Author Topic: Narcissistic Personality Disorder to be eliminated from new DSM?  (Read 12702 times)

lighter

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #15 on: December 02, 2010, 07:55:12 AM »
I think it might be appropriate to replace the term Narcissist with the term Interpersonal Psychopath/Sociopath in the DMV.

That would make it easier for the public to understand what N's are, IMO.

Lighter



[from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1994, commonly referred to as DSM-IV, of the American Psychiatric Association. European countries use the diagnostic criteria of the World Health Organization.]
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.[jma: NPD first appeared in DSM-III in 1980; before that time there had been no formal diagnostic description. Additionally, there is considerable overlap between personality disorders and clinicians tend to diagnose mixes of two or more. Grandiosity is a special case, but lack of empathy and exploitative interpersonal relations are not unique to NPD, nor is the need to be seen as special or unique. The differential diagnosis of NPD is made on the absence of specific gross behaviors. Borderline Personality Disorder has several conspicuous similarities to NPD, but BPD is characterized by self-injury and threatened or attempted suicide, whereas narcissists are rarely self-harming in this way. BPD may include psychotic breaks, and these are uncharacteristic of NPD but not unknown. The need for constant attention is also found in Histrionic Personality Disorder, but HPD and BPD are both strongly oriented towards relationships, whereas NPD is characterized by aloofness and avoidance of intimacy. Grandiosity is unique to NPD among personality disorders, but it is found in other psychiatric illnesses. Psychopaths display pathological narcissism, including grandiosity, but psychopathy is differentiated from NPD by psychopaths' willingness to use physical violence to get what they want, whereas narcissists rarely commit crimes; the narcissists I've known personally are, in fact, averse to physical contact with others, though they will occasionally strike out in an impulse of rage. It has been found that court-ordered psychotherapy for psychopaths actually increases their recidivism rate; apparently treatment teaches psychopaths new ways to exploit other people. Bipolar illness also contains strong elements of grandiosity. See more on grandiosity and empathy and its lack below.]The disorder begins by early adulthood and is indicated by at least five of the following:

 


Translation: Narcissistic Personality Disorder (NPD) is a pattern of self-centered or egotistical behavior that shows up in thinking and behavior in a lot of different situations and activities. People with NPD won't (or can't) change their behavior even when it causes problems at work or when other people complain about the way they act, or when their behavior causes a lot of emotional distress to others (or themselves? none of my narcissists ever admit to being distressed by their own behavior -- they always blame other people for any problems). This pattern of self-centered or egotistical behavior is not caused by current drug or alcohol use, head injury, acute psychotic episodes, or any other illness, but has been going on steadily at least since adolescence or early adulthood.
     NPD interferes with people's functioning in their occupations and in their relationships:
Mild impairment when self-centered or egotistical behavior results in occasional minor problems, but the person is generally doing pretty well.
Moderate impairment when self-centered or egotistical behavior results in: (a) missing days from work, household duties, or school, (b) significant performance problems as a wage-earner, homemaker, or student, (c) frequently avoiding or alienating friends, (d) significant risk of harming self or others (frequent suicidal preoccupation; often neglecting family, or frequently abusing others or committing criminal acts).
Severe impairment when self-centered or egotistical behavior results in: (a) staying in bed all day, (b) totally alienating all friends and family, (c) severe risk of harming self or others (failing to maintain personal hygiene; persistent danger of suicide, abuse, or crime).

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


Translation: Grandiosity is the hallmark of narcissism. So what is grandiose?

