DSM V Gets Narcissistic Personality Disorder Partly Right

Uploaded 10/13/2012, approx. 6 minute read

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

The diagnostic criteria for narcissistic personality disorder in the Diagnostic and Statistical Manual 5, about to be published next year, constitute a major advance over the text revision of the DSM-IV published twelve years ago.

The DSM-5 redefines personality disorders this way.

Quote, \'93The essential features of a personality disorder are impairments in personality functioning, both self and interpersonal, and the presence of pathological personality traits.\'94

According to the June 2011 text of the DSM-5, the following criteria must be met to diagnose narcissistic personality disorder.

Start with significant impairments in personality functioning in either identity or self-direction. In my view, it should have been in both identity and self-direction.

Narcissists suffer impairments in both areas.

Start with identity. The narcissist keeps referring to others excessively in order to regulate his self-esteem, according to the DSM-5. Actually, this should be to regulate his sense of self-worth, which comprises self-esteem but also other components.

The DSM also says that narcissists refer to other people for self-definition to define their identity.

The narcissist's self-appraisal is exaggerated, whether it is inflated, deflated, or fluctuating between these two poles, and his emotional regulation reflects these vacillations.

Well, finally, the DSM-5 accepted what I've been saying for decades, that narcissists can have an inferiority complex and they can feel worthless and bad and deficient, that they go through cycles of ups and downs in their self-evaluation, and that this cycling influences their mood and their affect.

The DSM-5 proceeds to tackle self-direction.

It says that the narcissist sets goals in order to gain approval from others, what I call narcissistic supply.

The DSM-5 ignores the fact that the narcissist finds disapproval equally rewarding as long as it places him firmly in the limelight.

The DSM says that the narcissist lacks self-awareness as far as his motivation goes, but actually the narcissist is not self-aware regarding any area of his life, not only motivation.

The narcissist's personal standards and benchmarks are either too high, says the DSM, which supports his grandiosity, or too low, which buttresses his sense of entitlement, entitlement which is incommensurate with his real life performance.

Next is the field of impairments in interpersonal functioning, functioning with other people.

And there the narcissist lacks either empathy or intimacy.

Again, the language is wrong, it shouldn't be empathy or intimacy, it should be empathy AND intimacy.

Start with empathy. The narcissist finds it difficult to identify with the emotions and needs of others, says the DSM, but is very attuned to their reactions when they are relevant to himself.

And this is precisely what I called years back called empathy. This is called empathy, the ability to empathize with other people, to be attuned to their needs, reactions, feelings, and so on, but only in order to make use of this knowledge for self-gain and self-purpose.

Consequently, says the DSM, the narcissist overestimates the effect that he has on others or underestimates it.

While in my view, the classic narcissist never underestimates the effect that he has on others, but the inverted narcissist does.

Intimacy. The DSM says that the narcissist's relationships are self-serving and therefore shallow and superficial. These relationships are centered around and geared at the regulation of the narcissist's self-esteem, in other words, obtaining narcissistic supply for the regulation of the narcissist's labile sense of self-worth.

The narcissist says that the DSM 5 is not genuinely interested in his intimate partner's experiences, implying that the narcissist fakes such interests convincingly.

The narcissist emphasizes his needs for personal gain, and by using the word need, the DSM 5 acknowledges the compulsive and addictive nature of narcissistic supply.

These twin fixtures of the narcissist's relationships render them one-sided. There is no mutuality, no reciprocity, and obviously, and consequently, no intimacy.

The DSM 5 then moves on to concentrate on pathological personality traits of the narcissist, and he calls them, he lamps them together under the category of antagonism.

DSM 5 says that narcissists antagonize other people with their grandiosity and attention seeking.

Grandiosity. Grandiosity has to do with the aforementioned feeling of entitlement.

The DSM 5 just adds that it can be, grandiosity can be either overt or covert, which corresponds, of course, to my taxonomy of classic versus inverted narcissists.

Grandiosity says that the DSM 5 is characterized by self-centredness, a firmly held conviction of superiority, arrogance, orchiness, and condescending and patronizing attitudes.

And then there is attention seeking. The narcissist puts inordinate effort, time, and resources into attracting other people, says the DSM 5, and these are, what I call, sources of narcissistic supply.

The narcissist places himself at the focus and center of attention. He seeks admiration, says the DSM 5, but there it gets wrong.

The narcissist does prefer to be admired and adulated, of course, who doesn't, but failing that any kind of attention would do, even if it is negative.

Even negative attention, notoriety, being feared, being hated, constitutes narcissistic supply.

That's why the DSM 5 is completely wrong, completely off the map.

The diagnostic criteria in the DSM 5 end with disclaimers and differential diagnosis, which reflect years of accumulated research and newly gained knowledge.

The above enumerated impairment says the DSM 5 should be stable across time, consistent across situations, not better understood as normative for the individual's developmental stage, adolescence, for instance, or for the individual's socioeconomic environment.

There are some environments, cultures, and societies, which encourage narcissism, actually. And the dis-imperiments says the DSM 5 should are solely, are not solely, due to direct physiological effect of a substance, drug, medication, or to a general medical condition, for instance, severe fat trauma.

Indeed, brain injury, as I've indicated in the past, does change the personality of the injured person and makes him temporarily a psychopathic narcissist.

So this is outside the diagnostic criteria. Brain injuries that induce psychopathic narcissism should not be diagnosed with narcissistic personalities.

All in all, the DSM 5 is a major improvement over the DSM 4 text revision. And we are looking forward, I'm looking forward towards the final version, which will be published somewhere in the middle of 2013. So I'll see you then.

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