Understanding Relational Dysfunction in Borderline, Narcissistic, and Antisocial Personality Disorders: Clinical Considerations, Presentation of Three Case Studies, and Implications for Therapeutic Intervention

Personality disorders are a class of mental disorders involving enduring maladaptive patterns of behaving, thinking, and feeling which profoundly affect functioning, inner experience, and relationships. This work focuses on three Cluster B personality disorders (PDs) (Borderline, Narcissistic, and Antisocial PDs), specifically illustrating how relational dysfunction manifests in each condition. People with Borderline Personality Disorder (BPD) experience pervasive instability in mood, behavior, self-image, and interpersonal patterns. In relationships, they tend to alternate between extremes of over-idealization and devaluation. Intense fear of abandonment, fluctuating affect, inappropriate anger, and black/white thinking deeply influence how they navigate personal relationships, which are often unstable, chaotic, dramatic, and ultimately destructive. They have a fundamental incapacity to self-soothe the explosive emotional states they experience as they oscillate between fears of engulfment and abandonment. This leads to unpredictable, harmful, impulsive behavior and chronic feelings of insecurity, worthlessness, shame, and emptiness. Their relationships are explosive, marked by hostility/contempt for self and partner alternating with bottomless neediness. Manipulation, lying, blaming, raging, and “push-pull” patterns are common features. Individuals with Narcissistic Personality Disorder (NPD) exhibit a long-standing pattern of grandiosity and lack of empathy. They have an exaggerated sense of self-importance, are self-absorbed, feel entitled, and tend to seek attention. Scarcely concerned with others’ feelings, they can be both charming and exploitative. Oversensitive to criticism, they are prone to overt or covert rage, gaslighting and self-referential thinking. Antisocial Personality Disorder (APD) is marked by impulsive, callous, and irresponsible behavior with no regard to be manipulative, parasitic, aggressive, cold, cruel, and self-serving. In addition to analyzing relational dysfunction in each disorder, this paper presents three relational case studies (BPD-couple, NPD-parent/child, APD-various relations) and discusses treatment implications.