have been damaged by the destructive intrusions of physical and/or sexual abuse.
Others are burdened by neuropsychiatric vulnerabilities, such as mood disorders or attention deficit/hyperactivity disorders. Yet, regardless of the degree of adversity or genetic vulnerability, children who are at risk to develop a dramatic personality disorder seem to share a striking incongruity — an uncanny sensitivity and reactivity. Thus, their “dramatic” quality to other people’s mental states, paradoxically coexisting with remarkable self-centeredness and utter disregard for other people’s feelings.
One moment they can be engaging and appealing, the next moment, however, their capacity to manipulate others and their rage, demandingness, and self-destructiveness become overwhelming. The incongruous coexistence of exquisite sensitivity and brutal lack of concern for others offers clues to the developmental disruptions leading to dramatic personality disorders — and of the factors that protect other children exposed to similar adversity and vulnerability.
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