The elimination of NPD from the DSM would be a disaster

narcissus

Apparently, the removal of Narcissistic Personality Disorder (DSM-V code 301.81; ICD-10 code F60.81) from the Diagnostic and Statistical Manual of Mental Disorders is still being considered.   Sam Vaknin talks about it in this video.

I think its removal would be disastrous. It already scares me that narcissism seems to be increasingly regarded as an advantage in today’s winner-take-all society and that we even have a potential US President who is a poster boy for malignant NPD. Trump has even been given the NPD label by many mental health professionals. Yet he still remains popular and is a serious contender for our next President.

But narcissism (not the healthy, but the pathological type) is definitely not a positive thing. Narcissists are actually miserable people even if they become successful (and many of them do not). These are people without a real sense of self, who have constructed a false one to compensate and must feed off others like vampires to keep their false self intact. They do others a lot of damage, even if they think they don’t have a problem. Under the facade, these are people who have a vast well of emptiness inside and if the false self is removed through loss of narcissistic supply, will become deeply depressed, possibly psychotic, and even suicidal. NPD is a serious mental illness, but I think people tend to forget that, because on the surface, people with this disorder can seem so functional. SEEM is the operating word here.

Many self-help books, especially those that tell you how to be successful, encourage you to develop narcissistic traits. I think these books are dangerous, not only because they encourage people to become narcissists, but also because they have caused a shift in thinking about NPD to the point that many no longer consider it a mental illness and in fact think of it as something to strive for. We need to stop pretending narcissism isn’t a problem. More attention needs to be paid not only to the damage narcissists cause others, but also to the internal world of the NPD, which is a painful and bleak one. NPD is a serious mental illness, not a “personality type.” Its removal from the DSM would cause untold damage to the world.

We also need more mental health specialists who are actually trained to treat people with NPD. I think part of the reason why it’s under consideration for removal is because most therapists don’t want to treat people with NPD. If you have the diagnosis, you are shown the door. They don’t want to deal with you and assume you are incurable. Hence, there are more narcissists walking around doing damage to themselves and others than ever before. I don’t think the non-malignant type of narcissist is as incurable as people think; it’s just because it isn’t an easy disorder to treat and therapists don’t want to be bothered working with people who have it. Old-school psychiatrists and psychologists such as Kohut, Kernberg, Masterson, and Lowen treated people with NPD successfully in their practices, but we seem to have forgotten that and just assume it’s incurable and worse, that it’s not even a mental illness but a personality type. This needs to change!

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Personality Disorders: The clusters A, B & C

This deserved to be reblogged.

Almost 10% of the United States population is personality disordered, with Cluster B being the rarest  (which surprised me).

It looks like Histrionic (Cluster B), Schizoid and Paranoid (Cluster A) and Dependent (Cluster C) are all slated to possibly be removed from the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).   That would leave only 6 personality disorders.  I don’t think that’s enough.  Schizoid Personality Disorder in particular doesn’t seem like it could be merged with anything else.  Perhaps they’re planning on adding  replacement categories.

living in stigma

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Question about DSM billing codes

I know these codes are only used for billing purposes, but I always wondered why they are numbered/ordered the way they are. Can anyone shed some light on why the decimal digits skip so many places and why the PD’s are ordered this way? For example why aren’t the groups (Cluster A, B and C) grouped together–Avoidant PD (Cluster C) is between Narcissistic (Cluster B) and Borderline (Cluster B). That doesn’t make any sense to me. The same thing with Dependent (Cluster C) being between Antisocial and Histrionic (both Cluster B). Are these numbers just assigned randomly or is there a reason? Maybe a psychiatrist or medical billing expert here can answer this.
I know it doesn’t matter but I’ve always been curious about this.

301.20 Schizoid
Personality Disorder

301.22 Schizotypal
Personality Disorder

301.4 Obsessive-Compulsive
Personality Disorder

301.50 Histrionic
Personality Disorder

301.6 Dependent
Personality Disorder

301.7 Antisocial
Personality Disorder

301.81 Narcissistic
Personality Disorder

301.82 Avoidant
Personality Disorder

301.83 Borderline
Personality Disorder

301.9 Personality
Disorder NOS

Is BPD a real disorder or should it be eliminated as a diagnosis?

bpd_treatments
The myriad ways experts “see” borderline personality disorder. (click to enlarge)

There’s a great deal of confusion and disagreement in the professional literature about the nature of Borderline Personality Disorder. The blogger BPDTransformation (whose blog is excellent if sometimes a little on the scholarly side), who was cured of BPD, thinks the label should simply be done away with and that BPD doesn’t really exist at all–the label being merely a placeholder for a group of symptoms that are widely variable, and that experts can’t even agree on. He believes BPD is categorized as a Cluster B (dramatic/emotional) disorder only because mental health experts can’t decide where else to put it.

