Is NPD in the new DSM or not?

[Dandelion]

I thought it was, but now a psychologist I know says it is not. I'm confused. ¨Tried to find it here, but you're only quoting DSM-4...

Thanks in advance

Mette

[Liftedup]

The new DSM stinks.

They took out Aspergers, so now lots of kids and others can't get help

They decided to make grief and shyness normal aspects of human living pathological.

Seems like politics wrote it, this time around.

[alatariel]

sounds like it. 

How in hades can they take Aspergers????

[Liftedup]

They did.

and it takes away help for adults and more.

 

[Chime]

My understanding is that is was being taken out until further research could be done -- although I have a theory that its inherent lack of success in treatment may have made this a push from iN$urance lobbyists, etc (I think the DSM is at times a questionable tool)

BUT, that it is now back in
http://www.dsm5.org/ProposedRevision/Pages/PersonalityDisorders.aspx

Who knows, though.  They're playing volleyball with it

Chime

[Chime]

Here's another:

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

Chime

[Dandelion]

In Europe we have ICD-10 - but there's also no NPD in it - it's so craaaazy that there no diagnosis! A nurse from psych ward told me that they use N traits to describe patients though - so they use charactaristics from NPD still even though there's no independent diagnosis. But where does that leave the rest of us? Teachers, social educators, psychotherapists - other laymen, that has responsibility for childrens and grown-ups well being?!

[Rosemary]

you darent even mention disorders in U.K. they look at you with a kind of smirk on their face like what are you talking about ??? youve been reading too many books sorta look   .

[Chime]

in the ICD-10 isn't it Passive-Aggressive, etc.?

Chime

[Dandelion]

You can see it here: http://apps.who.int/classifications/icd10/browse/2010/en#/F60.8

[Chime]

so F60.8 does list narcissism as a specific personality disorder...
why did I think it was lumped into something loosely called psychoneurotic, with passive aggressive, etc?
or is it that way?  maybe it doesn't matter... sort of different angles of similar monsters from where I am sitting.

Chime

[CZBZ]

Hi Mette,

On the left sidebar is a category titled "NPD and the DSM-5." It is located just above the category "Recent Forum Topics" and "The WoN Connection."

You'll find several articles listed in this category, discussing proposed changes to the DSM-5 which has not yet been published. Until publication in 2013, we continue to use descriptions of NPD as defined in the DSM-IV as an Axis II, Cluster B disorder.

Removing NPD as a specific personality disorder is, as others have mentioned, highly political. Of course it is. Many renowned psychologists have dedicated years of their career into understanding, defining, and describing the Narcissistic Personality Disorder as a categorical disorder, NOT a dimensional trait.

I have followed Elsa Ronningstam's writings about the DSM-5 so she is a good lead if you want to follow what's happening with NPD and the DSM-5. AT this point, they will not be eliminating the NPD from the DSM-5. A couple of her articles are listed on the left sidebar category: NPD and the DSM-5

You may also be interested in prior discussions on our forum. I've listed two of them.

WoN Thread, November 2010
A Fate the Narcissists will Hate: Being Ignored

WoN Thread, February 2010
Proposed Changes in the DSM


Narcissistic Personality Disorder in DSM V—in support of retaining a significant diagnosis by Elsa Ronningstam

"Individuals with the narcissistic personality type can present as overtly arrogant and haughty, with self-enhancing interpersonal behavior—i.e., being actively attention and admiration seeking, self-promoting, boastful, and competitive. They can also show vigorous self-serving interpersonal behavior—i.e., expecting unreasonable and unwarranted rights and services, accepting unreciprocated favors from others, or taking emotional, intellectual and social advantage of others. If expectations are not met, they tend to have intense reactions ranging from rage and retaliation to passive-aggressive rumination, to shame and severe self-criticism. While some readily express their reactions, others tend to exercise rigorous in-ternal control over their emotions, expressed behavior, or interpersonal relationships.

Those with a covert presentation have a more shy appearance and can be self-sufficient, controlled and polite, or avoidant, empty, and indifferent. On the surface they can appear tuned in, modest, or unassuming, hiding or feigning disinterest in self-promotion. However, their avoidance serves to sustain elevated self-esteem and they are still preoccupied with self-enhancing grandiose fantasies and passive aggressive reactions. They also suffer from internal vulnerability, insecurity, inferiority and shame.

A third presentation includes those who are more manifestly aggressive and hostile. Motivated by superiority, envy, vengefulness or sadism, they demonstrate systematic cruel, sadistic or violent interpersonal behavior. Some are charming, deceptive and seductive; others are calculating, exploitive and retaliating. Malignant, criminal or psychopathic behavior can also be present.”"


Commentary on “Personality Traits and the Classification of Mental Disorders: Toward a More Complete Integration in DSM-5 and an Empirical Model of Psychopathology” by John G. Gunderson

[CZBZ]

Thank you for the links, Chime! I've never actually studied the ICD-10 so I really appreciate having direct links to the F60.8 description.

