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Asghari B, Sabahi P, Hajitabar Firouzjaei N. Discriminant Analysis of Cluster B Personality Disorders Based on The Type of Defense Mechanism and Empathy. TB 2026; 24 (5) :50-59
URL: http://tbj.ssu.ac.ir/article-1-3822-en.html
URL: http://tbj.ssu.ac.ir/article-1-3822-en.html
Semnan University , babakasghari723@gmail.com
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Discriminant Analysis of Cluster B Personality Disorders Based on The Type of Defense Mechanism and Empathy
Babak Asghari(M.A.)¹, Parviz Sabahi(Ph.D.)², Nima Hajitabar Firouzjaei(M.A.)³
1.M.A. in Clinical Psychology, Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran. Email: asgharibabak723@gmail.com Tel: 09020292562
2.Associate Professor, Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran.
3.M.A. in Clinical Psychology, Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
Introduction: Cluster B personality disorders (antisocial, borderline, narcissistic, and histrionic personality disorders) are often difficult to differentiate because of substantial clinical overlap. Drawing on a psychodynamic and social–cognitive framework that incorporates emotion regulation, unconscious defensive processes, and interpersonal functioning, this study examined whether defense mechanisms and empathy dimensions could differentiate these diagnostic groups.
Methods: This cross-sectional study was conducted in 2024 and included 100 participants, comprising 80 patients with Cluster B personality disorders (20 individuals in each of the borderline, antisocial, narcissistic, and histrionic personality disorder groups) and 20 healthy controls. Data were collected using the Defense Style Questionnaire (DSQ) and the Davis Interpersonal Reactivity Index (IRI). The data were analyzed using multivariate discriminant analysis in SPSS version 26.
Results: Individuals with antisocial and narcissistic personality disorders reported greater use of immature defense mechanisms and lower levels of empathic concern than the other groups. Participants with borderline personality disorder reported higher levels of personal distress. The discriminant model correctly classified 95% of individuals with antisocial personality disorder, 90% of healthy controls, 75% of individuals with narcissistic personality disorder, 65% of individuals with borderline personality disorder, and 50% of individuals with histrionic personality disorder.
Conclusion: The findings suggest that patterns of defense mechanisms and empathy dimensions may help distinguish among Cluster B personality disorders. However, discriminative performance varied across diagnostic subgroups, and the findings should be interpreted in light of the cross-sectional design and the limitations of the classification model.
Keywords: Cluster B Personality Disorders, Defense Mechanisms, Empathy, Discriminant Analysis
Conflict of interest: The authors declared no conflict of interest.
References
1-Leichsenring F, Fonagy P, Heim N & et al. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry. 2024;23(1):4..
2-Prout TA, Di Giuseppe M, Zilcha-Mano S & et al. Psychometric Properties of the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30): Internal Consistency, Validity and Factor Structure. Journal of personality assessment. 2022;104(6):833-43.
3-Lingiardi V, Madeddu F. Revisiting defense mechanisms in contemporary clinical practice: evidence and perspectives. Research in psychotherapy (Milano). 2025; 28.877
4-Raimondi G, Balsamo M, Ebisch SJ & et al. Measuring empathy: A meta-analytic factor analysis with structural equation models (MASEM) of the Interpersonal Reactivity Index (IRI). Journal of Psychopathology and Behavioral Assessment. 2023;45(4):952-63.
5-Blunden AG, Henry JD, Pilkington PD & et al. Early affective empathy, emotion contagion, and empathic concern in borderline personality disorder: A systematic review and meta-analysis. Journal of affective disorders. 2024:S0165-327 (24) 01447-2.
6-di Giacomo E, Andreini E, Lorusso O & et al. The dark side of empathy in narcissistic personality disorder. Frontiers in Psychiatry. 2023;14:1074558.
7-Galván-Suárez R, Ontiveros-Uribe MP, Chavez-León E. Psychometric Correlation of Personality Disorders Along With Defense Mechanisms in Mexican Individuals With Depressive and Anxious Disorders: A Cross-Sectional Study. Cureus. 2023;15(1):e33805.