The stigma of BPD as a Cluster B disorder.

borderline_stigma

The problem with labeling BPD in the Cluster B category of personality disorders is the stigma that classification carries–that people with BPD (like those with NPD or ASPD) are evil, untrustworthy, selfishly manipulative, grandiose, dishonest, lack empathy, and really no better than people with malignant narcissism or even ASPD. (It sure doesn’t help any that an obviously sociopathic criminal like Jodi Arias has a diagnosis of BPD, when she more likely fits the criteria for high spectrum [malignant] narcissism, at the very least.) Insurance companies assume anyone with a Cluster B disorder is incurable, and therefore will not pay claims where a person is diagnosed with a Cluster B disorder. This is very damaging to those of us with BPD who have either successfully learned to modify and control our symptoms–or have even been cured, as BPDTransformation has been. People continue to believe we are lying about the success of the treatments or therapy we have received. Borderlines who have never been treated may find it difficult to find a therapist willing to work with them.

BPD is far more amenable to deep insight therapy than NPD (which is extremely difficult to cure but not impossible for non-malignants) and light years away from a disorder like ASPD (antisocial personality disorder), which can probably not be cured. Because the symptoms of BPD are so disagreeable to the sufferer (and not just to others), it is common for borderlines to present themselves for therapy, unlike people with NPD or ASPD. The vast majority or borderlines are unhappy with themselves and the way their lives have turned out. But many therapists won’t work with borderlines (other than with behavior modification treatments like DBT) because they know insurance companies will not pay such a claim.

What are borderlines on the border of, anyway?

tightrope

The name “borderline” itself is confusing. What are borderlines on the border of anyway? Neurosis and psychosis? A normal sense of self and Narcissism? Mexico and the United States?

The experts are all over the map on this, with some recent theories stating that BPD is actually a less adaptive, more ego-dystonic form of narcissism. But the original term “borderline” actually referred to the belief that the disorder was on the “border” between psychosis and neurosis:

[…]It is called borderline because it was originally thought that people were on the ‘border’ of psychosis and neurosis. BPD is also sometimes called Emotionally Unstable Personality Disorder (Borderline type). Approximately 75% of people given this diagnosis are women and 50% have experienced physical and/or sexual abuse.

Because BPD is more commonly diagnosed in women than in men, it’s also been referred to as the female form of narcissistic personality disorder (which is more commonly diagnosed in men than in women).

Psychotic, neurotic, both, or none of the above?

bpd (1)
Credit: Judgybitch/Dzhokhar Tsarnaev

The reason why BPD is sometimes regarded as the midpoint between neuroses (mild and easily treated anxiety or depressive disorders) and psychoses (disorders where the victim is out of touch with reality, such as schizophrenia and the manic-depressive form of bipolar disorder) is because people with BPD can, when emotionally upset, display psychotic or delusional symptoms such as splitting (black and white thinking), dissociation (feelings of unreality either about the self or the environment), magical thinking, severe paranoia, delusions of grandeur or persecution, and sometimes even hallucinations and disorganized speech or thought. However, for a borderline, these psychotic symptoms don’t last and as soon as the emotional crisis has passed, the borderline’s “sanity” normally returns. Antipsychotic medication can be helpful, but isn’t always necessary, as it usually is for a truly psychotic individual.

Others have speculated that BPD is really a severe form of PTSD or C-PTSD caused by trauma, and should be treated the same way as PTSD. Personally, I think it’s more long-standing than a reactive disorder like PTSD and is a true personality disorder, but it does make sense that BPD may have originally begun as a form of PTSD at an early age, often due to sexual abuse.

There is so much confusion and contradiction in the literature about BPD that I’m slowly coming around to BPDTransformation’s way of thinking that it should possibly be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) until mental health professionals can get a better handle on what BPD actually is, and whether it’s even a valid diagnosis (or simply a group of symptoms that could indicate several other disorders). There should at least be more agreement among the professionals at any rate.

