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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: What are constallations and clusters?  (Read 4310 times)
MxMan
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« on: June 11, 2009, 02:35:18 PM »

I apparently was misinformed about what i thought were different clusters of BPD. I was told about clusters 1,2 and 3. 1 being low functioning, 2 being high functioning and 3 being a combination fo the other 2. I was told that people generally fall in one of the first 2 categories but that lots of people are in the 3rd category where they exhibit traits of both high dunctioning and low functioning depending on situational things?

am i misunderstanding? was i misinformed? am i misunderstanding the terminology?
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JoannaK
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« Reply #1 on: June 14, 2009, 07:48:08 PM »

Sorry you haven't received any answers to date, MxMan.

At first I thought you were talking about Personality disorder clusters,  but after searching a bit, I did find that there are some therapists who have come up with "clusters" of BPD traits.  Here is a summary as described in a book on couple's counseling when one of the partners has BPD:

Quote
Based on cluster analyses of BPD criteria, Hurt et al. ( 23) described three clusters of criteria that could be used to define different groups of patients who would need different treatment strategies and would form different therapeutic or healing relationships. The three clusters proposed by Hurt et al. ( 23) provided our framework for deciding on the appropriateness of couple therapy and the approach to utilize. The rest of the paper will be devoted to describing the three-level hierarchy and to using a case to illustrate the type of patient that falls within each level.

Impulsive Cluster

Hurt et al. ( 23) characterized an impulsive cluster of patients who evidenced a history of impulsive, self-destructive, and treatment-threatening behaviors. The borderline patient with high levels of impulsivity is not a good candidate for couple therapy. Highly impulsive individuals tend not to be able to sustain marital relationships. However, at moderate levels of impulsivity, the marital relationship can help temper the impulsivity. Our research data indicated that the level of impulsivity is a strong predictor of the course of BPD personality disorder ( 12). Not only does past impulsivity predict future impulsivity; it also predicts the levels of affective and psychotic symptoms over time. Therefore, high levels of impulsivity that lead to serious consequences or a wide array of impulsive behaviors are indications for individual rather than couple therapy. Suicide threats and attempts can be problematic if they are frequent or of high lethality. In our experience, the borderline patient in a relationship tends to demonstrate less suicidality. As these behaviors or threats are often a form of communication, they can be appropriately dealt with in couple therapy and alternative forms of communication can be learned. Substance abuse can be a significant problem; however, if the therapist is. able to integrate substance-abuse therapy with couple therapy, significant progress may result.

Impulsive borderline patients will give a history of numerous therapy contacts that were terminated before completion, and therefore, they present a challenge to any therapist. These patients may be difficult to engage, and engaging them will be a central part of therapy. However, if they do not characterize the previous therapy experiences as very negative, these patients may be accessible for further work. Often the borderline patient goes through a series of brief therapies; however, the cumulative impact of the therapies may lead to important changes. Gunderson ( 2) observed this phenomenon and likened it to a "bucket brigade" in that each bucket of water in succession, that is each brief therapy, was a factor in decreasing the raging or impulsive fires within the borderline individual.

Individual or group therapy, utilizing cognitive behavioral approaches, should be the first line of treatment to decrease the impulsivity and develop alternate coping strategies. In the case example, we illustrate that such a couple should be referred for individual help. However, part of the intervention can be directed at developing a safety plan for each of the spouses while individual therapy works on dampening the level of impulsivity.

Identity Cluster

These borderline individuals demonstrate chronic feelings of emptiness, identity disturbance and intolerance of being alone. Hurt et al.( 23) describe how these individuals need someone as they rely on external input for self-definition. The borderline individual with identity-cluster characteristics joins with a spouse with similar identity features of the borderline disorder. They enter relationships that allow them to develop some stability of identity as a result of their enmeshed attachment to their partner. Paradoxically, although this couple may experience crises, they will have a strong commitment and attachment to the relationship. The development of mutually gratifying projective identifications between the partners leads to a "closed system" ( 24). Akhtar ( 21) characterizes the relationship as having "pathological homeostasis." However, couples with these features are the best candidates for couple therapy. The acute attachment crises can be stabilized in therapy and once a therapeutic alliance is established, sustainable change can be achieved by modifying the internal working models and reworking the projective identifications.

Affective Cluster

Borderline individuals in the affective cluster demonstrate intense, inappropriate anger, instability of affect, and dramatic and stormy relationships. Although, relationships will be intense, often a healthy spouse can serve as a receptacle for the emotional outpouring. The healthy spouse will tolerate the confusion and anger, however, only if the borderline partner meets some of his/her needs. Couples in which one spouse has BPD and the other demonstrates relative psychological health require another specific couple intervention. In our experience, a psychoeducational model for the healthier spouse can stabilize and maintain the relationship. Gunderson et al. ( 3) have recently described a psychoeducational approach for family members of borderline patients that would be applicable for the well-functioning spouse.

