Trump and his impressionistic speech: HPD or NPD?

make_america_great

I’m engaged in an interesting conversation in a Facebook group about Cluster B disorders. Someone raised an interesting point about Trump possibly having HPD instead of, or in addition to, NPD.   His “impressionistic speech,” which is a symptom of HPD, is a clue, but based on his inability to accept blame or criticism (and not just projecting it onto others), that seems a lot more NPD.

I’ll just let the actual conversation speak for itself because it raises some interesting points.  (There were more replies, but I’m leaving out the ones not relevant to the topic raised, which is Trump).

Someone in the group posted this question (who I will call Participant A) :

Random thought: Donald Trump initially appears NPD. But that fucking hair… the orange tan, and the impressionistic speech…makes me wonder if he’s not HPD, or at least comorbid. The one HPD I’ve known was basically a narc in a series of crazy outfits. And she sounded JUST like him with her wild lack of details, inappropriate sex talk and constant attention seeking behavior. Thoughts?  

Participant B:

I think a person with HPD might respond to all of the criticism a little differently than he does. He seems to hold tight to his grandiosity, a person with HPD would be more wounded and emotional. He ignores the fact that nobody wants to join his inauguration and even lies and pretends It’s sold out, inauguration dresses are sold out, etc. That looks like NPD to me.

Participant A:

The HPD I know did this exact thing though. I worked for her and while planning a conference she made me send out an email to supporters saying we had this amazing star studded line up (we had no one) and the tickets would soon be sold out (we had like 10 people signed up so far). As an NPD I personally would be too nervous to publicly fail, so I would opt to undersell the event, in case no one showed up, to save myself embarassment. If people show up, bonus points, because I look humble. She just threw wild shit out there with seemingly no concept of reality. Constantly contradicted herself too.

Participant B:

People with HPD are supposed to be more uncomfortable with criticism and more uncomfortable not being the center of attention. I think people with NPD have mental blocks up that sometimes don’t allow them to see when they’re disliked or unpopular. Maybe on a subconscious level they get it. I think a person with NPD might be better able to answer this though

Me:

I think it’s easier to have ASPD than NPD — NPDs and BPDs care very much what you think (even if they never admit it) while psychopaths and ASPDs generally don’t give a shit.

Participant B:

People with HPD are more easily influenced, they typically blame failure on others. He doesn’t even admit to any failure existing.  Superficial emotional displays or a little more agreement with the majority might be more HPD too…

Me:

That’s a good point. He could also be a somatic narc — with extremely tacky taste! Cluster B disorders often appear together, so it’s entirely possible he could be both NPD and HPD too. But no way is he *just* HPD — like Participant B said, he doesn’t admit to failure — ever.

Me (replying to Participant A):

I’ve heard that HPDs have “impressionistic speech” but I never understood exactly what that means. Can you give an example of Trump using this kind of speech? I’m not doubting you, but I’m just not sure what it is. Sort of a vagueness? Because he talks and talks and never actually says anything. Or it’s like word salad and makes no sense. Is that what you mean?

Participant A:

Earlier today, “It’s going to be Huge! We’re going to turn things around”. Ok, Donald, how are we going to do that? ” We will make America great again!” Lol. Literally just now: “My cabinet is so smart. We have the highest IQ of any cabinet ever assembled.” Oh ok, based on what fucking data? No explanation.

Definition and example of impressionistic speech: “A term used to describe a person’s speech when it consistently lacks in detail and emphasizes emotions. For example, if you asked someone what they thought of something, and they said that the thing was “just wonderful, fabulous”.”

Does he not consistently fit the bill, or what?

Me:

Ah, I see. My NPD mother (who I always suspected was HPD too) talked that way. “Everything was fabulous!” “Oh, I feel marvelous!” A lot of hyperbole, but no substance. At all. Yes, Trump does talk exactly like that and never can back up his grandiose claims. And people think he’s pissing gold.

HPD doesn’t seem to be that common for some reason. Or it gets diagnosed as BPD or NPD.