8-Jurist J, Traynor JM, Murray GE & et al. Under and Overmentalizing in Personality Disorders: A Principal Component Analysis of Nonadaptive Personality and the Movie Assessment of Social Cognition. Psychopathology. 2025;58(3):160-72.
9-Di Caro AV, Cavallo J, Scalone A & et al. Textures of Personality: The Role of Attachment Insecurities and Defense Mechanisms in Maladaptive Personality Functioning. Behavioral Sciences. 2025;15(9):1154.
10-Scaini CR, Vieira IS, Machado R & et al. Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder. Brazilian Journal of Psychiatry. 2022;44(5):469.
11-Di Giuseppe M, Buglio GL, Cerasti E & et al. Defense mechanisms in individuals with depressive and anxiety symptoms: a network analysis. Frontiers in psychology. 2024;15:1465164.
12-Di Giuseppe M, Buglio GL, Cerasti E & et al. Defense mechanisms in individuals with depressive and anxiety symptoms: a network analysis. Frontiers in Psychology. 2024;15:1465164.
13-Dinsdale N, Crespi BJ. The borderline empathy paradox: evidence and conceptual models for empathic enhancements in borderline personality disorder. Journal of personality disorders. 2013;27(2):172-95.
14-Fertuck EA, Stanley B, Kleshchova O & et al. Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder. Biological psychiatry Cognitive neuroscience and neuroimaging. 2023;8(6):651-9.
15-Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personality disorders. 2014;5(3):323-33.
16-Campos C, Pasion R, Azeredo A & et al. Refining the link between psychopathy, antisocial behavior, and empathy: A meta-analytical approach across different conceptual frameworks. Clinical psychology review. 2022;94:102145.
17-Ritter K, Dziobek I, Preissler S & et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry research. 2011;187(1-2):241-7.
18-Sharp C, Wall K. DSM-5 Level of Personality Functioning: Refocusing Personality Disorder on What It Means to Be Human. Annual review of clinical psychology. 2021;17:313-37.
19- Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics. Boston, MA: pearson; 2007 Mar 3.
Babak Asghari(M.A.)¹, Parviz Sabahi(Ph.D.)², Nima Hajitabar Firouzjaei(M.A.)³
1.M.A. in Clinical Psychology, Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran. Email: asgharibabak723@gmail.com Tel: 09020292562
2.Associate Professor, Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran.
3.M.A. in Clinical Psychology, Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
Introduction: Cluster B personality disorders (antisocial, borderline, narcissistic, and histrionic personality disorders) are often difficult to differentiate because of substantial clinical overlap. Drawing on a psychodynamic and social–cognitive framework that incorporates emotion regulation, unconscious defensive processes, and interpersonal functioning, this study examined whether defense mechanisms and empathy dimensions could differentiate these diagnostic groups.
Methods: This cross-sectional study was conducted in 2024 and included 100 participants, comprising 80 patients with Cluster B personality disorders (20 individuals in each of the borderline, antisocial, narcissistic, and histrionic personality disorder groups) and 20 healthy controls. Data were collected using the Defense Style Questionnaire (DSQ) and the Davis Interpersonal Reactivity Index (IRI). The data were analyzed using multivariate discriminant analysis in SPSS version 26.
Results: Individuals with antisocial and narcissistic personality disorders reported greater use of immature defense mechanisms and lower levels of empathic concern than the other groups. Participants with borderline personality disorder reported higher levels of personal distress. The discriminant model correctly classified 95% of individuals with antisocial personality disorder, 90% of healthy controls, 75% of individuals with narcissistic personality disorder, 65% of individuals with borderline personality disorder, and 50% of individuals with histrionic personality disorder.
Conclusion: The findings suggest that patterns of defense mechanisms and empathy dimensions may help distinguish among Cluster B personality disorders. However, discriminative performance varied across diagnostic subgroups, and the findings should be interpreted in light of the cross-sectional design and the limitations of the classification model.
