You're about to watch a video about the differences between mental illnesses, including personality disorders and especially cluster B personality disorders.
These differences are known as differential diagnosis, the way to tell apart diagnosis via the differences between them.
Now, normally, self-styled experts, especially online, keep getting these differential diagnoses horribly, irredeemably wrong.
And I'm here to the rescue, the blue professor of psychology to help them make sense of their alleged expertise.
But one lesson I've learned when you're on the road all night, do not record a video in the morning, which is what I did yesterday.
So there are a few things I forgot to mention.
And I'm going to review these issues now.
Now bear with me for two, three minutes while I clarify a few points and then proceed seamlessly to the video and have as much fun as I had when making it.
OK, one minor service announcement before we proceed.
I just received word from academia.edu, the biggest academic website in the world, that my work has been cited in more than 1,750 academic papers uploaded to academia.edu and that I'm ranked among the top 0.5% of 231 million academics worldwide.
So my ranking is in the upper 0.5%.
Those of you who are very interested in my narcissistic supply can go down to the description and click on the links.
But this is, of course, not the topic of today's video.
So I want to clarify a few things that you are going to hear in the video so that you don't get the wrong impression and I don't end up as misleading as those self-styled experts.
First of all, borderline personality disorder and narcissistic personality disorder, of course, these are real diagnoses.
Borderline personality disorder is real. It exists. It's the bedrock of modern psychology ever since 1975, at least probably ever since the 1960s.
No one is trying to eliminate the diagnosis of borderline personality disorder. No one, not Judith Herman, not other scholars, not myself, no one else.
There are a few self-styled experts online who possibly as clickbait discuss, suggest that BPD is not real, but that's ignorant nonsense. BPD is real.
But what we are trying to do, all of us, to varying degrees with varying authority, what we are trying to do is we are trying to recast, reconceive of borderline personality disorder and describe it in novel terms.
We are trying to redefine borderline personality disorder as a form of emotionally dysregulated post-traumatic condition, that is the work of Judith Herman, for example.
So the general idea is to keep the diagnosis of borderline personality disorder, to rename it, possibly, emotional dysregulation disorder, and to put an emphasis on the post-traumatic aspects and on the emotional dysregulation.
Ironically, this is going all the way back to the '60s and the '70s.
In the '60s and '70s, borderline, what is today called borderline personality disorder, was perceived in terms of the emotional dysregulation, the moodlability, the chaotic life, a disorganized personality, that's how it was called at the time, disorganized personality, and there was this concept of borderline personality organization, not disorder organization.
So we're just going back all the way to the '60s and '70s before the hype of personality disorders, nothing new under the sun, but no one, absolutely no one is suggesting that borderline personality is not real.
Anyone with a single day, a single day clinical experience with patients and clients would tell you that BPD most definitely exists.
And of course, any scholar, any student, first-year student would tell you that BPD exists.
Now what about CPT-SD?
In the video, I mentioned that it is difficult to tell apart complex post-traumatic stress disorder from borderline personality disorder.
Well, there's one major difference of course.
CPT-SD, complex trauma, is transient. It's temporary. It disappears after a while. It may take five days. It may take five months. It may take five years, but finally it's over and gum without a trace.
That's CPT-SD, not BTSD.
BTSD is something completely different.
Borderline personality disorder is lifelong. It's a lifespan disorder, though it ameliorates and often spontaneously vanishes after age 45.
But it starts at age 12. It's a lifelong thing. It has nothing to do with CPT-SD in this sense.
CPT-SD is a temporary, borderline-like reaction to extreme trauma and stress.
I mentioned psychopaths in the video multiple times, but I failed to make a distinction between Factor 1 and Factor 2 psychopaths.
These are two totally distinct types of people with antisocial personality disorder.
Factor 2, for example, are impulsive. They are extremely antisocial. They are delinquent, but they also have emotions. They have access to emotions.
Actually, their emotions are dysregulated, which led many modern current scholars to suggest that borderline personality disorder may be a form of feminine factor 2 psychopathy.
At any rate, Factor 2 psychopaths are very similar to borderlines when they are stressed or rejected or abandoned or traumatized or attacked and so on and so forth.
So it's not okay to generalize.
This is another reason to dispute the idiotic statement that all psychopaths are narcissists.
Factor 2 psychopaths cannot by definition be narcissists because they have emotions. They have very powerful emotions and narcissists do not have access to their positive emotions.
Psychopaths definitely don't have emotions.
So Factor 2 psychopaths are an example of a psychopath who has emotions and to some extent empathy.
And so this, of course, undermines the claim that all psychopaths, Factor 1, Factor 2, they are all narcissists.
It's rank nonsense propagated by profoundly ignorant people.
And I don't care how many academic degrees they have.
Okay, last point.
Self-awareness is not the same as transformative insight.
You could be self-aware. You could be perfectly cognizant of everything that's wrong with you. And yet you would be unable to induce a single change in your behavior, in your personality, in the decision you make and choices you take.
So transformational or transformative insight requires an emotional correlate.
Narcissists have no access to positive emotions, so they are incapable of transformative insight.