 

 

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Cluster B disorders: an explanation

Informative video about the Cluster B disorders that discusses what they have in common and what causes someone to develop them. BPD has been unfairly stigmatized because of its similarity in some ways to the other disorders in this cluster, but few people recognize that borderlines don’t lack empathy or a conscience the way people with NPD and ASPD do, even though they can be difficult to deal with and even abusive when they are triggered.

Why narcissists and borderlines are drawn to each other.

narc_borderline

I’t’s uncanny how often people with NPD and BPD seem to find each other. Every one of my boyfriends (except for one, who was severely bipolar) and my ex-husband were narcissists. I know a lot of other borderlines who say they have the same problem–they simply are not attracted to a man or woman who is not a narcissist. There are reasons why this happens.

Both BPD and NPD are included in the category of Cluster B personality disorders in the DSM-V (along with Histrionic and Antisocial personality disorders). Cluster B disorders are all characterized at their root by problems establishing an identity early in childhood and integrity of the Self which causes people with these disorders to act out toward themselves or others in destructive ways and to have problems either accessing or developing prosocial emotions like empathy. All are prone to lie excessively and manipulate others.

All Cluster B’s are easily offended and quick to anger, which can be expressed either covertly or overtly. Here’s a quick description of these personality disorders.

Antisocial personality disorder (ASPD or psychopathy) is the most likely to break the law and violate the rights of others (many are in prison), act impulsively, and have no empathy at all. People with ASPD who aren’t lawbreakers will be ruthless in business or their chosen profession, and feel no compunctions about hurting others to succeed and may even take pleasure from it.

Narcissistic Personality Disorder (NPD) is less likely to break the law (but this is not a given–some narcissists will break the law if they think they can get away with it) due to wanting to present a good image to others, but have little, if any, empathy, and act out toward others and manipulate them to protect the False Self they use in place of their true one which cannot be accessed. They act arrogant, entitled, paranoid and touchy. Think of the most spoiled or brattiest child you know. If you saw that same behavior in an adult, that’s what NPD looks like to others.

Histrionic personality disorder (usually found in women) is a somatic form of narcissism where there is obsession with physical appearance and emotions are expressed dramatically but the emotions themselves are shallow. Histrionics of both sexes are often sexually promiscuous.

Borderline Personality disorder is the most baffling of the four, because it’s a disorder of contradictions. BPD is characterized by black and white thinking, overpowering emotions, impulsivity, self-destructive behavior, and idealization/devaluation of others. People with this disorder oscillate rapidly between opposites–feeling love and hate for others, pushing others away and smothering them, and accepting or rejecting them. They do this because of their fear of abandonment. Unfortunately, borderlines in their desperate attempts to not be abandoned, cause others to abandon them, or are self sabotaging–they may reject others in order to avoid being rejected first. Borderlines, unlike the other Cluster B disorders, are able to feel empathy, but because they can get so overwhelmed by their fear of rejection and their overpowering emotions and drama, they can “forget” others exist. They can feel remorse and guilt when they realize they’ve behaved badly but it sometimes must be pointed out to them.

Borderlines are chameleons who don’t have a False Self per se, but instead adopt whatever “identity” will suit the moment and whatever person they are interacting with–to make the other person accept them. In some borderlines, this rapid switching from one persona to another can appear to others similar to DID (Dissociative Identity Disorder). Not only their behavior, but also their emotions (which they have trouble regulating or controlling), opinions, or even their appearance can change from one moment to the next. This differs from bipolar disorder, where dramatic mood changes oscillate much more slowly.

narc_borderline2

Of all the Cluster B disorders, people with BPD have a Self that is the most fragmented and least likely to have integrated into something called an identity (even a narc has a False Self so that’s a kind of identity). As a result BPD’s are the most prone to experience dissociative or even psychotic episodes, where the person loses touch with reality. Ironically, although Borderlines are “sicker” than narcissists, they are more likely to seek therapy (because their disorder is ego-dystonic and most are not happy with the way they behave and feel) and they are also more likely to be cured.