Keywords: Cluster B Personality Disorders, Defense Mechanisms, Empathy, Discriminant Analysis
Conflict of interest: The authors declared no conflict of interest.
References
1-Leichsenring F, Fonagy P, Heim N & et al. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry. 2024;23(1):4..
2-Prout TA, Di Giuseppe M, Zilcha-Mano S & et al. Psychometric Properties of the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30): Internal Consistency, Validity and Factor Structure. Journal of personality assessment. 2022;104(6):833-43.
3-Lingiardi V, Madeddu F. Revisiting defense mechanisms in contemporary clinical practice: evidence and perspectives. Research in psychotherapy (Milano). 2025; 28.877
4-Raimondi G, Balsamo M, Ebisch SJ & et al. Measuring empathy: A meta-analytic factor analysis with structural equation models (MASEM) of the Interpersonal Reactivity Index (IRI). Journal of Psychopathology and Behavioral Assessment. 2023;45(4):952-63.
5-Blunden AG, Henry JD, Pilkington PD & et al. Early affective empathy, emotion contagion, and empathic concern in borderline personality disorder: A systematic review and meta-analysis. Journal of affective disorders. 2024:S0165-327 (24) 01447-2.
6-di Giacomo E, Andreini E, Lorusso O & et al. The dark side of empathy in narcissistic personality disorder. Frontiers in Psychiatry. 2023;14:1074558.
7-Galván-Suárez R, Ontiveros-Uribe MP, Chavez-León E. Psychometric Correlation of Personality Disorders Along With Defense Mechanisms in Mexican Individuals With Depressive and Anxious Disorders: A Cross-Sectional Study. Cureus. 2023;15(1):e33805.
8-Jurist J, Traynor JM, Murray GE & et al. Under and Overmentalizing in Personality Disorders: A Principal Component Analysis of Nonadaptive Personality and the Movie Assessment of Social Cognition. Psychopathology. 2025;58(3):160-72.
9-Di Caro AV, Cavallo J, Scalone A & et al. Textures of Personality: The Role of Attachment Insecurities and Defense Mechanisms in Maladaptive Personality Functioning. Behavioral Sciences. 2025;15(9):1154.
10-Scaini CR, Vieira IS, Machado R & et al. Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder. Brazilian Journal of Psychiatry. 2022;44(5):469.
11-Di Giuseppe M, Buglio GL, Cerasti E & et al. Defense mechanisms in individuals with depressive and anxiety symptoms: a network analysis. Frontiers in psychology. 2024;15:1465164.
12-Di Giuseppe M, Buglio GL, Cerasti E & et al. Defense mechanisms in individuals with depressive and anxiety symptoms: a network analysis. Frontiers in Psychology. 2024;15:1465164.
13-Dinsdale N, Crespi BJ. The borderline empathy paradox: evidence and conceptual models for empathic enhancements in borderline personality disorder. Journal of personality disorders. 2013;27(2):172-95.
14-Fertuck EA, Stanley B, Kleshchova O & et al. Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder. Biological psychiatry Cognitive neuroscience and neuroimaging. 2023;8(6):651-9.
15-Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personality disorders. 2014;5(3):323-33.
16-Campos C, Pasion R, Azeredo A & et al. Refining the link between psychopathy, antisocial behavior, and empathy: A meta-analytical approach across different conceptual frameworks. Clinical psychology review. 2022;94:102145.
17-Ritter K, Dziobek I, Preissler S & et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry research. 2011;187(1-2):241-7.
18-Sharp C, Wall K. DSM-5 Level of Personality Functioning: Refocusing Personality Disorder on What It Means to Be Human. Annual review of clinical psychology. 2021;17:313-37.
19- Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics. Boston, MA: pearson; 2007 Mar 3.
Type of Study: Research |
Subject:
Psychology
Received: 2025/08/2 | Accepted: 2025/10/14 | Published: 2025/11/19
Received: 2025/08/2 | Accepted: 2025/10/14 | Published: 2025/11/19
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