6 Signs of Narcissism You May Not Know About (Psychology Today)

Interesting article about the lesser-known indicators of narcissism from Psychology Today. Contrary to popular opinion, narcissists do not love themselves, only their image.
I agree with Dr. Seltzer that these six traits should be added to the official diagnostic criteria for NPD.

6 Signs of Narcissism You May Not Know About: How can you recognize the fragility behind the narcissist’s grandiosity?
Post published by Leon F Seltzer Ph.D.

narc_lovers

The recently published 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) lists precisely the same nine criteria for narcissistic personality disorder (NPD) as did the previous version, published 19 years earlier. So these longstanding diagnostic yardsticks are by now quite familiar—not only to professionals but to interested laypeople as well. Because only the extreme, or “classic,” narcissist fits all of these criteria, DSM specifies that an individual need meet only five of them (barely more than half) to warrant this unflattering label.

As a starting point, I’ll reiterate these selected criteria—before, that is, adding six important ones of my own, which either complement or extend these “official” yardsticks. My particular measures for identifying pathological narcissists are based not only on my exposure to the voluminous writings on this character disorder, but also on 30+ years of clinical experience. This experience includes doing personal, couples, and family counseling with such troublesome individuals. But it also involves working independently with those involved with narcissists—whether their distressed children, spouses, parents, friends, or business associates—who repeatedly express enormous frustration in trying to cope with them.

To begin, however, here are DSM’s requirements (link is external) (slightly condensed, and with minor bracketed amendments) for “earning” the unenviable diagnosis of Narcissistic Personality Disorder:

1. Has a grandiose sense of self-importance.
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration [regularly fishes for compliments, and is highly susceptible to flattery].
5. Has a sense of entitlement.
6. Is interpersonally exploitative.
7. Lacks empathy: is unwilling [or, I would add, unable] to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty [rude and abusive] behaviors or attitudes.

So what’s left out here? Actually, as regards identifying descriptors, quite a bit. And I’ve no doubt that other therapists could add further to the six additional characteristics I’ll provide here—features that, although regrettably minimized or omitted from DSM, I‘ve routinely seen displayed by the many dysfunctional narcissists I’ve worked with. So, to enumerate them, such individuals:

1. Are highly reactive to criticism.

grinch

Or anything they assume or interpret as negatively evaluating their personality or performance. This is why if they’re asked a question that might oblige them to admit some vulnerability, deficiency, or culpability, they’re apt to falsify the evidence (i.e., lie—yet without really acknowledging such prevarication to themselves), hastily change the subject, or respond as though they’d been asked something entirely different. Earlier for Psychology Today I wrote a post highlighting this supercharged sensitivity called “The Narcissist’s Dilemma: They Can Dish It Out, But . . . ”. And this aspect of their disturbance underscores that their ego—oversized, or rather artificially “inflated”—can hardly be viewed as strong or resilient. On the contrary, it’s very easily punctured. (And note here another related piece of mine, “Our Egos: Do They Need Strengthening—or Shrinking?”). What these characteristics suggest is that, at bottom and despite all their egotistic grandiosity, they…

2. Have low self-esteem.

narcissists_hate_themselves

This facet of their psyche is complicated, because superficially their self-regard would appear to be higher and more assured than just about anyone else’s. Additionally, given their customary “drivenness,” it’s not uncommon for them to rise to positions of power and influence, as well as amass a fortune (and see here my post “Narcissism: Why It’s So Rampant in Politics”). But if we examine what’s beneath the surface of such elevated social, political, or economic stature—or their accomplishments generally—what typically can be inferred is a degree of insecurity vastly beyond anything they might be willing to avow.

That is, in various ways they’re constantly driven to prove themselves, both to others and to their not-so-confident “inner child” self. This is the self-doubting, recessive part of their being that, though well hidden from sight, is nonetheless afflicted with feelings and fears of inferiority. Inasmuch as their elaborate defense system effectively wards off their having to face what their bravado masks, they’re highly skilled at exhibiting, or “posturing,” exceptionally high self-esteem. But their deeper insecurities are yet discernible in their so often fishing for compliments and their penchant for bragging and boasting about their (frequently exaggerated) achievements. That is, they’re experts at complimenting themselves! And when—despite all their self-aggrandizement— others are critical of them, they…

3. Can be inordinately self-righteous and defensive.

right_wrong

Needing so much to protect their overblown but fragile ego, their ever-vigilant defense system can be extraordinarily easy to set off. I’ve already mentioned how reactive they typically are to criticism, but in fact anything said or done that they perceive as questioning their competence can activate their robust self-protective mechanisms. Which is why so many non-narcissists I’ve worked with have shared how difficult it is to get through to them in situations of conflict. For in challenging circumstances it’s almost as though their very survival depends on being right or justified, whereas flat out (or humbly) admitting a mistake—or, for that matter, uttering the words “I’m sorry” for some transgression—seem difficult to impossible for them.