Because borderlines are chameleons,* they make perfect supply for a narcissist. They lack an identity of their own, so they “become” whatever others expect them to be. It’s not really a mask in the same sense as a narcissist, but they can wear a sort of temporary mask that can change from one moment to the next or disappear completely, leaving the borderline in a depressed or near-psychotic emotional state. A borderline can be whatever the narcissist wants them to be, and as a result are easily manipulated and can become very codependent.

Borderlines can be very manipulative themselves, but because their personality is less integrated and and the narcissist appears to have an integrated self (even though it’s a false one), they are no match for a narcissist. Unless the narcissist is very low on the spectrum (or is a covert and vulnerable one), they cannot be overpowered by a borderline and will always get their way over the borderline’s needs.

Borderlines (like narcissists) never felt loved or valued, but the borderline hasn’t shut out their need to be loved and craves it more than anything else. A narcissist (in the beginning of a relationship) can appear to be highly passionate and attentive, promising the borderline all the love he or she needs–and be convincing enough they capture the heart of a borderline, who thinks they’ve met the perfect mate.

Relationships between narcissists and borderlines may be stormy and “unhealthy,” but when they work, they work well, with the narcissist giving the borderline a kind of identity as a codependent to the narcissist, and the borderline giving the narcissist the supply they need.

I think there’s often a familial aspect too. Cluster B disorders tend to occur in families, in varying configurations. If one or more parents is a narcissist (or a borderline), they are far more likely to raise narcissistic or borderline children, because both disorders are due to abuse and Cluster B parents tend to put their own needs ahead of their children’s, even if (in the borderline) their selfishness isn’t intentional. Therefore, borderlines and narcissists who were raised in abusive families tend to be attracted to people who unconsciously remind them of other members of their families, especially the parents. This type of connection is called a trauma bond because the connection is due to shared trauma and a conscious or unconscious willingness to to be abused or to abuse a partner. A relationship between a borderline and a narcissist is not what anyone would call functional, and yet in a way it can work for both of them, if they don’t wind up killing each other first. Some of these trauma bonds are examples of Stockholm Syndrome, where the abused identifies with their abuser.

Going No Contact with a narcissist is the best gift an abused borderline can give herself (or himself), but separating may be especially hard for them and they are likely to be drawn to another narcissist, so they need to stay on guard and be especially vigilant of red flags.

* I think their ability to be emotional chameleons is the reason why the entertainment, film and television industries seem to have a plethora of actors who have BPD.

Graphic example of how Facebook feeds narcissism in young women.

Young girl using laptop on Facebook page

Okay, so my daughter isn’t exactly a kid anymore, since she’s 22, but she’s still young enough that she likes participating in those awful Facebook groups where random people rank your photo based on how attractive they think you are.

Her profile picture was ranked along with 3 other girls in this group.
Here she sums up what happened.

facebook_trolling

She got a lot of comments telling her not to be upset, or that people were just jealous of her good looks (she is very pretty, but I didn’t see the photos of the other girls). This morning she told me her feelings were still hurt today in spite of encouraging comments she got from her friends and boyfriend who kept telling her how beautiful she is.

This sort of thing isn’t unusual. It happens every day, all over social media. Not only can such online “contests” lead to bullying based on one’s appearance by total strangers, but they also feed a girl’s narcissistic supply or cause narcissistic injury, even in non-narcissists (my daughter does not have NPD, but can act very narcissistic). Let’s be honest here–we all have some need for narcissistic supply (positive feedback), especially when we’re still young and unsure of our place in the world.

The teenage and young adult women who participate in these contests learn to value surface attributes such as physical appearance or sexiness above anything else. I see it happening everywhere. Millennial girls seem more obsessed with how cute, sexy or pretty they are than any generation that came before them, and I think this is due to the plethora of reality shows, beauty contests and Facebook photo rankings they are inundated with, as well as the trend for taking as many Selfies or Youtube videos of yourself as you possibly can and posting them for the public to see and comment on. This seems to be a generation with more than its fair share of female somatic narcissists and girls with HPD (histrionic personality disorder).