Here's the link to the above information, but I don't know how accepted this information is so beware! 

https://www.homestudycredit.com/courses/contentTF/secTF21.html

I do believe the clusters described above have been created by well-credentialed professionals in the field of borderline personality disorder. 

I could not find any information equating the term "clusters" with high or low functioning.
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MxMan
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« Reply #2 on: June 17, 2009, 03:14:33 PM »

I could not find any information equating the term "clusters" with high or low functioning.

thanks much. i may have just misinterpreted something i was told or read somewhere. at this point i'm feeling as if i've done so much reading i lose track of where the info came form.
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aster

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« Reply #3 on: January 15, 2010, 09:26:31 AM »

i wasn't sure where to post this:

yesterday i ran across something on this site, not sure if it was a thread on a board or an article or what...but it talked about the different clusters of BPD. a, b, and c. it listed traits of them and said 99% of folks online where dealing with cluster b type.

anyone know what i am talking about? if so where is it?

thanks:)
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aster

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« Reply #4 on: January 15, 2010, 10:49:28 AM »

hello:)

let me try it this way:

does anyone know if there is a place on this site that lists the different types of BPD?

thank you!

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« Reply #5 on: January 15, 2010, 11:35:53 AM »

My guess is that you read this;

https://bpdfamily.com/message_board/index.php?topic=64485.msg680532#msg680532

This may be more helpful overall:

https://bpdfamily.com/bpdresources/nk_a102.htm

CONSTELLATIONS The clinical definition of Borderline Personality Disorder is very broad. It is defined in terms of nine criteria of which 5 or more are indicative of the disorder. This translates to 256 clusters of criteria, or constellations as they are known, any one of which is diagnostic for BPD.

Within these constellations, there are high functioning borderlines that operate well in society and whose disorder is not very obvious to new acquaintances or the casual observer. Also within these constellations are the low functioning borderlines who are more apparent as they can't hold jobs, or they self-harm (cutting).

Suicidal attempts/ideation and anorexia/bulimia are some of the most serious aspects of this disorder - yet, many with the disorder do not exhibit either.

CLUSTERS: The DSM-IV lists ten personality disorders, grouped into three clusters in Axis II. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled Personality disorder not otherwise specified.

This is a background on the DSM clusters:

Cluster A (odd or eccentric disorders)

  • Paranoid personality disorder (DSM-IV code 301.0): characterized by irrational suspicions and mistrust of others.


  • Schizoid personality disorder (DSM-IV code 301.20): lack of interest in social relationships, seeing no point in sharing time with others, misanthropy, introspection.


  • Schizotypal personality disorder (DSM-IV code 301.22): characterized by odd behavior or thinking.


Cluster B (dramatic, emotional or erratic disorders)

  • Antisocial personality disorder (DSM-IV code 301.7): a pervasive disregard for the law and the rights of others.


  • Borderline personality disorder (DSM-IV code 301.83): extreme "black and white" thinking, instability in relationships, self-image, identity and behavior.


  • Histrionic personality disorder (DSM-IV code 301.50): pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions.


  • Narcissistic personality disorder (DSM-IV code 301.81): a pervasive pattern of grandiosity, need for admiration, and a lack of empathy.


Cluster C (anxious or fearful disorders)

  • Avoidant personality disorder (DSM-IV code 301.82): social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction.

  • Dependent personality disorder (DSM-IV code 301.6): pervasive psychological dependence on other people.


  • Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder) (DSM-IV code 301.4): characterized by rigid conformity to rules, moral codes and excessive orderliness.
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aster

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« Reply #6 on: January 17, 2010, 10:24:06 AM »

A-HA! i found it:):

Cluster Two: The Invisible BPs

Unlike Cluster One BPs, they:

1.   Denial is their primary characteristic. They disavow having any problems and see no need to change. Relationship difficulties, they say, are everyone else’s fault. If family members suggests they may have BPD, they almost always accuse the other person of having it instead. (This is why I strongly advise non-BPs to leave this disclosure to a trained professional)

2.   They cope with their pain by raging outward, blaming and accusing family members for real or imagined problems (“acting out”)

3.   They refuse to seek help from the mental health system unless someone threatens to end the relationship. If they do go, they usually don’t intend to work on their own issues. In couples therapy, their goal is often to convince the therapist that they are being victimized

4.   They may hide their low self-esteem behind a brash, confident pose that hides their inner turmoil. They usually function quite well at work and only display aggressive behavior toward those close to them (high functioning). But the black hole in the gut and their intense self-loathing are still there. It’s just buried deeper

5.   If they also have other mental disorders, they’re ones that also allow for high functioning such as Narcissistic Personality Disorder (NPD) or Antisocial Personality Disorder (APD). (These mostly appear concurrently in men—especially APD)

6.   Family members’ greatest challenges include coping with verbal abuse, protecting children, trying to get their family member to seel treatment, and maintaining their self-esteem and sense of reality. Partners, especially, are in relationships with Cluster Two BPs.       

