NPD to be included in DSM-V as of 21st June

[bellelang83]

Just found out the good news - NPD has been included as of the 21st June into the proposed changes to the DSM-V. Must have been the uproar it caused in the psych community that allowed it to be added back in. It's also more detailed in it's current manifestation.

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=19

[CZBZ]

Thanks, Bellelang! It was quite a feat, eliminating NPD from the DSM-V when respected psychologists have documented clinical research on this personality type for decades. The Big Names came out when the committee proposed eliminating NPD and measuring narcissism as a dimensional trait. For myself, I couldn't see why the two could not co-exist so this is good news.  Some of the 'debate' has been public...if you run a search, you can find articles written from every side of the debate and some rather 'heated' arguments, too. 

My sense is that tightening the criteria will eliminate  some of the confusion people have about a narcissistic trait OR a persistent, consistent characteristic. A brief scan of the committee's proposal reinforces an article I read by Elsa Ronningstam suggesting self and interpersonal impairment would indicate a more pervasive form of pathological narcissism, possibly NPD. Levels of Personality Functioning.

Someone with NPD will have interpersonal conflicts; i.e.: marital problems, inability to get along with people at work, interrupted careers, drama issues in the neighborhood, etc. They will manifest self-impairment, too such as depression, self-regulation, substance use, eating disorders, even suicidal ideation.

In other words, someone with NPD will cause problems in every relationship whether it's with other people or with themselves. This can of course, become extremely complicated because NPD is often co-morbid with other disorders (one reason why the DSM-V committee wanted to eliminate NPD completely).

I look forward to reading future articles about the committee's proposal to include both NPD and narcissism as a dimensional personality trait.


Hugs,
CZ

[JennyWren]

If we remove NPD from the DSM-V....will all the Ns evaporate?

A nice thought. 

[CZBZ]

  Back atcha!

I figure if they remove NPD from the DSM-V, the only thing that will happen is that narcissists will be given a different diagnosis cuz for sure they've 'earned' a spot in the DSM Bible. Many Ns would be viewed as having BPD and others will be pushed into a more accurate category: antisocial PD (psychopathy). I kinda felt neutral about it all because ultimately, what an azzhole's diagnosis might be doesn't matter a whole hill of beans. He or she is pathological, what more does anybody need to know?

We could have a diagram of Normal to Abnormal human behavior and leave it at that. BUT, therapists are still hoping they can address/treat a client's problems and help them become less horrible. 

A diagnosis is for treatment and that's the primary value for having tight criteria helping the therapist pinpoint a client's problems.

Hugs,
CZ

[JennyWren]

To me, the only thing that counts is what treatments/therapies are effective in changing/improving Ns behaviours. It`s lovely an` all to have them labelled up all accurately (if only...sigh!)...but if makes not a jot of difference if all that means is "They have NPD....run away and never speak of them again". We know that.

It would be lovely if instead of worrying so much about what to call them, we could round some up, and have psychologist boffins prod them until it was understood WHAT ON EARTH they are thinking! And maybe find a way to deal with...or manage them more effectively. Coz right now....we are in the dark ages when it comes to this mindset. Perhaps we could try leeches?!!??

[bellelang83]

I think without a diagnosis however you couldn't pin point their behaviour and say it was certifiable. I always thought my NM was a nutcase but until I found out about NPD and told this to the police when they brought the mental health unit team around I never could say her behaviour was that of a disordered person. People would merely say she was manipulative or shrewd but I knew her behaviour to be a lot worse than that. Since I didnt know what was wrong with her and couldn't put a label on her, I was more inclined to be subjected to her madness without ever being able to do anything constructive about it. My fear about removing NPD from DSM-V was that suppose others were in my shoes and went looking for a reason as to why their partner/parent were a certain way and they read a set of criteria which did not fully encompass their pathology they would most likely not have found out the truth like we did. So I was quite concerned when I first found out they were removing it from the DSM V. I think it's been rightly restored now they've bowed down to pressure from their own community.