The simplest everyday way that narcissists show their exaggerated sense of self-importance is by talking about family, work, life in general as if there is nobody else in the picture. Whatever they may be doing, in their own view, they are the star, and they give the impression that they are bearing heroic responsibility for their family or department or company, that they have to take care of everything because their spouses or co-workers are undependable, uncooperative, or otherwise unfit. They ignore or denigrate the abilities and contributions of others and complain that they receive no help at all; they may inspire your sympathy or admiration for their stoicism in the face of hardship or unstinting self-sacrifice for the good of (undeserving) others. But this everyday grandiosity is an aspect of narcissism that you may never catch on to unless you visit the narcissist's home or workplace and see for yourself that others are involved and are pulling their share of the load and, more often than not, are also pulling the narcissist's share as well. An example is the older woman who told me with a sigh that she knew she hadn't been a perfect mother but she just never had any help at all -- and she said this despite knowing that I knew that she had worn out and discarded two devoted husbands and had lived in her parents' pocket (and pocketbook) as long as they lived, quickly blowing her substantial inheritance on flaky business schemes. Another example is claiming unusual benefits or spectacular results from ordinary effort and investment, giving the impression that somehow the narcissist's time and money are worth more than other people's. [Here is an article about recognizing and coping with narcissism in the workplace; it is rather heavy on management jargon and psychobabble, but worth reading. "The Impact of Narcissism on Leadership and Sustainability" by Bruce Gregory, Ph.D. "When the narcissistic defense is operating in an interpersonal or group setting, the grandiose part does not show its face in public. In public it presents a front of patience, congeniality, and confident reasonableness."]

In popular usage, the terms narcissism, narcissist, and narcissistic denote absurd vanity and are applied to people whose ambitions and aspirations are much grander than their evident talents. Sometimes these terms are applied to people who are simply full of themselves -- even when their real achievements are spectacular. Outstanding performers are not always modest, but they aren't grandiose if their self-assessments are realistic; e.g., Muhammad Ali, then Cassius Clay, was notorious for boasting "I am the greatest!" and also pointing out that he was the prettiest, but he was the greatest and the prettiest for a number of years, so his self-assessments weren't grandiose. Some narcissists are flamboyantly boastful and self-aggrandizing, but many are inconspicuous in public, saving their conceit and autocratic opinions for their nearest and dearest. Common conspicuous grandiose behaviors include expecting special treatment or admiration on the basis of claiming (a) to know important, powerful or famous people or (b) to be extraordinarily intelligent or talented. As a real-life example, I used to have a neighbor who told his wife that he was the youngest person since Sir Isaac Newton to take a doctorate at Oxford. The neighbor gave no evidence of a world-class education, so I looked up Newton and found out that Newton had completed his baccalaureate at the age of twenty-two (like most people) and spent his entire academic career at Cambridge. The grandiose claims of narcissists are superficially plausible fabrications, readily punctured by a little critical consideration. The test is performance: do they deliver the goods? (There's also the special situation of a genius who's also strongly narcissistic, as perhaps Frank Lloyd Wright. Just remind yourself that the odds are that you'll meet at least 1000 narcissists for every genius you come across.) [More on grandiosity.]

2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
 


Translation: Narcissists cultivate solipsistic or "autistic" fantasies, which is to say that they live in their own little worlds (and react with affront when reality dares to intrude).

3. Believes he is "special" and can only be understood by, or should associate with, other special or high-status people (or institutions)
 


Translation: Narcissists think that everyone who is not special and superior is worthless. By definition, normal, ordinary, and average aren't special and superior, and so, to narcissists, they are worthless.

4. Requires excessive admiration
 


Translation: Excessive in two ways: they want praise, compliments, deference, and expressions of envy all the time, and they want to be told that everything they do is better than what others can do. Sincerity is not an issue here; all that matter are frequency and volume.

5. Has a sense of entitlement
 


Translation: They expect automatic compliance with their wishes or especially favorable treatment, such as thinking that they should always be able to go first and that other people should stop whatever they're doing to do what the narcissists want, and may react with hurt or rage when these expectations are frustrated.

6. Selfishly takes advantage of others to achieve his own ends
 


Translation: Narcissists use other people to get what they want without caring about the cost to the other people.

7. Lacks empathy
 


Translation: They are unwilling to recognize or sympathize with other people's feelings and needs. They "tune out" when other people want to talk about their own problems.
    In clinical terms, empathy is the ability to recognize and interpret other people's emotions. Lack of empathy may take two different directions: (a) accurate interpretation of others' emotions with no concern for others' distress, which is characteristic of psychopaths; and (b) the inability to recognize and accurately interpret other people's emotions, which is the NPD style. This second form of defective empathy may (rarely) go so far as alexithymia, or no words for emotions, and is found with psychosomatic illnesses, i.e., medical conditions in which emotion is experienced somatically rather than psychically. People with personality disorders don't have the normal body-ego identification and regard their bodies only instrumentally, i.e., as tools to use to get what they want, or, in bad states, as torture chambers that inflict on them meaningless suffering. Self-described narcissists who've written to me say that they are aware that their feelings are different from other people's, mostly that they feel less, both in strength and variety (and which the narcissists interpret as evidence of their own superiority); some narcissists report "numbness" and the inability to perceive meaning in other people's emotions.

