Asperger's Disorder Misdiagnosed as Narcissistic Personality Disorder (NPD)

Uploaded 8/6/2010, approx. 4 minute read

My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

Asperger's Disorder, erroneously known as Asperger's Syndrome, can be diagnosed in toddlers as young as three years old. Narcissistic personality disorder cannot be safely diagnosed until late adolescence.

And still, Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder.

In both types of patients, both types of disorders, the patient is self-centered and engrossed in a narrow range of interests and activities.

Social and occupational interactions are severely hampered. In conversational skills, this give and take of verbal intercourse, these skills are primitive.

The Asperger's patient body language, his eye-to-eye gaze, his body posture, his facial expressions, this body language is constricted and artificial and it's in this sense very similar to the narcissist's. Nonverbal cues are virtually absent in their interpretation in others, lacking again in both types of patients.

And yet, the gulf between Asperger's and pathological narcissism is vast.

First of all, the narcissist switches between social agility and social impairment voluntarily.

His social dysfunctioning is the outcome of conscious haughtiness and arrogance. It's the result of his reluctance to invest what he regards as scarce mental energy in cultivating relationships with people he deems to be inferior and unworthy.

But when confronted with potential sources of narcissistic supply, the narcissist suddenly transforms. He easily regains his social skills. He suddenly becomes charming, possessed of social graces and gregarious.

So in the narcissist, social awkwardness is a choice. In the Asperger's, it's an inevitability. It's a feature.

Consequently, many narcissists reach the highest ranks of their community, church, firm or voluntary organization. They become pillars of the community. Most of the time, they function flawlessly.

And this is not true of the Asperger's patient. The Asperger's patient often wants to be accepted socially. He wants to have friends, to get married, to be sexually active, to sire offspring or children. He just doesn't have a clue how to go about it.

The Asperger's affect, his ability to express emotions is limited. His initiatives, for instance, to share his experiences with his nearest and dearest or to engage in foreplay with an attractive counterparty, his initiatives are thwarted. His ability to divulge his emotions, this ability is tilted.

He is incapable of reciprocating and he is largely unaware of the wishes, needs and feelings of his interlocutors or counterparties.

Inevitably, Asperger's patients are perceived by others to be cold, eccentric, insensitive, indifferent, repulsive, exploitative or emotionally absent.

And to avoid the pain of rejection, Asperger's patients confine themselves to solitary activities. They are like schizoids.

But unlike the schizoids, they don't do so by choice. They limit their world to a single topic, hobby or person, and they dive in with the greatest all-consuming intensity, excluding all other methods and everyone else.

It is a form of hurt control. pain regulation. Asperger's patients are subject to so much ridicule, so much mockery and so much censure, social censure, that they simply withdraw.

Thus, while the narcissist avoids pain by excluding, devaluing and discarding others, the Asperger's patient achieves the same result by withdrawing and by passionately incorporating in his universe only one or two people and one or two subjects of interest.

Both narcissists and Asperger's patients are prone to react with depression to perceived slights and injuries.

But Asperger's patients are far more at risk of self-harm, mutilation or suicide.

Narcissists rarely engage in such behaviors.

The use of language is another differentiating factor between Asperger's patients and narcissists.

A narcissist is a skilled communicator. He uses language as an instrument to obtain narcissistic supply or against his enemies or perceived enemies as a weapon, to obliterate them, to discard sources.

Cerebral narcissists derive narcissistic supply from the consummate use they make of their innate verbosity, not so the Asperger's.

The Asperger's patient is equally verbose at times and taciturn on other occasions, but his topic are few and thus tediously repetitive. He is unlikely to obey conversational rules or etiquette. For instance, Asperger's patients never let others speak in their turn.

Nor is the Asperger's patient able to decipher nonverbal cues and gestures or to monitor his own misbehavior on such occasions.

Narcissists are similarly inconsiderate, but only towards those who cannot possibly serve as sources of narcissistic supply. When they come across people whom they believe can supply them with attention, adulation and admiration, narcissists are attentive, they are considerate, they are empathic, they fake emotions wonderfully.

