Background

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.

If you enjoyed this article, you might like the following:

Signs You are Victim of Narcissistic Abuse, Not Common Abuse (Stress, Depression Management Webinar)

Narcissistic abuse is a subtype of abusive behavior that is pervasive, sophisticated, and can be practiced either covertly or overtly. Victims of narcissistic abuse often experience depression, anxiety, disorientation, and dissociative symptoms. This type of abuse can lead to complex post-traumatic stress disorder (CPTSD) and even elements of post-traumatic stress disorder (PTSD). The way individuals process and react to trauma can lead to either regression into infantile behaviors or personal growth and maturation, depending on their emotional regulation and maturity.


Narcissist: Is He or Isn't He?

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.


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.


Lonely, Schizoid Narcissist

Narcissistic personality disorder is often diagnosed with other mental health disorders, such as borderline, histrionic or antisocial psychopathic personality disorder. Narcissism is often also accompanied by substance abuse and other reckless and impulsive behaviors, and this we call dual diagnosis. There is one curious match, one logic-defying appearance or co-appearance of mental health disorders, narcissism, together with schizoid personality disorder. A minority of narcissists, therefore, choose the schizoid solution. They choose to disengage, to detach both emotionally and socially.


Narcissist's Victim: NO CONTACT Rules

Professor Sam Vaknin advises victims of narcissism and psychopathy to maintain as much contact with their abuser as the courts, counselors, evaluators, mediators, guardians, or law enforcement officials mandate. However, with the exception of this minimum mandated by the courts, decline any and all gratuitous contact with the narcissist or psychopath. Avoiding contact with the abuser is a form of setting boundaries, and setting boundaries is a form of healing. Be firm, be resolute, but be polite and civil.


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.


Why Narcissist APPEARS So STUPID (Borderlines and Psychopaths, too!)

Professor Sam Vaknin discusses the topic of narcissistic abuse and the intelligence of individuals with Cluster B personality disorders. He explains that while these individuals may possess high IQs, they often exhibit behaviors that appear foolish and self-defeating. Vaknin attributes this to factors such as grandiosity, lack of empathy, identity disturbance, and external locus of control. He argues that these individuals are ultimately disabled and ill-equipped to navigate life and human relationships, despite their intellectual abilities.


Narcissism: Multiple Personality Disorder/Dissociative Identity Disorder?

Narcissistic personality disorder is not a form of dissociative identity disorder (DID) because the false self of a narcissist is not a full-fledged personality, as happens in DID. The false self is a mere construct, a reactive pattern, and lacks many functional and structural elements. DID alters have a date of inception, but the false self is a process without a cut-off date. Narcissism is a total, pure solution of self-extinguishing and self-abolishing, while other personality disorders are diluted versions of self-hate and perpetuated self-abuse.


Narcissistic Personality Disorder Diagnostic Criteria (DSM IV-TR)

Narcissistic Personality Disorder (NPD) is an extreme form of pathological narcissism, which is one of four personality disorders in Cluster B. The International Classification of Diseases, Edition 10, does not recognize NPD as a personality disorder, while the Diagnostic and Statistical Manual, 4th Edition, text revision, provides a diagnostic criteria for NPD. The DSM defines NPD as an all-convasive pattern of grandiosity in fantasy or behavior, need for admiration or adulation, a lack of empathy, usually beginning by early adulthood and present in various contexts such as family life or work. The narcissist feels grandiose and self-important, is obsessed with fantasies of unlimited success, and is devoid of empathy.


Covert, Women Narcissists Make It Into NEW DSM 5-TR

The DSM-5 acknowledges covert or vulnerable narcissists and accepts parity between women and men in terms of being diagnosed with narcissistic personality disorder. However, the DSM-5 is still disappointing and the Diagnostic and Statistical Manual Committee is still somewhat influenced by the insurance and pharmaceutical industries. The DSM-5 introduces dimensional models for personality disorders, which represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another. The DSM's alternative model for narcissistic personality disorder specifies typical features of narcissistic personality disorder are variable and vulnerable self-esteem, with attempts at regulation through attention and approval seeking, and either overt or covert grandiosity.

Transcripts Copyright © Sam Vaknin 2010-2023, under license to William DeGraaf
Website Copyright © William DeGraaf 2022-2023
Get it on Google Play
Privacy policy