Further, their “my way or the highway” attitude in decision-making—their stubborn.competitive insistence that their point of view prevail—betrays (even as it endeavors to conceal) their underlying doubts about not being good, strong, or smart enough. And the more their pretentious, privileged, exaggeratedly puffed-up self-image feels endangered by another’s position, the more likely they are to…

4. React to contrary viewpoints with anger or rage.

rage2

In fact, this characteristic is so common in narcissists that it’s always surprised me that DSM doesn’t specifically refer to it among its nine criteria. Repeatedly, writers have noted that angry outbursts are almost intrinsic to both narcissistic and borderline personality disorders. And although (unlike the borderline) it’s not particular fears of abandonment that bring out their so-called “narcissistic rage,” both personality disorders generally react with heated emotion when others bring their deepest insecurities too close to the surface.

The reason that feelings of anger and rage are so typically expressed by them is that in the moment they externalize the far more painful anxiety- or shame-related emotions hiding just beneath them. When they’re on the verge of feeling—or re-feeling—some hurt or humiliation from their past, their consequent rage conveniently “transfers” these unwanted feelings to another (and see here my PT post “Anger—How We Transfer Feelings of Guilt, Hurt, and Fear”).

The accompanying message that gets communicated through such antagonistic emotions is “I’m not bad (wrong, stupid, mean, etc.), you are!” Or, it could even be: “I’m not narcissistic, or borderline! You are!” (Or, in slightly milder version, “If I’m narcissistic, or borderline, then so are you!”) And if the mentally healthier individual has no clue as to what provoked their outburst in the first place, such a sudden explosion is likely to make them feel not only baffled but hurt, and maybe even frightened. But what cannot be overemphasized here is that narcissists…

5. Project onto others qualities, traits, and behaviors they can’t—or won’t—accept in themselves.

635223192958830312Projection2

Because they’re compelled from deep within to conceal deficits or weaknesses in their self-image, they habitually redirect any unfavorable appraisal of themselves outwards, unconsciously trusting that doing so will forever keep at bay their deepest suspicions about themselves. Getting anywhere close to being obliged to confront the darkness at their innermost core can be very scary, for in reality their emotional resources are woefully underdeveloped.

Broadly recognized as narcissists by their fundamental lack of self-insight, very few of them (depending, of course, on how far out they are on the narcissistic continuum) can achieve such interior knowledge. For in a variety of ways their rigid, unyielding defenses can be seen as more or less defining their whole personality. And that’s why one of the most reliable ways for them to feel good about themselves—and “safe” in the world they’re essentially so alienated from—is to invalidate, devalue, or denigrate others. So they’ll focus on others’ flaws (whether or not they really exist) rather than acknowledge, and come to terms with, their own. And in many curious ways this habit causes them to…

6. Have poor interpersonal boundaries.

space_invasion
Space invasion!

It’s been said about narcissists that they can’t tell where they end and the other person begins. Unconsciously viewing others as “extensions” of themselves, they regard them as existing primarily to serve their own needs—just as they routinely put their needs before everyone else’s (frequently, even their own children). Since others are regarded (if they’re regarded at all!) as what in the literature is often called “narcissistic supplies”—that is, existing chiefly to cater to their personal desires—they generally don’t think about others independently of how they might “use” them to their own advantage. Whatever narcissists seek to give themselves, they generally expect to get from others, too (which is yet another dimension of their famous—or infamous—sense of entitlement).

Even beyond this, their porous boundaries and unevenly developed interpersonal skills may prompt them to inappropriately dominate conversations and share with others intimate details about their life (though some narcissists, it should be noted, can display an extraordinary, however Machiavellian, social savvy). Such private information would probably focus on disclosing facts others would be apt to withhold. But having (at least consciously) much less of a sense of shame, they’re likely to share things they’ve said or done that most of us would be too embarrassed or humiliated to admit. Still, with an at times gross insensitivity to how others might react to their words, they’re likely to blurt out things, or even boast about them, that others can’t help but view as tasteless, demeaning, insulting, or otherwise offensive.