Of the 50,000 non-BPs who have rotated through the online Community in the past decade, about 99% are in a relationship with a Cluster 2 BP. For parents, this figure is lower (or their loved one falls in Cluster 3, a combination of both).
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« Reply #7 on: January 17, 2010, 11:39:45 AM »

This is the reference you are referring to:

https://bpdfamily.com/message_board/index.php?topic=63511.0

Sometimes the terminology gets confusing as much of it is still developing.

Clusters usually refers to DSM-IV categories.

Constellations usually refers to groupings of symptoms.

Subtypes usually refers to the constellations of symptoms that have been characterized or studies specifically. Subtypes are discussed in this article: www.ncbi.nlm.nih.gov/pubmed/1452761

Randy's "BPD clusters" are informal observations (non scientific) that she made when writing her new self help book.

Hope that helps.
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Randi Kreger
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« Reply #8 on: February 03, 2010, 11:27:26 AM »

I wanted to clarify something I've posted about before and reconsidered before finishing Essential Family Guide. I made the "cluster" post (my real world observations) BEFORE the Esential Family Guide was published. "Cluster" was the wrong word to use because the DSM divides personality disorders into clusters, see below. (Please note these clusters are NOT divisions of BPD, but divisions of all the personality disorders. ) BPD is "cluster B".Cluster A (odd or eccentric disorders)Paranoid personality disorder (DSM-IV code 301.0): characterized by irrational suspicions and mistrust of others. Schizoid personality disorder (DSM-IV code 301.20): lack of interest in social relationships, seeing no point in sharing time with others, misanthropy, introspection. Schizotypal personality disorder (DSM-IV code 301.22): characterized by odd behavior or thinking. [ Cluster B (dramatic, emotional or erratic disorders)Antisocial personality disorder (DSM-IV code 301.7): a pervasive disregard for the law and the rights of others. Borderline personality disorder (DSM-IV code 301.83): extreme "black and white" thinking, instability in relationships, self-image, identity and behavior. Histrionic personality disorder (DSM-IV code 301.50): pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions. Narcissistic personality disorder (DSM-IV code 301.81): a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Cluster C (anxious or fearful disorders)Avoidant personality disorder (DSM-IV code 301.82): social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. Dependent personality disorder (DSM-IV code 301.6): pervasive psychological dependence on other people. Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder) (DSM-IV code 301.4): characterized by rigid conformity to rules, moral codes and excessive orderliness. What I eventually developed went beyond the old SWOE categories of higher functioning/acting out vs lower-functioning/acting in. Instead, I developed a matrix of the following (from the book):People with the same BPD diagnosis can act quite differently. Researchers have been trying to some categorize them for decades.  One "real world,” subjective way is to divide them into three categories:   1. Lower-Functioning/"Conventional"2. Higher-Functioning/"Invisible"3. Combination (a mixture of both styles No category is "better” than the other. Each category has four dimensions (the matrix I was referring to) with these variables:1. Coping techniques (the acting in and out portion)2. Co-occurring mental health issues (often narcissistic PD vs bipolar and eating disorders, things needing intensive help)3. Functioning 4. Impact on family members (having a BP family member in treatment for self-harm is very different than a high conflict divorce with a treatment resistent BP)So anyway, I put this all in a chart, which you can see right now at www.67.227.133.66/abc/subcategories-of-people-with-BPD/But this link will change. Skip, if you could reproduce this chat somewhere on your site that would be magical. It will take awhile to undo what I put in SWOE.
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eniale
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« Reply #9 on: May 16, 2013, 12:34:23 PM »

Today my therapist talked about "clusters", meaning a person with a personality disorder can have more than one disorder, possibly several.  In my own case, the person shows symptoms of BPD (problems with interpersonal relationships, wide mood swings, fear of abandonment) and also symptoms of narcissist personality disorder -- highly critical of me, very sensitive to any imagined slights against himself.  In addition, he is commitment phobic -- these folks (both men and women) will "sabotage, destroy or run away from any relationship that shows a solid future."  They never leave when things are bad, only when they are good.  They are terrified to the point of phobia of commitment.  Now, combine that with a BPD's fear of abandonment, and you have a terribly confused, CONFLICTED person.  A person who is commitment phobic wants love, but runs from commitment; a BPD person fears abandonment.  No wonder such people can literally drive you nuts. 
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