8. Is often envious of others or believes that others are envious of him
 


Translation: No translation needed.

9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes
 


Translation: They treat other people like dirt.






« Last Edit: December 02, 2010, 09:41:48 AM by lighter »

Guest

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #16 on: December 02, 2010, 09:47:32 AM »
Agreed, thanks for that Lighter. I haven't read a list of traits for a long time and a reminder is interesting. I was particularly struck by the expression "Narcissists cultivate solipsistic or "autistic" fantasies" - it explains something I couldn't describe before.

CB I agree about the self-harm too: they simply won't do it. Might threaten it I guess?

The two different directions of lack of empathy made me think ((a) accurate interpretation of others' emotions with no concern for others' distress, which is characteristic of psychopaths; and (b) the inability to recognize and accurately interpret other people's emotions, which is the NPD style.) Can one person appear to exhibit both? If there's an emotioin they do have - fear? shame? - they may react as (a) whereas they may have no idea what is going on with, say, me sympathising with someone else and show (b). But this is on the basis that (a) is really understanding emotions and I wonder. I suppose it's like a computer interpreting.  Maybe I've been in contact with people more towards the psychopath end of the scale that I imagine. Sometimes i think so for sure. An NPD + Psycho. Interesting if nothing else.

sKePTiKal

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #17 on: December 03, 2010, 08:18:03 AM »
Quote
2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
 
Translation: Narcissists cultivate solipsistic or "autistic" fantasies, which is to say that they live in their own little worlds (and react with affront when reality dares to intrude).

Thanks Lighter! This is the feature that most drives me into a self-destructive coniption-fit of frustration and exasperation. But, the fastasy or delusion isn't only limited to starring in a "happily ever after" narrative. The way I've gotten to know it, is where the story-line is how much was sacrificed and what a martyr who "out of the goodness of her heart".... yada, yada, yada. Completely denying the existence of other choices - and the direct negative results of the self-imposed martyrdom. Including what the same choice looked & felt like from MY experience!! There is a distinct inABILITY to understand that I might see it/feel it differently or to understand why. As if I - me - who I really am as a person - doesn't exist in their reality; I only exist as the character that they have created for me.... and difficulty arises, if I speak or act "out of character".

It's different from the "we all have our reality" phenomenon, in that there is an acknowledgement that one is choosing to see things a specific way and accepting that others might have a completely different viewpoint. What distinguishes the N, is that he/she will persist persuading and expecting other people to accept their own "reality" as being the only "real" one... and everyone else who sees something else, is just out to hurt, harass, embarrass or discredit them (or alternately stupid, foolish or crazy) - because they had a different experience of the same situation or series of events!

And lord, don't hold their feet to the fire with "proof" that they're wrong, either!! It's as if they are able to dissociate their brains on command... and they literally don't hear you or see what you're showing them. They are ONLY able to exist in that "autistic fantasy" - and have extreme difficulty dealing with normal, real situations of everyday life. Maybe this is why there's always a co-N, or often enough to see the pattern. They need someone to interact with the real world. For them. Because they can't - their self-narrative won't allow it.... unless they are "making everyone jump" according to their whim and delusional reality.
Success is never final, failure is never fatal.

Guest

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #18 on: December 03, 2010, 10:29:31 AM »
Amber, yes. Altho I can get frustrated, now I tend not to so much. Frustration comes from wanting it to change? If I think long and hard enough,I guess what I end up feeling is sick. Sick of 'them', cold with it. There are too many. Etc.

Yeah, we don't exist as real people, but then nobody does to them. I really don't care any more about that, how I appear or don't, to some screwed up N-scale psycho half-human (I agree with Sam: they are *not* fully human). So they might think I'm crazy/stupid/harmful? Who cares. Really.