They might, for instance, share—and with considerable pride!—how they “chewed” someone out, and expect the other person to be impressed by their courage or cleverness, when in fact the listener may be appalled by their lack of kindness, tact, or restraint. Additionally, they may ask others questions that are far too personal or intimate—again unwittingly irritating or upsetting them. And such a situation can be particularly difficult for the other person if the narcissist is in a position of authority over them so that not responding could, practically, put them in some jeopardy.

To conclude, I can only hope that these additional characterizations of the pathological narcissist (vs. those with less pronounced narcissistic qualities) may be helpful in enabling you to identify them before their “malignancy” does a number on you. And if you’ve already been duped by their machinations or manipulations, perhaps this piece will be a “heads up” for you to prevent them from wreaking any further havoc in your life.

NOTE 1: I’d be remiss if I didn’t point out that the narcissism addressed here centers on its most maladaptive, or “toxic,” forms. Unlike DSM (the standard diagnostic reference tool for mental health professionals), the Psychodynamic Diagnostic Manual (link is external)(PDM, 2006)—respected, but much less well known than this official volume—explicitly notes that the disorder exists “along a continuum of severity, from the border with neurotic personality disorders to the more severely disturbed levels.” And additionally, that “toward the neurotic end [these] narcissistic individuals may be socially appropriate, personally successful, charming and, although somewhat deficient in the capacity for intimacy, reasonably well adapted to their family circumstances, work, and interests.”

Not every narcissist has NPD.

narcissist_continuum

As has been done with autism spectrum disorders, it’s becoming increasingly common to think of NPD as falling on a spectrum of narcissism, ranging from normal or healthy narcissism (which most of us have to some degree) all the way to psychopathy/sociopathy (variations of Antisocial Personality Disorder or ASPD) at the top. What we call malignant narcissism is actually NPD shading into ASPD.

Narcissism is a normal trait that helps us survive, but it becomes pathological when there is too much of it. On the narcissism spectrum, just below NPD and above healthy narcissism is a disorder called The Destructive Narcissistic Pattern, or DNP. It’s not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), but Dr. Nina Brown has written books about the disorder, which I haven’t read yet (I never even heard of DNP until a few days ago), but here is a description of DNP:

The destructive narcissistic pattern (DNP) is a term used to describe a constellation of characteristics generally associated with pathological narcissism, but which are fewer and less severe. Nonetheless, these characteristics negatively impact relationships. The destructive narcisist’s typical interaction produces negative reactions in others. For example, the individual devalues others, lacks empathy, has a sense of entitlement, and is emotionally shallow. He may function very well and be successful economically, but is unable to form and maintain stable relationships, as evidenced by numerous partners or marriages. The DNP, Brown asserts, is often unrecognized. Although others may find him frustrating and difficult, the individual with DNP can be charming when charm is perceived to be to his benefit.

Dr. Brown’s book “The Destructive Narcissistic Pattern” can be purchased on Amazon.

The blogger CZBZ has also written about DNP on her blog, “The Narcissistic Continuum” and has devised a detailed graph that shows the placement of disorders on the narcissistic spectrum: http://n-continuum.blogspot.com/2013/11/narcissism-key-from-healthy-to.html

DNP is probably much more common than full-blown NPD. These people can be very difficult to deal with but because their symptoms are less severe they would be more likely to respond to (and seek) therapy and may not be completely without empathy and have a stunted or limited conscience instead of an absent one.

The only problem I have with this continuum is that almost everyone would be on the narcissism spectrum, since most people (except for those whose self esteem has been all but obliterated) have some degree of healthy narcissism.

My brilliant friends also have Aspergers

Gale Molinari http://www.galesmind.com just wrote an amazing article about her Aspie friends, where she points out the ways Aspergers has made these two women even better friends to her than they might otherwise be.

It’s so wonderful to see someone write about the positive aspects of Aspergers and how this “mental disorder” gives its “victims” a depth and understanding and focus neurotypicals do not have.

There is a growing community of people with Aspergers who have started an “Aspie rights” movement who’s aim is to get Aspergers removed from the DSM and psychiatric and medical literature as a mental illness and also lobbies for it to stop being considered a handicap, disability, or even a form of mental retardation (which its more severe forms are often confused with). Aspies are not retarded. They also lobby for a more Aspie-friendly world, where for instance, instead of a face to face interview for a job, another kind of application system, such as a Instant Message interview or a written essay can better serve an Aspie applicant and show a potential employer their true talents.