I can’t keep my daughter from participating in these sort of activities since she’s an adult and she seems to enjoy them (and usually gets a lot of compliments about how pretty she is), but I worry about a “low ranking” (which really wasn’t that bad) like she got yesterday damaging her self esteem (which is shaky to start with) or teaching her to value physical appearance above other qualities like personality, intelligence, or kindness.

Are BPD and complex PTSD the same disorder?

age_3_1961_2
Me at age 3 in the zone. Was the template for my BPD already laid down?

Ruji, a new commenter on this blog, made an interesting observation–that BPD should be divided into at least two subtypes: Empathy Challenged/Character Disordered (closer to NPD/ASPD) and Highly Sensitive Person with Emotional Dysregulation (closer to the type I have, although at different times in my life or when extremely stressed I have displayed the more character-disordered subtype). I agree with her. Ruji’s idea is remarkably similar to The World Health Organization’s two subtypes of BPD:

1. F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):

–marked tendency to act unexpectedly and without consideration of the consequences;
–marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
–liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
–difficulty in maintaining any course of action that offers no immediate reward;
–unstable and capricious (impulsive, whimsical) mood.

2. F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

–disturbances in and uncertainty about self-image, aims, and internal preferences;
–liability to become involved in intense and unstable relationships, often leading to emotional crisis;
–excessive efforts to avoid abandonment;
–recurrent threats or acts of self-harm;
–chronic feelings of emptiness.
–demonstrates impulsive behavior, e.g., speeding, substance abuse

Psychologist Theodore Millon has gone even further, proposing that BPD should be divided into four subtypes:

1. Discouraged (including avoidant features): Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.

2. Petulant (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.

3. Impulsive (including histrionic or antisocial features) Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.

4. Self-destructive (including depressive or masochistic features) Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.

Millon’s Types 1 and 4 would correspond to the Highly Sensitive Person/Emotional Dysregulation type mentioned above (and therefore closer to the Avoidant/Dependent PDs); Type 2 sounds very much like NPD; and Type 3 seems closer to ASPD or Histrionic PD.

complex_ptsd
BPD symptoms are almost identical to those of Complex PTSD.

There are so many diverse–almost opposite–symptoms that can appear with this disorder that one person with BPD can be very different from the next. In fact, you can take 10 borderlines and they will all seem very different from each other, with barely any similarities in their behavior at all. One will be shy, fearful and retiring, never making waves, acting almost like an Aspie or an Avoidant; while another may break the law, lie constantly, and act obnoxious and rage whenever things don’t go their way. A borderline could be your raging boss who drinks too much and ends every annual Christmas party with one of his infamous rages, or it could be the sweet and pretty schoolteacher who goes home every night and cuts herself. She could be the come-hither seductress or the nerdy computer programmer. He may have few or no friends or a great many.

This diversity is not the case with the other personality disorders, which have more cohesiveness in the symptoms their sufferers display. So I wonder–is BPD really a personality disorder at all? Does it even exist, or is it really just a group of trauma-caused symptoms the experts in their ivory towers stuck in a single box called “BPD” because they didn’t know how else to classify them?

In fact, all these diverse subtypes have one thing in common–they are all very similar or identical to the symptoms of someone with complex PTSD (C-PTSD). People with C-PTSD are often misdiagnosed as Borderlines because their behaviors can be just as baffling and manipulative, and both disorders also include dissociative, almost psychotic episodes. Extrapolating from that, I wonder if ALL borderlines actually have C-PTSD.

Earlier today I posted an article outlining 20 signs of unresolved trauma, and I was struck by how similar these were to the symptoms of BPD. And there is also this article that Ruji just brought to my attention that also describes how remarkably similar the two disorders are, but that the idea of fear of abandonment (which is recognized as the root cause of BPD) is not recognized as a factor in causing PTSD and that may be part of why they have been kept separate.