It's my sense and maybe some of you agree, that tightening criteria for the NPD will benefit everyone...most especially psychologists who need a better diagnosis if they intend to help their clients. We've had numerous discussions on our forum trying to describe the 'covert' narcissist rather than the DSM-IV description of the Grandiose narcissist. Forum members descriptions match what is currently being researched by professionals in the field and it is to OUR detriment especially, if we define narcissism as grandiosity. Sure, for one 'type' of narcissism, that is true. My opinion however, is that covert narcissism is more dangerous to others and more difficult to treat which is why we talk about pathological narcissism on a broader range of descriptors than the DSM-IV categorical depiction.

Also, I think that many people who have been described as narcissists (grandiosity, callousness, lack of empathy, aggressive) would be better classified as psychopaths; however, psychopathy as a personality disorder is defined as Anti-Social Personality Disorder (Axis II, Cluster B). And the challenge with using the anti-social personality disorder to describe malignant narcissists is that it is behavioral...meaning: 'criminal activity', going to jail, breaking laws...and smart narcissists are too manipulative and cunning to get caught but that does not mean they aren't psychopaths. You see the issue?

The DSM is a great tool for professionals who need two things:

1) a method for billing insurance companies for reimbursement of services delivered
2) specific treatment for that particular disorder


As far as Aspergers being eliminated from the DSM-5 goes:

1) Aspergers will be included on the autism spectrum which means people will still receive treatment
2) Autistic children (very intelligent) were originally diagnosed as 'Aspergers'  during the Nazi eugenics policy sterilizing and killing the mentally handicapped. (link)
3) People with Aspergers argue both for and against being included in the autism spectrum. Many people with Aspergers feel that there is nothing wrong with them calling other people 'neurotypicals'; however, some people with Aspergers are unable to function on their own and require a diagnosis allowing them receive special services such as disability, career training, etc. They argue for Aspergers to be included on the autism spectrum. The tech-minded Aspies however, argue for 'normalization'...after all, they are making 'bank' now. 

After all, narcissists and psychopaths are considered to be high-achievers if they are successful making money. Why not be honest and base mental health on a person's bank balance? I am JUST jokin' PEOPLE. I do dislike very much, how we admire financially successful people and normalize their rapacious appetites for endless consumption, entitlement to anything they want, and total and completely disgusting exploitation.

Short break to blurt a few expletives and now back to the regular programming. As I was saying:

Passive-Aggressive Disorder was eliminated from the DSM-IV because it unfairly perjorized women who did not have power to confront and therefore resorted to passive-aggressive behaviors. Paula Caplan has been a champion for women by challenging DSM classifications that would 'harm women'.


And that is everything I know and now it is time to read another book.
 


CZ
 

[Chime]

Hi CZ!
But, thanks thanks belong to Mette
 
Chime

[Dandelion]

Thanks for some great posts as always CZ. I do have a problem reading those articles, I can't seem to keep my mind focused on them. I guess my current situation removes some of my ability to focus on things - either that or I have developed ADHD - Oh LOOK A SQUIRREL! 

Anyhow - I am really puzzled by the translation on that webpage, because Danish psychiatrists say it IS not a diagnosis in it self, it is just traits that can be part of another diagnosis. And yes - when the shite hits the fan, it doesn't really matter if it's a diagnosis or not, the important thing is to be able to recognize a toxic personality and act on it.

Mette

[CZBZ]

"Oh Look! A Squirrel!"   

O my gosh...that is what I say all the time to my ADD sister when we're driving somewhere together. We can be having an in-depth conversation and she'll interrupt, "Wow! Look at that woman's shoes!" I had to start laughing or shoot her. Jail isn't very appealing to me, tho. Now I just shout back, "Oh Look! A Squirrel!"

I have four sisters and we each have notable disorders. Narcissism being common in my entire family going back several generations, at least that's my view. I tend to research endlessly, being particularly interested in a variety of topics, narcissism being one of them. I'm a little bit "Aspie" in that way but it's a good way. I'd surely be bored in a world of so-called normal people who didn't have a few quirks and peccadilloes. The key to successful living is finding a niche for your quirks and peccadilloes so your self-esteem isn't taking a serious blow when people insist you're too weird for words. For example, I'd never set my aspirations on public speaking (the audience would die of boredom when I wheeled out my research books) just like a narcissist ought never set his-or-her aspirations on Family Life.

j'est kiddin'...I've been thinking too hard today. 

Anyhow - I am really puzzled by the translation on that webpage, because Danish psychiatrists say it IS not a diagnosis in it self, it is just traits that can be part of another diagnosis. And yes - when the shite hits the fan, it doesn't really matter if it's a diagnosis or not, the important thing is to be able to recognize a toxic personality and act on it.