Even a narcissist who is one of the leading experts in the world on narcissistic personality disorder, hint hint, is not capable of change, period, because his self-awareness, his knowledge of the disorder do not translate to any internal dynamic which would lead to any sort of learning which would then result in change.
Narcissists in this sense, not self efficacious, even if they are fully self-aware.
Okay, kids and cadets, onward Jewish soldiers in my case, to my YouTube. Enjoy yourselves.
And if you have anything to say, I promise to ignore it, so post it on the comments section. Don't you just love the Wagneran Horror Show?
The misinformation online by self-styled experts is a tsunami.
And here I am with a bucket trying to somehow turn back the tide.
But I'm afraid it's a lost cause.
Still, to soothe the conscience that I never had, I am doing what I can.
And today we are going to discuss differential diagnosis in dark triads.
Wow, what a title. Are you not impressed by my mastery of ten dollar words?
Differential diagnosis simply means how to tell diagnosis apart, how to differentiate between diagnosis, how different diagnoses are, differential diagnosis.
Dark tetrad personalities are personalities which are composed of four important elements.
Subclinical narcissism, subclinical psychopathy, subclinical sadism and Machiavellianism, manipulativeness.
Now everyone inhis dog and mother-in-law online is of course by now a global expert on cluster B and on dark personalities.
So I keep seeing these posts on Instagram and these videos on YouTube where dark personalities or tetra, dark tetrad personalities are described as narcissists and psychopaths.
No they are not.
Dark triad personalities and dark tetrad personalities and dark personalities in general are not psychopaths. They are not narcissists.
Dark personalities are subclinical.
In other words, the narcissism and the psychopathy in dark personalities is under the diagnostic threshold. It cannot be diagnosed.
These people do not have a diagnosis of psychopathy and narcissism.
Self-styled experts once and for all?
Can't you do a bit of homework?
Because I'm about to teach you a few things about differential diagnosis, how to tell diagnosis apart.
But to be fair on self-styled experts online, even therapists and psychologists get cluster B personality disorders very, very wrong because they are not adept. They are not competent when it comes to differential diagnosis.
Today I'm going to discuss five behaviors or traits which help us to differentiate between different cluster B personality disorders.
For example, between borderline and psychopath and narcissism.
The first thing that I want to focus on is a chaotic life.
A patient comes to a therapist and she describes a life comprised of ups and downs, vicissitudes, vagaries, exigencies, lost jobs, distraught relationships, bloody mess.
And the therapist strokes his or her chin and says, "This kind of chaos, this kind of disorganized, disheveled, disordered, unstructured life indicates that you have borderline personality disorder."
A chaotic life does not mean necessarily that the patient has borderline personality disorder.
Many other types of mental illnesses conjure up and generate chaotic lives, consider for example bipolar disorder or schizophrenia, psychotic disorders and many others.
Mental illness results in chaotic lives. You can't use this as a differential diagnosis in the case of borderline.
So what should you use?
Emotional dysregulation and mood lability.
Again, lability is not dysregulation. Lability is ups and downs, cycling.
Emotions can be labile. Moods can be labile, but labile emotions and labile moods are not the same as emotional dysregulation.
Emotional dysregulation means that the emotions overwhelm the individual's ability to function, paralyze the individual, drown the individual. That's dysregulation.
Now it is true that dysregulation often leads to lability, but they're not the same.
Emotional dysregulation is a strong indicator of borderline personality disorder.
And when it is coupled with mood lability, we are most definitely on the cusp of diagnosing someone with borderline personality disorder.
Now, borderline personality disorder resembles very much certain presentations of complex trauma, CPTSD, complex post-traumatic stress disorder.
Trying these two apart is not easy, requires a lot of acumen, experience, knowledge and reading which a vast majority of therapists and psychologists regrettably lack.
So do your homework, study.
Many narcissists and psychopaths, especially psychopaths, lead highly disorganized lives.
It doesn't make them borderline.
Mood lability is common in other mental health disorders by itself and on its own.
It's not a differential aspect of borderline.
Emotional dysregulation is a strong indicator.
Number two, grandiosity.
One who has grandiosity, this cognitive distortion and inflated fantastic self-image, that is not necessarily narcissistic personality disorder.
Grandiosity is common not only to narcissists.
Psychopathy, psychopaths are grandiose.
Particularly in the PCLR, which unfortunately is the only test currently used to diagnose psychopaths or the major test currentlynarcissistic grandiosity.
So grandiosity is typical of psychopaths.
Grandiosity is typical of borderlines.
Grandiosity is typical of paranoid.
Grandiosity is typical of the manic phase of bipolar one disorder, bipolar disorder one.
Grandiosity is a cognitive distortion.
It's a way of seeing the world wrongly, reframing realities, equivalent of a defense mechanism, gone awry. It's often coupled with fantasy, a fantasy defense.
And yes, of course, it's very common in narcissism, but not only in narcissism.
And this is the source of the idiotic, and I repeat idiotic, ignorant statements.
By self-styled experts online that all psychopaths are narcissists.
No, not true.
You're ignorant if you say this.