Many if not most Aspies have brilliant minds and high intellectual capacity but can do little or even nothing with their minds because in order to get ahead in the western world (things apparently are easier for Aspies in places like Japan, which doesn’t rely on social gregariousness and aggression), a person must have great social skills and the ability to “think on their feet,” “network” and “schmooze” with higher ups–and always know the right thing to say at the right time.

Aspies have difficulty doing these things, and can come off as awkward, weird, lacking affect, painfully shy, lacking empathy (see my rant about THAT!), or even “slow,” so they are often overlooked for promotions or higher level work. Many people assume because they don’t communicate well verbally and sometimes seem lost in their own world, that they are stupid. But that is just one big fat lie.

Even low functioning people with autism –the ones who have to be institutionalized and cannot care for themselves (and are what most people still think of when they think of autism)–are probably extremely intelligent–but have focused ALL their attention and thinking on ONE OR TWO THINGS. They may be focusing so intensely on their topic of fascination and encyclopedic knowledge (the so-called “idiot savant” phenomenon) to the point they literally are not living in the physical world and must be cared for by others.

Higher functioning people with autism (Aspies) still tend to focus intensely on things and can become obsessed (to a point neurotypicals find weird or unhealthy) with whatever fascinates them. They hate to be interrupted by outside things or people when mentally engaged in their interests or hobbies. But since their autism is much less severe, they can still attend to the outside world if they must. But they aren’t very good at it and prefer not to.

Most Aspies were also bullied as children due to their differences and lack of ability to socialize the way others do (and their high sensitivity), and may have been bullied by their own families (especially if, as I did, they had one or more narcissistic parents or siblings) and frequent bullying can destroy any self esteem a child with Aspergers may have, making things even harder for them when they try to get a foothold in the professional world as adults. Studies have shown that high self confidence is a far better indicator of adult success in life than high intelligence is. Ever wonder why your boss is stupider than you are? Maybe he just likes himself more than you like yourself. This is why narcissists (except the needy type, who thrive on pity and handouts) usually do so well in the working world (though they fail miserably on the relationship/family front).

But I digress.

Some of the most brilliant people in history have had Aspergers (Einstein himself) and were thought to be unintelligent as children because of their slowness in learning social skills. Einstein didn’t talk until he was 3 and his teachers thought he was retarded. Anyway, my point is, because of the Internet (on which Aspies thrive–more so than in the physical world; see my article “Aspies Rule the Internet”), Aspergers is slowly losing its status as a mental illness and being recognized as a variation, much like LGBT was considered a mental illness as recently as 1973, but now hardly anyone thinks of it that way anymore, even people who are opposed to it.

Read on!

galesmind

Aspergers girl

Aspergers another form of autism is not well understood. Because people with Aspergers can have trouble communicating they can be assumed to be unintelligent and strange. The exact opposite is true. Because of social media I have had the pleasure of meeting two wonderfully talented women that also happen to have Aspergers. One on Word Press who has been a mentor and great supporter, the other a fabulously talented kind young lady on Facebook. Because of the nature of social media they can be more comfortable and are really able to portray themselves as they truly are without the shadow of preconceived ideas.
asperger bullies
Some of these ideas are hateful, harmful and untrue and also damaging to the psyche.

http://aspergerstest.net/aspergers-in-adults/

Here is a website among many explaining Aspergers syndrome. While Aspies (as they refer to themselves) may have challenges they also excel in other things that take intense concentration and dedication…

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My daughter is officially BPD, not NPD!

BPD

So, my daughter finally agreed to see a psychiatrist and took a battery of tests and interviews in his office.

She got her her official diagnosis. She has a number of mental issues but I am so thankful NPD isn’t one of them. She’s Borderline, as I suspected, not that that’s any bowl of blackberry/cherry compote either.

She is agreeing to see a therapist, probably because the psychiatrist recommended it to her instead of me (and she also told me he was “hot”!) 😀 I bet probably has something to do why she agreed to it.

I asked the psychiatrist who did the evaluation to write out his findings IN ENGLISH instead of Doctorese. He had his receptionist write out the results for me; here they are.

AXIS I: 296.89 Bipolar Disorder II, 300.02 Generalized Anxiety Disorder
AXIS II: 301.83 Borderline Personality Disorder
AXIS III: 292.2 Cannabis Related Disorder, 291.9 Alcohol Related Disorder NOS, 305.10 Nicotine Dependence, ICD-9 493.3 Asthma, Unspecified
AXIS IV: 309.81 Post-traumatic Stress Disorder, v62.2 Occupational Problem,v62.81 Relational Problem NOS

Not great dx’s, but I’m glad because of all these disorders, even BPD, have a better prognosis and are more amenable to therapy than any form of Narcissistic Personality Disorder. That doesn’t diminish the seriousness of a few of the disorders she does have, though. Hopefully she sticks with her therapist this time.

