Signs of SWITCHING in Narcissists and Borderlines (Read PINNED comment)

Uploaded 1/18/2024, approx. 26 minute read

Switching between self-states, pseudo-identities, sub-personalities, ego-states, never mind what you call them. Switching is a common phenomenon in dissociative identity disorder, formerly known as multiple personality disorder, although it's not a single disorder, it's a family.

It is also common in borderline personality disorder, narcissistic personality disorder and in my humble or not so humble opinion, antisocial personality disorder aka psychopathy in the most extreme and malignant cases.

Switching, anyone who is witnessed switching in a borderline or a narcissist will never forget it. It is a terrifying experience. No wonder some people use terms like positions, possession or demons to describe what's happening.

The switch can be abrupt, it could be sudden, it could be unexpected, it could be ostensibly untriggered for no reason or the switch could be gradual, incremental, but at any rate it is discernible, it's visible.

I'm going to teach you the science and how to tell that a switching event is about to take place.

But I repeat, anyone who is witnessed switching in a borderline or a narcissist will never forget it. The change in body posture, the new personality that takes over, behaviors which are hitherto unprecedented, unexpected temper tantrums, narcissistic rage or on the very contrary an eerie calm, acting out recklessness, crazy making, drama, all these are typical of switching.

Switching is a major regulatory mechanism in borderline personality disorder and in narcissistic personality disorder and this is the topic of today's video lecture.

And here I am about to switch on you to Sam Wacklin, the author of Malignant Self-Love and Narcissism Revisited and in my switched identity as a professor of psychology in CEPS Commonwealth Institute for Advanced Professional Studies and formerly in Southern Federal University as a visiting professor.

Okay credentials aside, let us delve right into the maelstrom of the switching phenomenon in borderline and narcissism.

The entire video was triggered by a comment that I've received on one of my YouTube videos, one of a few comments I haven't deleted and it said, "Are there known signs of women with BPD, borderline personality disorder, of how they are or where before and when they committed suicide compared to those who have not or don't especially during the holidays?" Suicide of course is a form of acting in rather than direct, direct aggression outwards, aggression is directed inwards and becomes self-destructive to the extreme. Suicide is acting in but it is also coupled with acting out. So it's the equivalent of a temper tantrum writ large. Acting in because of course it destroys the object of frustration which is the person with BPD but acting out because it punishes everyone around the borderline person. Mother, father, siblings, friends, they're devastated in the wake of a suicide.

So it's a way to punish people, it's a way to act out against people even as the borderline person destroys herself in the process.

So it's a very unique combination of acting out and acting in together with internalized aggression and externalized aggression.

Suicide is self-punitive and other punitive, generally a punitive measure.

Suicide though is preceded by switching. Before the borderline person commits suicide, she switches to another self-state known as secondary psychopathy. Before the narcissistic person becomes self-destructive, before the narcissist destroys everyone around him, his life, his accomplishments and ends badly before he does any of this which is the equivalent of suicide in narcissistic personality disorder, there is a process of switching.

The borderline switches to a secondary psychopathic self-state and the narcissist ironically switches to a borderline organization self-state. Let's translate this into English. The borderline is prone to suicide. About 11% of people with borderline personality disorder commit suicide before she commits suicide. I'm using she, it's of course a he, he is a she. Gender pronouns in this lecture are totally interchangeable.

Half of all people diagnosed with borderline personality disorder are men and half of all people diagnosed with narcissism are women.

So before she switches, before she commits suicide, I'm sorry, the borderline switches into a secondary psychopathic self-state and then she becomes extremely violent and this violent is self-directed and other directed.

Suicide is used as a tool, as a weapon, suicide is weaponized against the borderline's nearest and dearest, it's their punishment.

Similarly, when the narcissist for example is mortified or under tremendous stress or repeatedly narcissistically injured or collapses, fails to obtain narcissistic supply over a long period of time, the narcissist switches, he switches into a borderline state, he becomes emotionally dysregulated, reckless and he tends to act out.

The narcissist becomes a borderline, the borderline becomes a psychopath and this becoming, this process of becoming is what is known as switching.

One last comment before I describe the phenomenon itself.

Both people with borderline personality disorder and people with narcissistic personality disorder are prone to switching because they are very acquainted with and they often use the defense mechanism of splitting and self-splitting.

These are defenses, infantile, immature, childish, baby defenses that have survived in their initial primordial form in the adult.

So borderlines and narcissists tend to split people.

People are all bad or all good, situations are all black or all white, something is all good or all evil.

This is known as dichotomous thinking, splitting the world, splitting everyone in the world and the splitting is not permanent.

Today you could be all good and tomorrow you disagreed with the narcissist or you had a fight with the borderline and you become all bad.

But at any rate you're bound to be all good or all bad, there's nothing in between. You're never going to be gray, there's never gray, there are no shades of gray in the borderline and narcissist world.

This is the splitting defense.

There's another derivative defense, self-splitting.

The same way the narcissist and the borderline split other people, they split themselves. The borderline sometimes feels that she's all good and sometimes feels that she's all bad. The narcissist feels that he's invincible and omnipotent and omniscient and godlike and then he could have a period where he feels ruined and collapsed and a loser and a failure and inferior.

So this is a form of self-splitting.

And of course, self-splitting is possible because both the borderline and the narcissist do not possess a core identity. They don't have a stable self-constellated, integrated, always there, consistent. They don't have a self. They are selfless in a way.