[CZBZ]

For some reason, people are more amenable to saying someone has a NPD than saying they're psychopathic. Perhaps it's because we can each understand 'narcissism' from our personal experiences. We know what it was like being a self-centered teenager or a totally clueless child who didn't yet grasp 'altruism' and the whole world revolved around our birthday party. So people can relate to some degree is my point. That we might also have psychopathic 'holes' in our heads is too hard for people to identify with.

If you say your Mom is a psycho, everyone assumes its hyperbole. Or they assume you're a total brat, as ungrateful as they come and you need to be reminded that she's your mother-by-gawd-give-her-a-break. If you tell them however, that she has a mental illness or disorder, THEN they listen more carefully to what you have to say.

The thing about narcissism that is troublesome though is that people minimize the severity of this disorder because they assume narcissists are like themselves---occasionally self-centered and thoughtless and perhaps too materialistic. So some people believe eliminating NPD from the DSM would better distinguish 'normal narcissism' from 'pathological narcissism'.

Its the same thing with any mental disorder/illness.This is good and bad...because people lack in-depth knowledge about mental illnesses/disorders, they over-pathologize people who are likely more mentally  healthy than themselves. Take Aspergers, for example. It's frustrating how fearful people are of someone with Aspergers yet they think a rat bazturd is an American Hero.


Hugs,
CZ

[too_many]

Speaking of Asbergers, CZ, do you watch Parenthood?  One of the child characters was diagnosed with it last season, (instead of anxiety as Steve Martin's son was in the movie), so I'd be curious how the character rings for you, if you've seen any episodes.  It does seem like the show has a following among Asperger parents... I love all the characters, even if I can have issues sometimes with the plots. I hope it gets to keep running!

[CZBZ]

Nope, haven't seen Parenthood. I don't watch much television now that i have Netflix. Parenthood isn't streaming on Netflix yet but when it is, I'll watch it!


Thanks for the tip!
CZ

[JennyWren]

I find part of the problem is the actual term Narcissist. While the poetic mythological roots of the word are nicely apt...it means that somebody who is simply vain is described as Narcissistic. It is a word in general use as a mild and quite funny vanity issue.

But is a word with so many shades of meaning. Then there is the idea of "Healthy Narcissism". None would be terribly pleased if you expressed your considered opinion that they displayed a healthy level of Psychopathy. 

I think this confuses an already confusing set of definitions. NPD in itself seems inset with types and subtypes and shades of subtypes....and subtypes with slightly different hats on and little mostaches.

The DSM definitions are nice for diagnosing NS if you can glue them down long enough...but it is so  complicated as a disorder...and with the grey areas of associated vocabulary use of the word Narcissist.

[CZBZ]

I so agree with you, Jennywren! Once social psychologists began writing and studying narcissism, it moved this disorder into the realm of normality. We've reduced a serious disorder to being a braggart which isn't realistic of course. Braggarts can be completely lovable and empathetic. They just like attention.

So there is a lot of confusion right now and people who are seriously malignant, are getting a Free Pass. People now assume that a narcissist is someone who poses too long in front of a mirror. Good and bad, right? It's good because perhaps people can change narcissistic behaviors before it's too engrained. It's bad because a malignant narcissist is de-pathologized.

As always, we flip from one extreme to the other.


Hugs,
CZ

[Legs]

Me too on the agreeing with Jenny...there should be a more descriptive term to describe what a true N does..the targeting of an innocent, the pretend stage where they lure you in by making you think they are your soulmate, the disdain when you are not 40 anymore...now you had the indecency to turn SIXTY????? How dare you. The sneaking, lying, cheating, thieving deception..the lies are the worst thing to me. Even when you finally do understand exactly what they are and what they've done, the don't even have the balls to admit it. And then when you no longer see them as they desire to be seen, you're out with yesterday's trash. All of that has noting to do with looking at your image and falling love with your own beauty. THERE NEEDS TO BE A BETTER NAME for toads like Lucifer.

I am back in angry place and hope I can use some of the energy to get organized. I spent a few days doing art and it was pleasing and I am glad to see I still have my sense of humor intact. I do wish I knew how to post a picture and I would post an altered card that I made last night for a challenge for a stamp company. It's not done in Photoshop..it's all old-fashioned cutting and pasting and then I did scan it and made the background really black.