It’s creepy how close the code for BPD (301.83) is to NPD (301.81). But they’re just billing codes so it probably doesn’t mean much.

Sociopath vs. psychopath: is there a difference?

psychopathy

I’ve been using the terms psychopath and sociopath interchangeably on this blog, even though I’m aware there are differences between the two. I was curious enough to Google what the difference is, and came across an article in Psychology Today that explains how they are alike–and how they differ.

How to Tell a Sociopath from a Psychopath
By Dr. Scott Bonn

Many forensic psychologists, psychiatrists and criminologists use the terms sociopathy and psychopathy interchangeably. Leading experts disagree on whether there are meaningful differences between the two conditions. I contend that there are clear and significant distinctions between them.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released by the American Psychiatric Association in 2013, lists both sociopathy and psychopathy under the heading of Antisocial Personality Disorders (ASPD). These disorders share many common behavioral traits which lead to the confusion between them. Key traits that sociopaths and psychopaths share include:

A disregard for laws and social mores
A disregard for the rights of others
A failure to feel remorse or guilt
A tendency to display violent behavior
In addition to their commonalities, sociopaths and psychopaths also have their own unique behavioral characteristics, as well.

Sociopaths tend to be nervous and easily agitated. They are volatile and prone to emotional outbursts, including fits of rage. They are likely to be uneducated and live on the fringes of society, unable to hold down a steady job or stay in one place for very long. It is difficult but not impossible for sociopaths to form attachments with others. Many sociopaths are able to form an attachment to a particular individual or group, although they have no regard for society in general or its rules. In the eyes of others, sociopaths will appear to be very disturbed. Any crimes committed by a sociopath, including murder, will tend to be haphazard, disorganized and spontaneous rather than planned.

Psychopaths, on the other hand, are unable to form emotional attachments or feel real empathy with others, although they often have disarming or even charming personalities. Psychopaths are very manipulative and can easily gain people’s trust. They learn to mimic emotions, despite their inability to actually feel them, and will appear normal to unsuspecting people. Psychopaths are often well educated and hold steady jobs. Some are so good at manipulation and mimicry that they have families and other long-term relationships without those around them ever suspecting their true nature.

When committing crimes, psychopaths carefully plan out every detail in advance and often have contingency plans in place. Unlike their sociopathic counterparts, psychopathic criminals are cool, calm, and meticulous. Their crimes, whether violent or non-violent, will be highly organized and generally offer few clues for authorities to pursue. Intelligent psychopaths make excellent white-collar criminals and “con artists” due to their calm and charismatic natures.

The cause of psychopathy is different than the cause of sociopathy (1). It is believed that psychopathy is the result of “nature” (genetics) while sociopathy is the result of “nurture” (environment). Psychopathy is related to a physiological defect that results in the underdevelopment of the part of the brain responsible for impulse control and emotions. Sociopathy, on the other hand, is more likely the product of childhood trauma and physical/emotional abuse. Because sociopathy appears to be learned rather than innate, sociopaths are capable of empathy in certain limited circumstances but not in others, and with a few individuals but not others.

Psychopathy is the most dangerous of all antisocial personality disorders because of the way psychopaths dissociate emotionally from their actions, regardless of how terible they may be. Many prolific and notorious serial killers, including the late Ted Bundy and John Wayne Gacy, and Dennis Rader (“Bind, Torture, Kill” or BTK) are unremorseful psychopaths. Psychopathic killers view their innocent victims as inhuman objects to be tormented and violated for their amusement.

Contrary to popular mythology, most serial killers are not mentally ill or “evil” geniuses. See my related article: http://www.psychologytoday.com/blog/wicked-deeds/201406/serial-killer-myth-1-theyre-mentally-ill-or-evil-geniuses

tedbundy ed_gein
Although both were deadly serial killers, Ted Bundy was a psychopath who gave a good impression and knew how not to get caught; Ed Gein was most likely a sociopath who acted more impulsively, was more disorganized and didn’t give a very good first impression. Though both men’s crimes were equally heinous, Bundy’s eyes seem “colder” than Gein’s.