Your last para: oh yep. This is why they need co-Ns; this is why we have laws and prisons.

sKePTiKal

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #19 on: December 04, 2010, 08:04:40 AM »
ah! thanks Guest; I hadn't seen "frustration" in the same light as "hope"... like hoping my mom would change = being frustrated that my brother (who is GC) wants to beat me up with his anger and makes everyone around him crazy by not being engaged in what is going on around him... and then needs to blame someone, which can't be himself... then looks for someone to beat up with anger... he is constantly sabotaging or throwing a monkey wrench into what should be straightforward, simple processes... with totally absurd justifications for it. Delusional "reasons".

yeah; I guess I should just take a number on the frustration thing. It's not something special he reserves for me; it's not personal; it's just his schtick. Back slowly away from the foaming at the mouth N..... distract him... then, spring the trap. Now I know where this kind of thinking comes from!  I've had a lot of practice.

:D

Success is never final, failure is never fatal.

sKePTiKal

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #20 on: December 04, 2010, 08:23:30 AM »
oh..............yeah.

I think I just convinced myself that the success of healing for those of us who've been "limited" through relationships with these people, who for sake of clarity & understanding need to have a name and a set of definable characteristics.....

in other words, I think it's important to keep NPD in the DSM.

How much more difficult would it be for one of us to heal, if we couldn't simply refer to a known set of traits of NPD - and therefore the known kinds of "fall out" on others which do seem to have identifiable patterns?
Success is never final, failure is never fatal.

Guest

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #21 on: December 04, 2010, 10:57:46 AM »
CB, whoah, my goodness, yes, put the father in the psych ward or somewhere just as secure. Agreed, labels aren't everything by any means.

Amber, at least the DSM folks don't control the intertubes eh? Doesn't matter what they call it or don't call it. This website and others will be found by people who want answers etc.

Lupita

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #22 on: December 04, 2010, 11:35:26 AM »
I have the sneaking suspicion that this committee has narcissistic people inside.

It is like saying that all our suffering does not exist.

debkor

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #23 on: December 04, 2010, 12:26:28 PM »
I understand that you can be very self centered and not be a narcissist.  I also understand that (narcissist) is being applied very freely to people who don't fit (narcissist) but have some of the traits (and by non professionals). 

But to know a (true narcissist) you have to live with them 24/7  and don't need to be a professional.  Of course at one time we may not have been able to (label)
NPD but we sure did know (NPD). 

So we went runining.....HELP ME...some of us middle aged  to the professionals (with many years of either living/raised by 24/7) of not A Person (young) narcissistic (w) traits manipulation and so on that can still (grow out of or grow up) and haven't yet?  Well we really can't say they are narcissist (because that don't exsist) but they sure are narcissistic with manipulations for the last 65 years....HELLO!!!!!!!!

Oh come on now!

I can say when I was with ex-h (in our 20's) and the mental health professionas to diagnosis (narcissistic with manipulation traits) probably would have been appropriate.
And there were many more traits then just that.  But I can see how they do not want to label (at young ages) and hope with T or just one Growing Up ...can happen.
And I can see (at the age of 54) that it is appropriate to diagnosis NPD. 

It's 28 years later....and only 1 1/2 -2  don't remember .....My ex-approached our S (for contact) with (new to be) Personality Disorder/narcissistic (w) every trait there is to have....but in the year 2013 (i think it said) no longer a narcissist?

To the commitee:::
Fome Me::

HA,HA, HA, HA, HA, HA, HA, HA, HA!!!!!!!!!!!!!!!!!!!

Shwoooosh!!!!  Felt like that old time  ....Gas Lighted ...feeling!

I AIN'T BUYING IT!

I understand you don't want to Jump on....YEAH they are NARCISSIT

but what about ....28 years later  (like my kids a father) with no hope/no healing AND no Professional in the Mental Health Field (being able to help him) for when he did go he didn't stay. 

And I think someday (there will be a break through) but not today. 

So the DSM of NPD. (healed me) help me understand, let go, heal, be compassionate and forgive.   It also helped me teach my children about thier father's disorder and to have no hatred, compassion and forgiveness. 