I posted on your question about narcissism and depression, Mette. I hope my explanation didn't make matters worse. As it is today, we don't have clear-cut answers on how narcissism should be defined or even the etiology of narcissism (how it develops). So i can see why the Danish website would refer to narcissism as an aspect of personality since the dimensional view of narcissism has been researched quite heavily. They are trying, imo, to make psychology more of a science which requires measurable data.

Many of the articles in our narcissism library are based on social psychology, a dimensional view of narcissism that is based on a continuum of healthy to unhealthy narcissistic traits. Everyone has narcissistic traits that fluctuate over our lives. It is the general consensus of social psychologists such as Dr. Keith W. Campbell, that people can be called narcissists if they exhibit high narcissistic traits. Even when they do not meet criteria for a NPD.

Clinical psychology is a categorical definition of the Narcissistic Personality Disorder. You either have NPD or you don't depending on whether or not five of the nine criteria have been met. A client can have four of the nine criteria and NOT be defined as having NPD. With five criteria, they ARE npd. Rather ridiculous for anyone to assume that because the psychologist didn't check Box Number Five, that person is safe and normal.  This description of pathological narcissism relies on clinical work, treating clients with a NPD.

So academics (social psychologists) bump heads with clinicians is my view and they're acting like the rest of us when our view is being invalidated. They argue. I must admit to laughing quite a bit when psycholgists fire off angry emails or DEFEND their point of view with ad hominem attacks. Just like the rest of us.

In my view, we need a dimensional understanding for narcissism AND a categorical clinical description of the NPD.

CZ
 

[Dandelion]

Well, the topic came up since I wrote in my new book, that NPD is in DSM-4 and not an independent diagnosis in ICD-10 and described the criterias - and a psychologist wrote on my Facebook wall, that I was wrong.  So I got confused.

Haven't read your response yet, will in a while.

I REALLY REALLY wish we could sit next to each other and talk. Reading English for more than 30 minutes makes my head ache...

[CZBZ]

Is there any feature that will allow you to translate our webpages?? I can check the software gurus and see if WoN can install a translator, like google offers. The concern of course is that our 'slang' might show up as swear words or something, ha!!

Let me see if there's anything available. I really admire your knowledge of English and your persistence!

About the psychologist who said you were wrong about NPD being listed in the DSM-IV, he or she is wrong. AS of today, it will also be listed as an independent diagnosis in the DSM-5. Un-friend that guy! 

I don't know about the ICD-10.

Hugs,
CZ

[Dandelion]

YAY!

[CZBZ]

This article was published today on PsychCentral by the publisher and editor-in-chief, John Grohol: Diagnosis of a DSM 5 News Cycle

A few short excerpts from the article:

"...Kelland fails to note that Europe and the U.K. don’t actually use the DSM to diagnose mental disorders — it’s a U.S. reference manual for mental disorders diagnosis. So while it’s nice that some Europeans are expressing concern about this reference text, their concern isn’t exactly much relevant. Context is everything, and Reuters failed to provide any useful context in that article..."

"...The rest of the “briefing” was simply rehashing all of the same old arguments that both we and many, many others have already covered. It’s silly and a little demeaning to try and argue these things in the press, over and over again, because it comes down to one set of professional opinions against another. Whose set is “better” or more legitimate? Nobody can tell, because nobody has access to the future.

Oh. Except for Allen Frances, M.D. He has apparently left his position as a doctor and taken up residency as a psychic, because he told the U.K.’s Telegraph:

“DSM5 will radically and recklessly expand the boundaries of psychiatry. Many millions will receive inaccurate diagnosis and inappropriate treatment.,” said Allen Frances of Duke University, North Carolina.

Wow, really? You always seem to miss mentioning how the current DSM-IV — overseen by the same Allen Frances — has done exactly the same thing (according to its critics).

Because this press conference — uh, I mean “briefing” — was conducted in the U.K. by U.K. organizations, it was picked up in the U.K. media. (Here’s a nice summary of the coverage".)

There are quite a few links embedded in his full article, plus extra links at the bottom of the page if you're interested.

CZ
 

[CZBZ]

Dandelion, I started a separate thread yesterday. You can read it here: DSM-5: T 05 Narcissistic Personality Disorder    There is a great link on that thread comparing the DSM-IV's categorization of NPD with the revised DSM-5 proposal.

CZ
 

[Dandelion]

Great summary CZ - love it - it actually made me smile through the tears (I just wrote in my journal), so thank you so much for that.
I will read the article.

I do read a lot of the articles you have posted - even the hairy ones, because I have an idea that it will improve my english. I just read them slowly. I sometimes use Google translate to read them, but the hairier they are the more horrible the translation get LOL

Thank you

[CZBZ]

Dandelion,

I will create a sidelink comparing the DSM-IV's criteria to the new revised criteria for the Narcissistic Personality Disorder. I appreciate you bringing this topic to my attention. I should have done that a long time ago but didn't even think about it!

CZ