Although the traits of a psychopath more closely resemble those of a person with Narcissistic Personality Disorder (NPD) than those of the more impulsive, disorganized sociopath, both are actually described here as variations of ASPD, not NPD. Once again, if ASPD is really “NPD on crack” then it follows that NPD and ASPD are both on the same spectrum, with ASPD (and psychopathy/sociopathy) at the top of the spectrum. If this is in fact the case, people with NPD, even malignant narcissists, may border on psychopathy, but would not actually qualify as true psychopaths.

Here’s a little graph I devised to illustrate where all the Cluster B disorders may fall on a spectrum. These are just my guesses and are not based on psychological research, just my instinct and gut feelings.

psychopathy_graph
Click image to enlarge.

Is antisocial personality disorder really NPD on crack?

I have to admit I’ve been confused by the distinctions between the Cluster B personality disorders, especially those of NPD and ASPD. There seems to be little distinction in most literature between NPD and ASPD (antisocial personality disorder) with most experts saying the difference is just a matter of degree, with ASPD (psychopathy or sociopathy) being higher on the spectrum than NPD.

Let’s turn to the Bible of mental disorders for some clarification. These are from the DSM IV-TR, but have apparently been updated, because these descriptions are all labeled obsolete. But for our purposes, I’ll stick with these criteria.

Diagnostic criteria for 301.81 Narcissistic Personality Disorder

Handsome narcissistic young man looking in a mirror

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) is often envious of others or believes that others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes

Diagnostic criteria for 301.7 Antisocial Personality Disorder

antisocial_personality

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course ofSchizophrenia or a Manic Episode.

Just for comparison’s sake, let’s include the (obsolete) criteria for the other two Cluster B disorders: BPD (Borderline Personality Disorder) and HPD (Histrionic Personality Disorder):

Diagnostic criteria for 301.83 Borderline Personality Disorder

borderline

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

(3) identity disturbance: markedly and persistently unstable self-image or sense of self

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

(7) chronic feelings of emptiness

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

(9) transient, stress-related paranoid ideation or severe dissociative symptoms

Diagnostic criteria for 301.50 Histrionic Personality Disorder

histrionic_personality

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) is uncomfortable in situations in which he or she is not the center of attention

(2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

(3) displays rapidly shifting and shallow expression of emotions

(4) consistently uses physical appearance to draw attention to self

(5) has a style of speech that is excessively impressionistic and lacking in detail

(6) shows self-dramatization, theatricality, and exaggerated expression of emotion

(7) is suggestible, i.e., easily influenced by others or circumstances

(8) considers relationships to be more intimate than they actually are

It does seem that ASPD is more linked to criminality than NPD, most likely due to poor impulse control, which isn’t a problem in people with NPD. People with ASPD are more willing to break the law and are more likely to be in prison. They are less likely to be concerned with image or consequences of their actions (most people with NPD want to maintain their sqeaky clean image which means staying out of prison). Antisocials also seem more prone to violent behavior.

The DSM criteria for ASPD seem to describe psychopathy/sociopathy. Most narcissists are probably not psychopaths, but are on the same spectrum. Does this mean that ASPD and NPD should really be considered the same disorder, with ASPD higher on the psychopathy spectrum?

BPD is more clearly distinguishable from ASPD and NPD because a person suffering from this disorder does have a conscience and can feel empathy and remorse, but like someone with ASPD they have problems with impulse control. Also, their motives for doing what they do are different: they fear abandonment, while people with ASPD and NPD fear their true self being exposed.

HPD seems very similar to the somatic form of narcissism and includes many narcissistic traits. However, it seems that someone with HPD would be more prone to drama, neediness and tantrum throwing (although these traits aren’t unknown in narcissists). Like BPD, the motives for the sufferer’s behavior seem based on insecurity and fear of abandonment rather than the need to maintain a false front.

NPD and ASPD are more common in males than females, and HPD and BPD are more common in females than males. Does gender determine what disorder a child is more likely to develop later in life? Are BPD and HPD really the “female” forms of the other two disorders?

ASPD almost seems like an exaggeration of typically male traits–aggressiveness, lack of emotion (except rage), and risk taking; whilst HPD seems like an exaggeration of typically female traits — excessive emotionality, preoccupation with beauty/sexiness, and excessive neediness. BPD and NPD are somewhere in between these two and can include elements of both: ASPD –> NPD –> BPD –> HPD

The fact that the American Psychiatric Association keeps changing their criteria just makes things even more confusing.