The BPD label, like any Cluster B label, is very damaging to its victims because of the “evil and character-disordered” stigma it carries. One psychologist has even included us, along with narcissists, among the “People of the Lie”!

Yes, it’s true some borderlines do act a lot like people with NPD or even Malignant Narcissism or ASPD, but most probably do not, and are really much more similar to people with Avoidant or even Dependent personality disorders, which hurt the sufferer more than anyone else. But if you have a BPD label, people start backing away from you slowly due to the stigma. Therapists are reluctant to treat you because they assume you will be either difficult and hateful in therapy sessions, or will never get better. Insurance companies won’t pay claims where there is a BPD diagnosis, because it’s assumed there is no hope for you. I’ve had this problem when I’ve tried to get therapy. I remember one therapist who I had seen for the intake session, who told me he needed to obtain my psychiatric records before we could proceed. The session had gone smoothly and I felt comfortable with him. A few days later I received a phone call and was told he did not treat “borderline patients” and wished me luck. So that’s the kind of thing we’re up against if we’ve had the BPD label slapped on us.

Also, as an ACON blogger who works with a lot of victims of narcissistic abuse, my BPD label sometimes makes people wary of me and they begin to doubt that my motives here are honest. At first I was reluctant to talk about my “Cluster B disorder” here, because I knew it might be a problem for some ACONs, who think borderlines are no better than narcissists. But I eventually decided that to hide it away like an embarrassing family secret would be misleading so I “came out” about having BPD (I never actually lied about it, but played it down in the beginning and rarely mentioned it). I’m glad I fessed up, but there have been a few people who left this blog after I came out about it or began to doubt my motives. So there’s that stigma and it’s very damaging.

Both C-PTSD and Borderline PD are caused by trauma. Both are complex defensive reactions against future abuse and both involve things like splitting, dissociation, psychotic episodes, self-destructiveness, wild mood swings, and behavior that appears to be narcissistic and manipulative.

The way I see it, the only real difference between C-PTSD and BPD is that the traumatic event or abuse happened at an earlier age for someone with BPD, perhaps during toddlerhood or infancy, while all forms of PTSD can happen at a later age, even adulthood. But the symptoms and defense mechanisms used to avoid further trauma are the same for both.

Histrionic personality disorder: the other Cluster B disorder

Histrionic personality disorder (HPD) is the forgotten step-child of the Cluster B group of personality disorders, which also includes the Borderline, Narcissistic and Antisocial personality disorders.

HPD: the “other” Cluster B disorder.

histronic_pd

NPD is of course the King of the Cluster B disorders (which is exactly the way a narcissist would have it). It’s one of the hottest topics on the Internet right now, with ACONs everywhere (adult children of narcissists) rising from the silence of abuse like vampire slayers on a mission of justice. In addition, there are probably hundreds of blogs and forums about NPD and the damage people with that disorder inflict on everyone else. If you Google the word “narcissist” or “narcissism” you will see thousands of articles, personal stories, quotes, videos and support groups for victims of narcissistic abuse (but only a sprinkling of the same for people WHO HAVE the disorder–because NPD normally hurts its victims more than its sufferers).

Borderline personality disorder (BPD) is also widely discussed on the web, and it appears to be a common catch-all diagnosis, especially for women who were victims of abuse or sexual abuse and show emotional instability resulting from that. People diagnosed with BPD may actually be suffering from an array of other disorders (such as PTSD) and labeled BPD because the experts have so little understanding of BPD and it might not even be a real disorder anyway. Or maybe it is a real disorder but is a lot rarer than you’d think because so many people (mostly women) are erroneously diagnosed with it. In any case, there are blogs, support groups and forums all over the web for people with BPD and those who love them (or must cope with them).

And finally, if you’re like me and enjoy reading about psychopathic and sociopathic murderers, serial killers, mass murderers, cult leaders, and other violent (and non-violent) criminals, you are going to find out a lot about Antisocial personality disorder (ASPD), which is actually at the top of the narcissistic spectrum if you’re of the school of thinking that believes narcissism runs on a continuum from merely manipulative to heinous beyond words. Sociopath World is an interesting website that features blog posts written by ASPD writers. If you like this sort of stuff, or are just curious to find out what the inside of a sociopath’s head is like, I recommend checking out the site.