So as of today::  It's still NPD and so many effected by people whom suffered from this diorder have been helped (understanding) the disorder.

The damage that will be done (will be to the people effected by it) more then the narcisisist. 

Like I sad...I can see being very carefull to not diagnosis a young person...Agreed.

But 28 years later?  I think your safe!

NPD.






JustKathy

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #24 on: December 04, 2010, 06:07:45 PM »
Quote
But 28 years later?  I think your safe!

Exactly. To remove it now sends a message that the disorder no longer exists, that these people who have tortured us are what? Cured? Might as well call them cured if they don't have NPD anymore.

I have no problem with the DSM removing NPD IF they intend on replacing it with another term. With the word narcissist being thrown around casually by talk show hosts and tabloids, I'd actually prefer a new name for the disorder. But to have nothing at all is bad, really bad. We, as victims, have suffered SO much. We deserve some validation. Call it Whackadoodle Syndrome, I don't care, but call it SOMETHING. Don't try to tell us that it no longer exists.

mudpuppy

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #25 on: December 04, 2010, 09:28:58 PM »
From the NYT article:

Quote
He also blamed a so-called dimensional approach, which is a method of diagnosing personality disorders that is new to the DSM. It consists of making an overall, general diagnosis of personality disorder for a given patient, and then selecting particular traits from a long list in order to best describe that specific patient.

This is in contrast to the prototype approach that has been used for the past 30 years: the narcissistic syndrome is defined by a cluster of related traits, and the clinician matches patients to that profile.


Now one can quarrel with the new approach, but to say that someone who has NPD will now be declared normal and not disordered is not accurate. Nor does it seem to be a method of denying what they do to their victims or the seriousness of their illness.

mud

JustKathy

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #26 on: December 05, 2010, 09:31:52 AM »
I'm not saying that Ns will be declared normal in the literal sense. That's my own interpretation - if NM no longer has NPD, then what DOES she have? If thy are not going to replace NPD with another clinical term, it essentially means that the mother who I have believed for decades to have NPD, no longer has it. It leaves me dangling in a confused state and places me back at square one, when I didn't know what was wrong with her.

With this change, I need, for my own validation, a new clinical term that I can apply to my NM. According to the quote that Mud posted, she still has a personality disorder, but I would need to start the identifying process all over again, sit down with a psychiatrist, go through her particular traits, and identify some new term. So it sounds like ten of us on this board could see a professional, go through this process, and each come out with a slightly different diagnosis. That's just messed up. One thing I've found in reading this board over the years, is that all Ns have eerily similar traits, right down to using the same vocabulary words. Seems to me that they SHOULD fall into one clear category, not be analyzed on an individual basis.

sunblue

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #27 on: December 05, 2010, 09:28:43 PM »
Oh no!  I think this would be a very, very bad move!  It's one thing to redefine NPD,clarify it...but not to eliminate  it.  It's been hard enough for anyone like us, vicitims of Ns, to be taken seriously by the medical community.  If it's eliminated from the DSM, it's just as if the damage and pain we endure means nothing...that it's not real and doesn't matter.

Espeically since it seems NPD behavior is on the rise, why now eliminate it from the DSM?  At least when it's in the DSM, you have a chance that it can be treated...if not for the N, at least for the family who gets hurt by them.  It's not the N who will feel ignored by this move, it's those of us who have struggled with the effects of it all our lives.  After all, Ns rarely feel pain of their illness since they don't think they're ill.  they would never get treated on their own anyway.

This is heartbreaking to me.

Hopalong

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #28 on: December 05, 2010, 10:13:50 PM »
What are your thoughts, Doc G?

tx,

Hops
"That'll do, pig, that'll do."

lighter

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Re: Narcissistic Personality Disorder to be eliminated from new DSM?
« Reply #29 on: December 06, 2010, 07:02:35 AM »
I wouldn't mind seeing NPD replaced with something outsiders can more easily understand.

If I say, Psychopath with heavy Narcissistic features...... nobody knows or cares what the second part means.

If I say Narcissist, everybody has a preconceived notion of what that means TO THEM, usually something silly.

It's too confusing, IME to say Narcissist.

I'm still voting for Interpersonal Psychopath Disorder.
IPD.