Asperger's want to, but cannot.

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The negativistic, passive-aggressive personality disorder is not yet recognized by the committee that is cobbling together the diagnostic and statistical manual. People diagnosed with a negativistic passive-aggressive personality disorder resemble narcissists in some important respects. Despite the obstructive role they play, passive-aggressives feel unappreciated, underpaid, cheated, discriminated against, and misunderstood. Passive-aggressives may be sullen, irritable, impatient, argumentative, cynical, skeptical, and contrarian.

Can You Diagnose Your Narcissist?

Narcissistic personality disorder is a disease that can only be diagnosed by a qualified mental health diagnostician. People often compile lists of traits and behaviors that they believe constitute the essence of narcissism, but these are often misleading. Only five of the exhaustive list of criteria need to coexist in a patient for them to be diagnosed with narcissistic personality disorder. It is not proper for laymen to diagnose people, even if narcissists rarely attend therapy or subject themselves to diagnostic tests.

The “Lone Wolf” Narcissist and His Prey

Narcissists require constant validation and attention, and their sense of entitlement clashes with their dependence on others for self-worth. Lone wolf narcissists who withdraw from society can become dangerous due to their unquenched hunger for narcissistic supply. Schizoids, on the other hand, are indifferent to social relationships and have a limited range of emotions and affect. Psychopaths lack empathy and disregard others as instruments of gratification, and they are often criminals. When narcissism, schizoid disorder, and psychopathy converge, it can result in extremely dangerous individuals.

Schizoid and Paranoid Narcissist

Narcissistic personality disorder is often diagnosed with other mental health disorders, other personality disorders such as borderline, histrionic or antisocial. This phenomenon of multiple diagnosis in the same patient is called co-morbidity. Narcissists are often paranoid and some of them are schizoid. The narcissist depends on people, but hates them and despises them. A minority of narcissists choose the schizoid solution.

Narcissists: Difficult and Hateful Patients

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Avoidant personality disorder is characterized by feelings of inadequacy, inferiority, and a lack of self-confidence. People with this disorder are shy and socially inhibited, and even constructive criticism is perceived as rejection. They avoid situations that require interpersonal contact and find it difficult to establish intimate relationships. The disorder affects 0.5 to 1% of the general population and is often co-diagnosed with mood and anxiety disorders, dependent and borderline personality disorders, and cluster A personality disorders.

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Narcissism is a spectrum of behaviors, from healthy to pathological, and the Diagnostic and Statistical Manual specifies nine diagnostic criteria for narcissistic personality disorder (NPD). A malignant narcissist is someone who has NPD and wreaks havoc on themselves and their surroundings. They feel grandiose and self-important, exaggerate accomplishments, and demand recognition as superior without commensurate achievements. They require excessive admiration, adulation, attention, and affirmation, and are interpersonally exploitative, devoid of empathy, and constantly envious of others.

Lonely, Schizoid Narcissist

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Covert narcissists and passive-aggressive individuals share some traits, but there are key differences between them. Covert narcissism involves hidden grandiosity, while passive aggression is about internalizing negative emotions and expressing them indirectly. Both can be emotionally invested in failure and have a negative impact on others. However, passive-aggressive individuals focus more on frustrating and undermining others, while covert narcissists are more invested in their own grandiosity.

DSM V Alternative Model for Narcissistic Personality Disorder (NPD)

The Diagnostic and Statistical Manual (DSM) is the bible of the psychiatric and psychological profession. The DSM-5 provides diagnostic criteria for Narcissistic Personality Disorder, but these criteria are deeply flawed and do not reflect the knowledge accumulated over the last 14 years. The DSM-5 attempts to remedy these shortcomings by proposing an alternative model of narcissism, which is more advanced than the DSM-4 but still falls short in certain areas. Overall, the DSM-5 is light years more advanced than the DSM-4 in subsuming and synthesizing current knowledge about narcissists, but there is still a long way to go.

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