A fourth (and rather interesting) Cluster B disorder, HPD or Histrionic personality disorder, somehow got lost in the Cluster B shuffle. You don’t hear much about it and there’s very little written about it either, except for cursory mentions in the psychological and psychiatric literature, and it’s rarely featured by itself–it’s only mentioned in articles about the Cluster B disorders in general. But while it’s not widely talked about, Histrionics (mostly women) are frequent characters in movies, novels and TV shows because they make good theater.

histrionic_symtoms

People with HPD crave attention, so much that Sam Vaknin speculates that HPD may actually be the somatic, “female” form of NPD–or at least resembles it a lot. Most (but not all) Histrionics are women. A woman with HPD will act very much like a somatic narcissist, but may show somewhat more empathy or genuine (but shallow) emotion than a true narcissist. In fact, showing emotion is what Histrionics do best–hence their name. Their exaggerated emotional displays are over-the-top and dramatic. They are the original drama queens. I’m going to go out on a limb here and speculate that a lot of male HPD’s are probably flamboyantly gay men of the type who have exaggerated feminine affectations and interests (this is certainly not a slur on gay men, just an observation). Histrionics are also easily bored and besides attention, crave constant activity or social interaction. They tend to smother those they become attached to.

For convenience’s sake (and because most histrionics are women), I’ll describe a hypothetical woman with this disorder.

Histrionic Haley.

histrionic_personality

Haley was the youngest child of her family of origin, and also the prettiest. At the age of 12, her parents divorced and her mother remarried. Haley’s stepfather appeared to love her–but that was just how things appeared. In actuality, he came into her room at night and forced himself on her, telling her how pretty she was and what a beautiful woman she was turning into. He made her strip naked and lie down on the bed while he fondled her developing breasts. When Haley questioned him about why he did this, her stepfather told her he was just “checking to see how she was developing.”

Haley was spoiled by both her mother (a narcissist who actually hated Haley for “seducing my husband” but still needed her because Haley made HER look good) and her stepfather, who constantly bought her clothes, mostly revealing outfits that showed off her adolescent curves.

Haley was never encouraged to think for herself or develop her mind or any skills other than her physical appearance and flirting ability. Her mother, a somatic narcissist, taught Haley that acting helpless and exaggeratedly feminine was the most effective way to attract a boy. Haley was spoiled rotten but abused at the same time. She was attractive, obsessed with clothes, makeup and shopping, and used her “feminine wiles” to attract boys, who she proceeded to manipulate (usually using sexy smiles, skimpy outfits, exaggeratedly demure behavior, or tears) to get whatever she wanted.

Haley was highly romantic–besides being obsessed with cheap romance novels, she was constantly “in love” with someone. Unfortunately she never learned how to love anyone on a deeper level because she didn’t know how to give, only take. She learned that sex was the best way to obtain what she wanted, and that’s all most of her lovers wanted her for anyway, so she was more than happy to oblige. Due to her immaturity and emotional instability, she was prone to drawn out, over the top tantrums when she didn’t get her way. Of course, her frequent temper tantrums, crying jags, unreasonable demands, and general high-maintenance behavior caused all her relationships to be short lived. With each breakup, Haley got worse, and upped the ante for the next relationship, believing she hadn’t asked for enough the last time. It never occurred to Haley that she might be too demanding and high maintenance. She never learned from her own mistakes, because being needy and demanding was all she had ever been taught.

Haley had good social skills, and became the life of any party she attended. While she had no close friends (due to her inability to maintain any deep and meaningful relationship), she had plenty of acquaintances and casual friends, who though of her as a dynamic, fun and exciting woman. She had lots of charm, was very pretty, and adored being the center of attention–just as she had been in her family growing up. Each year she would throw herself a huge birthday party, and expansively invite more people than she could realistically afford to entertain. But that didn’t matter because she had so many admirers, no one cared that the food and drink always ran out. Haley kept everyone entertained. Even though she’d almost always wind up sobbing loudly and theatrically at some point due to some slight during these parties, even that in itself kept her admirers around, who became protective of her. Haley basked in all the solicitous attentions she received.