All psychopaths are grandiose.
Few psychopaths are also narcissists.
This is a comobility.
But don't confuse or conflate grandiosity with narcissism because it exposes you immediately as a quack.
A con artist, regardless of your academic degree.
It is not true.
The sadism is only about inflicting physical pain.
Sadism is also, for example, about humiliating someone in public. Sadism is about deriving gratification, pleasure, a sense of omnipotence from demeaning debate. Debasing, defiling, degrading, shaming, and humiliating another person in any conceivable way. That's why in abusive relationships with sadists, the sadism is not confined to sex. There is an element of sexual sadism, but there is also verbal sadism, for example.
Sadism is all pervasive. It is an extensive parameter. It's exactly like narcissism.
When you are a narcissist, you are a narcissist with your wife, you are a narcissist with your children, you are a narcissist at work, you are a narcissist when you watch television and criticize the prime minister. You are a narcissist, period.
All the elements of your narcissism manifest in all areas of your life.
Narcissism is all pervasive to use the language of the DSM. It's ubiquitous.
The same goes for sadism. Sadism is all over the place.
If your boyfriend is a sadist, he's going to defile and degrade you sexually, going to treat you as an object, inflict pain on you possibly.
When the sex is over, he's going to humiliate you and shame you in front of your parents, friends, and family, or otherwise cause you pain and bask and smile with glee. At your discomfort.
This is sadism.
Next, cruelty, callousness, ruthlessness, mercilessness.
Do not signify necessarily psychopathy.
Yes, many psychopaths are cruel, callous, ruthless, relentless, and merciless. That much is true because they're goal oriented. They want to accomplish a goal. As they've accomplished a goal, they're no longer cruel, callous, ruthless, and merciless.
But these qualities, these traits, these modes of behavior are not typical only of psychopaths.
Depending on the circumstances, someone with a borderline personality disorder can be all the above, aggressive, violent, cruel, callous, ruthless, merciless, lacking in empathy. Such a borderline can behave this way when they act out.
Narcissist when they are mortified and they choose the external solution. I advise you to watch my videos on narcissistic mortification.
These kind of narcissists also become cruel, callous, vengeful, vindictive, ruthless, merciless, and so on.
Paranoids when they're in a state of panic, heightened anxiety are also this way.
So just by observing behaviors, you cannot diagnose someone with any modicum of safety.
Safe diagnosis relies on much more than casual anecdotal observations.
Next, a lack of introspection and self-awareness does not necessarily mean that the person is a narcissist.
Many narcissists are aware of their own abrasiveness, grandiosity, entitlement, and antisocial misconduct.
Most narcissists correctly self-identify as narcissists, as I've been saying for decades.
Narcissists are also aware of the fact that they dissociate. So that you are aware that you are a narcissist doesn't mean that you have perfect memory, doesn't mean that you have a core identity, doesn't mean that you don't try to make sense of your own memory gaps via the process of confabulation.
And a lack of self-awareness is common in many other mental health disorders.
Narcissists are not cognizant of their confabulations and their fantasies. And of course, they cannot dredge up the memory gaps, the periods which they have dissociated. They are not aware of the shared fantasy as a fantasy, the mistake reality for fantasy.
Narcissism is a fantasy defense. That's a definition of narcissism.
But the lack of self-awareness, the impaired reality testing, the dysfunctional introspection, they're typical not only of narcissists, many borderlines and many psychopaths and many paramoids and even schizoids, schizotypals, people with bipolar disorder, even in depression.
In all these situations, there is an impairment, there's a deficiency in introspection and self-awareness. There are defenses, dissociative defenses and other defenses against self-knowledge that can lead to trauma and injury.
Finally, external regulation is not unique to borderline personality disorder. External regulation is when we export ego functions, when we use other people to perform functions which are usually performed internally by healthy people.
So healthy people, for example, gauge reality on their own.
The borderline, the narcissist, especially the borderline, gauges reality through her intimate partner, through her intimate partner's gaze.
There are other ego functions.
The borderline uses her intimate partner not only for ego functions but to regulate her moods, her emotions, I'm sorry, and to stabilize her moods.
External regulation is typical of borderline.
That much is true.
But there are other mental health disorders which involve external regulation.
Even mental health disorders that are the opposite of borderline.
For example, narcissism, pathological narcissism, narcissists regulate externally via narcissistic supply, so do paranoid and to a large extent so do people with psychotic disorders.
Lazy creatures are easy to observe and say, "Oh, this guy is so cruel, he must be a psychopath." Or "This guy is so grandiose, he's definitely a narcissist." Or "This guy lacks self-awareness so he's lying about his dissociation and memory gaps and confabulation." Or "This guy has a chaotic life, so this girl has a chaotic life, she must be a borderline."
No. He must go a lot deeper.
Structured interviews, several sessions of observation, talk to the patient a lot, administer tests, some of them more rigorous than others.
And only at the end of this corridor, diagnostic corridor, can you state with any modicum of certainty, not high, what the diagnosis may be.
Be humble in the face of the complexity of the human mind and the human minds, bugs and glitches.