Why is it that compared to other mental illness’s like depression, ADHD, autism and anxiety people seem to be so hostile to NPD? I always see things about ‘mental health awareness’ yet this is never applied to personality disorders.
Just look up “narcissism”, “NPD” or “narcissistic personality disorder” and the results are about how dangerous people with NPD are and how to spot somebody with NPD or if your ex boyfriend is a narcissist etc… etc…
I was watching this video earlier by a YouTube user ‘ShortFatOtaku’ called “Low IQ Twitter Discourse Awards!” and there was this one guy on twitter who said that if you claim advocate for the mentally ill you such do so with personality disorders as well. A statement I completely agree with:
https://youtu.be/3EJedJ8MhNA YouTube
ShortFatOtaku response with “wow your going to let that narcissist kill you and take everything from you?” I shouldn’t have to explain how bad faith and unhinged that is.
Why do people think this way about narcissists? Having NPD doesn’t make someone an inherently bad person. As someone who has NPD I haven’t abused or manipulated anyone ever. Sure, I struggle with empathy, I have to make an effort to think about other people and ok I have a never ending need for validation but that doesn’t mean I’m a bad person I understand I have a problem I didn’t choose to be like this. Manipulation and grandiosity are awful traits that I have but they don’t define me. I’m a good friend, I’m a good sister, I’m a good coworker and there are people out there who benefit from my existence. NPD doesn’t have to define me I’m more then my diagnosis.
I think the important thing is really just that mental illness doesn’t shield you from accountability for how you impact other people, and for a personality disorder that primarily manifests in traits that harm people, that’s a hard thing to reconcile with that person’s merits. Doesn’t mean you can’t or shouldn’t, just that because you are still responsible for potentially hurting people, and have a disorder that makes you very likely to do so, those things will be very hard for people to square.
Another example is paraphilias. Paraphilias can include things like pedophilia, which manifests in a desire to do something that would subject someone to profound amounts of trauma, the likes of which most of us couldn’t even begin to appreciate. Can someone with such a paraphilia be a good person who is kind, and does not harm people in that way? Yes. Can that person be largely a good person in most contexts, but cause people enormous harm as a result of their paraphilia? Also yes.
In some ways we are all people with conditions that affect who we would be otherwise, and in other ways we are all just people, and conditions are used descriptively to communicate the traits that we have.
At the end of the day, the thing that matters is how you treat people. If you cause people harm, it might be more understandable given the context of a personality disorder, but it doesn’t absolve you of any responsibility. And if you don’t, then you haven’t done anything wrong. And I mean that for each moment in time, each interaction. Humans are messy and complicated, and generally ideas like “good person”, “bad person”, are reductive.
I’m sorry you feel trapped or defined by your diagnosis. That can be a painful place to be. I have a close friend with borderline personality disorder who has at times felt similarly. Only thing that matters is whether you’re an asshole. Only thing that ever has mattered, only thing that ever will.
Edit: just want to be very clear- the fact that it will be hard for people to engage with you purely based on your behaviour in a given interaction is not something you deserve. Its the actions and how they affect people that count, even if I can empathize with why it’d be hard for people
for a personality disorder that primarily manifests in traits that harm people
Drag thinks you’ve misunderstood the diagnostic criteria. The criteria specifically refer to manifestations of the traits that harm the patient. Traits that harm others aren’t counted as diagnostically significant. Like, take the “excessive need for admiration” criterion. That one’s only medically significant if the patient is suffering because of their need. If they’re abusing other people into praising them and getting what they want, then they don’t have NPD.
For example, Donald Trump has the traits as a layperson would understand them, but not as a psychiatrist would understand them. Because they’re not hurting him. Doctors only care if the patient is suffering. No pain, no disorder.
Are you positive that’s entirely correct? There are definitely disorders who’s definitions are shaped by their impact on others, like Munchausen’s by proxy, but I’m not a psychologist or psychiatrist. I could see it being described as a form of impairment to an important area of life to not being able to form healthy non-destructive relationships, and I think impairment is one of the criteria by which a disorder can be defined
I could also just be wrong though, and it’s a fair point regardless. Perhaps “defined by” wasn’t quite the right way to word things
Edit: upon rereading I didn’t actually say it was “defined by”, but the wording is still imperfect. I can only be but so anal about technicalities though; communicating my point is more important
The caregiver or partner then continues to present the person as being sick or injured, convincing others of the condition/s and their own suffering as the caregiver.
The causes of FDIA are generally unknown, yet it is believed among physicians and mental health professionals that the disorder is associated with the ‘caregiver’ having experienced traumatic events during childhood
The primary motive is believed to be to gain significant attention and sympathy, often with an underlying need to lie and a desire to manipulate others
Drag isn’t especially familiar with MBP, but this is what Wikipedia says in the introduction. That the caregiver is convinced that they’re suffering and that they need attention and sympathy. Those are the actions of someone who’s in pain, and a link to trauma makes it all make sense.
But yes, the fact that medicine is for helping patients is controversial in the psychiatric community. There’s considerable debate on the subject. But the guy who wrote the DSM IV criteria for NPD has stated in multiple interviews that Trump doesn’t have NPD, because he isn’t suffering.
American psychiatrists have to follow the Goldwater Rule, which says not to speculate on the disorders of public figures. Why? Because that’s not what diagnosis is for. Diagnosis is the first step in a plan to treat a patient and help them. Diagnosis should never be about insulting, labelling, or stigmatising a patient in the eyes of others. That’s a violation of the Hippocratic Oath.
That’s not true. NPD diagnostic criteria in the DSM-5-TR (latest version) still contains manipulation efforts and similar behavior. Quote:
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:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- 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).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
So… Donald Trump probably meets criteria for a narcissistic personality disorder diagnosis (if he ever agrees to start a “mental health journey”).
And it’s true that many disorders need to cause “clinically significant distress”, but personality disorders can be diagnosed even if they don’t cause distress to the person but causes it to others (e.g. ASPD). The DSM had to consider egosyntonic disorders, after all.
All 9 of those criteria only apply if they distress or impair the patient. Also, they’re outdated. That’s the DSM-IV’s criteria. And they’ve been criticised -
The NPD diagnosis in DSM has been criticized for being one-sided and relying primarily on external socially and interpersonally striking and provocative features.
As such, it has failed to capture the full range of narcissistic personality pathology, especially the internal vulnerability and insecurity characterized by severe self-criticism, insecurity, confusion, shame, aloneness, and fear.
Instead, the diagnosis has primarily emphasized external characteristics related to boasted grandiosity, and obviously adverse interpersonal functioning.
That’s why the DSM 5 criteria have more focus on the individual’s impairment and distress:
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and pathological personality traits.
To diagnose a narcissistic personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by:
- Impairments in self-functioning (a or b):
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high to see oneself as exceptional or too low based on a sense of entitlement, often unaware of their own motivations.
- Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain
B. Pathological personality traits in the following domain:
- Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert self-centeredness; firmly holding to the belief that one is better than others, condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
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.
E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