Haley also used her sexuality in inappropriate ways. On several job interviews, she wore revealing see-through tops or short shorts, or allowed her bra strap to “accidentally” fall down her shoulder from under a tight spaghetti strap tank top. She openly flirted with her male interviewers. While a couple of employers fell for the bait and hired her–Haley was never taken seriously as an employee and then she’d tearfully complain to anyone who would listen about how she was treated like a sex object and got no respect.

How HPD differs from BPD

comedy_tragedy

Histrionic personality disorder resembles BPD in some ways–but the Borderline is ambivalent about relationships and tends to alternately smother and abandon people–their tendency toward “splitting” (black and white thinking) causes them to idealize others followed by devaluation or pre-emptive rejection when they perceive a slight. A histrionic will just keep on smothering and making more demands. They lack the ambivalence of a borderline.

While a borderline may be sexually promiscuous or seductive, not all are–and they don’t use their sexuality or body to exclusively the way someone with HPD does. Borderlines also tend to be more self-destructive (cutting, eating disorders, drug abuse, compulsive gambling, etc.) than a Histrionic, and more prone to suicide or suicidal ideation, as well as having dissociative and sometimes psychotic symptoms that Histrionics lack.

Cluster B personality disorders and the emotional thermostat.

If you think of the Cluster B (“dramatic”) disorders (characterized by either too much emotion or the masking of true emotions) as malfunctions or problems of the sufferer’s “emotional thermostat,” their differences make more sense. The emotional thermostat determines how a person handles their own emotions or reacts to those of others.

emotional_thermostat

Borderline Personality Disorder (BPD): inability to regulate emotions (a thermostat that works but is having problems–cutting on the heat or air when it isn’t needed or shutting it off when it is, but half the time works perfectly). This explains their ambivalence in relationships (“I hate you…don’t leave me,” “go away, come closer.”)

Histrionic Personality Disorder (HPD): inability to control emotions (a thermostat that is always on High and blasting heat even when it’s already too hot). That’s why they overreact to everything.

Narcissistic Personality Disorder (NPD): inability to access true emotions (a thermostat that sets to “cold” and turns on the air conditioner when heat is needed, and “hot” and turns on the heat when the air conditioning needs to be on). This explains their lack of empathy and show of fake emotions that may not fit a given situation.

Antisocial Personality Disorder (AsPD–psychopathy, sociopathy): total inability to empathize or respect the rights of others (a broken thermostat that doesn’t work at all.) People with ASPD are unable to feel any emotions except rage.

Maybe we throw around the N label too freely.

Hand with pointing fingerletter_N

I’ve written about this before, but I think it’s something important we ACONs need to remember that can save us and others untold heartache.

We need to be careful about labeling someone a narcissist until we have gotten to know them well enough to be sure. I think ACONs and other victims of abuse are sometimes very quick to label people narcissists who may actually have some other, less malignant disorder such as Borderline Personality Disorder, OCD (some people with OCD can seem very cold), Histrionic Personality Disorder, or even Aspergers (Aspies are often accused of being unempathic just because they don’t express their emotions very well). Some conditions are easily confused with NPD because the behaviors shown may be similar.

Narcissists are actually a small minority of the population, but when you’re a codependent, high empathy type of person, they can seem to be everywhere because we attract them like flies to honey. That being said, the times we live in and a society that rewards narcissistic behavior have probably made NPD more common than it used to be.

Whenever we do pin the N label on someone, it’s our own subjective opinion. In most cases, the person in question probably does have NPD (we are all adults here and it isn’t that hard to see the red flags), but remember it’s an informal diagnosis, not a bona fide diagnosis made by a mental health professional.

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.