Anyway, I just wanted to chime in and b*tch about the crappy term we are using for these horrid selfish and nasty creatures.....and hope all of you have a decent weekend with NO N's in sight!!! I know where I'd like to stick that Giant Roman Candle!!!


Legs

[SusyP14]

YEAH!!!  Thanks for letting us know!!! That makes me happy

[Julia]

I like the new definition... it is clearer than the DSM IV list of traits saying if someone has 5 out of 9 they were N.

Reading this new definition, my XN seems so much more clearly NPD. It focuses on the functioning of the person, and that is one area where his mask  definitely more than slipped, it fell off and floated over the 100 ft waterfall as he pondered pushing me in (perhaps to fetch it for him??)

Anyway, lots of great comments here.  Personality disorders don't go away no matter what we call them, but I think that more survivors will be able to find there way out of the web if it is clearly and uniquely identified.

 I, personally had a hard time identifying XN as an N, (despite his diagnosis), because many of the former criteria  focused on grandiosity, and confidence and that is not foremost with my XN. The new definition strikes me as more clear for both mental health specialists as well as survivors.

Julia

[Freezer Burned]

On a TV docu-drama someone, probably a psychiatrist, called the defendant a Narcissistic Sociopath. That sounds like a workable definition to me, because as long as we know the person is a Sociopath, it really isn't that important what Narcissistic means. And if they are only Narcissistic and not a Sociopath, then they probably aren't intentionally dangerous, correct? I'm assuming that the Garden Variety Narcissists are not any more "dangerous" than stupid people or clueless people or people overcome with greed can sometimes be.

[too_many]

I like that all the descriptions have this caveat at the bottom:

D.   The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

Because it seems to acknowledge that sometimes it can be the situation more than the person. 

[JennyWren]

Having just read the DSM-V definition properly and taken time to consider how it relates to the people I have observed...I must say I think the new wording is a little more precise for those professionals needing to use it for diagnostic purposes.

It also fits NH beautifully. 

[bellelang83]

The grandiosity feature also threw me when it came to my mum. She didn't boast so much - she was more results oriented. She got the nice cars, home and clothes which made her feel superior but if anyone hinted that she wasnt superior then she would snap and remind them she was god's gift to humanity. So the former description was lacking somewhat for me in tems of pinpointing N/Ps as well and agree they the new description is much more relevant. Also it seems to describe the covert Ns behaviour much better.

[Imogene]

Interesting.  When I read the more particular breakdown of the disorder (on a 0-5 scale), I realize that I don't know who my husband is at all.  I honestly don't know where to put him in a lot of these categories.  It's a bit spooky.  Who is this person I've been living with all these years?

[rossignolchante]

Interesting, my exNbf has a lot of the Anti-social personality disorder traits as well.  On the scaling, he would rate (in my unprofessional estimation) in the 2-3 zone. 

[Imogene]

Hm.  Maybe I should hop over and check out anti-social. . . . Well, it's neither no more or no less relevant, really.  He has some of both, and maybe none of either.  It's spooky, I tell you, how little I actually know this person.

[JennyWren]

I`ve had a brief look at the Personality Functioning levels for NPD and Anti-social too.

The difficulty is trying to understand a personality that is so convoluted and has no realistic self-awareness. Most of the information I THINK I know about NH is an act...or his false self...or mirroring..or just plain smoke-and-mirrors.

I think the new DSM - V stuff is much clearer. It seems like a good system for diagnosis. But it always comes back to how on earth you get an N to present honestly to a medical professional. They can play a blinder to their life partner for decades. I would imagine the number of Ns that would be willing to open up to a health professional would number.....well...approximately zero.

[CZBZ]

This link will open a prior thread about proposed changes in the new DSM-V. There are some great articles linked to that thread if you're interested in reading about the debate.

I also add a new category on the left side panel with new articles posted in our library about the DSM-V.


Hugs all,
CZ