And this is known as identity disturbance. When you have an identity disturbance, when your identity is not, let's say, stable over the lifespan, when your identity changes on a dime and from day to day and in response to cues from the environment and from others, when you don't have a constellated self, when you don't have an integrated ego, when all you have is an emptiness inside you, when you're nothing but a void or a black hole, an empty schizoid core, then you're constantly in flux. You are reactive to the outside, to the environment because you don't exist. You become the outcome of other people's opinions about you, other people's actions, other people's choices determine who you are, other people's decision making push you to and fro like a cork on ocean waves.

So this flotsam and jetsam existence of the narcissist and borderline, the lack of a stable integrated core identity, the constant use of splitting defenses against other people and against themselves. All these prepares the ground for switching.

Switching is essentially, as the name implies, a transition from one state to another and back, back and forth.

And this is possible if you can simultaneously harbor or include in your mind two states, three states, six states, and you can do this only if you don't have a unitary self and if you constantly split.

So these are the psychodynamic or psychological foundations of switching.

Now switching occurs in borderlines and narcissists when they are confronted with a threat, when they're threatened, but also when they are confronted with a promise, for example intimacy.

Both borderlines and narcissists perceive good things such as love, such as intimacy as threats. What you would regard as a promising thing, something to look forward to, a reason to get up in the morning and to enjoy life, narcissists and borderlines would regard as imminent looming menace because in the narcissist and borderline's life there's never been a happy ending. Everything ended badly, every promise was broken, every intimacy violated, every love ended in hurt and pain.

So they've learned to associate positive things with negative outcomes and consequently they react identically to promises and threats.

And so these promises and threats can provoke switching.

So ironically when the borderline for example is faced with a wonderful partner who is proposing to her and you know she's about to start a great life together and to graduate and to have a career and when things go extremely well she's likely to switch and destroy everything.

So same with the narcissist. It's a form of asserting control. Things are going to end badly but on my terms and conditions. I'm going to make them end badly. I'm in control of this process. I'm making it happen.

So this is not happening to me but I'm making it happen. And so threats and promises. These threats and promises can be real, they can be imaginary, they can be anticipated, they can even be recalled, figments of memory.

So some memories can trigger switching. This is erroneously known as emotional flashbacks. Flashback occurs only in PTSD, post-traumatic stress disorder. There is no such thing as emotional flashback. It's a nonsensical juxtaposition of two words. There's no such thing clinically.

We don't teach it in any university. This is rank nonsense.

However, it is true that recalled situations, emotions in memory can trigger switching.

And so this is the background, this is the landscape that provokes switching in borderlines and narcissists.

Switching, in other words, is responsive to real or anticipated or imaginary or recalled environmental cues.

The borderline and the narcissist switch in reaction to stress, anxieties such as separation insecurity also known as abandonment anxiety or engagement anxiety, substance abuse, medication, holidays, important events, life crisis, traumas, new people, crowds, modification and so on.

All these can and very often do trigger switching, even sensor sensory inputs, smells, sights, sounds can provoke switching.

Indeed, one of the one of the great biggest, at least in terms of number of pages, one of the greatest documentations of switching is Marcel Proust's work, Remembrance of Things Past.

The book, which is I think the largest, I think it's 3000 pages, the largest book ever written, the book starts with a smell. The protagonist of the book passes near a house and there's a smell wafting out of the house, smell of specific type of cookie. And this provokes an avalanche of memories.

And there is a great description of switching. And throughout the book, there are multiple occasions of switching expertly described by the amazing Proust, who spent most of his life in bed consumed by tuberculosis and possibly hypochondriasis and other mental health disorders.

So we have established by now that switching is essentially a splitting defense, self-directed self-splitting is a form of self-splitting. It is a reaction to perceived, real, imaginary, anticipated, recall, threat, or promise, because borderline is the narcissist perceived promises as threat.

And we also understood that switching is utterly triggered by events outside the borderline in the narcissist in the outside world, external events in the environment, we call these environmental cues.

Okay. Now, switching, as I said, is very visible, very discernible. By the end of this lecture, if you listen carefully and survive it, you'll be able to tell when narcissist or borderline is about to switch.

It is switching is preceded by a period of emotional dysregulation.

Now, this period could be as brief as 10 seconds, or it could be as long as 10 months. But there's always emotional dysregulation, which precedes the switching.

This has been first described by Hoban, H-O-U-B-E-N, and he coined the phrase emotional switching.

So there's always emotional dysregulation. Suddenly, there are speech acts, behaviors, body language, micro-expressions, facial expressions, crying, screaming. Suddenly, there are behaviors indicative of emotions, which overwhelm the defenses of the narcissist and the borderline, emotions which create a clinical process known as decompensation.

The defenses are deactivated, the borderline and the narcissist remain face to face in direct contact with reality, external reality in the case of the borderline, internal reality in the case of the narcissist, is shame, is reservoir of shame and guilt and rage, early childhood, repository.

So emotional dysregulation, it's very easy to tell emotional dysregulation because emotional dysregulation in the vast majority of cases is somehow externalized.

The borderline will suddenly cry, weep, weep or cry. She will crumble. The narcissist would throw a temper tantrum. Both of them would mumble and become paranoid. They would both begin to talk about dying or suicide.

And so emotional dysregulation is very easy to spot. I mean, you need to be seriously obtuse and insensitive to not notice emotional dysregulation.

And then the reaction is what has happened here? Why are you like that? What's wrong?

So if you if you suddenly find yourself in a situation where you want to ask, you feel compelled to ask the borderline or the narcissist, what's wrong, dear? Or what's wrong, not dear, then you're faced with emotional dysregulation.

Now, emotional dysregulation precedes switching. And this is a phase known as emotional dysregulation.

We have to have a phase called emotional dysregulation.

And then there are three types of switching, consensual switching, forced switching and triggered switching.

I will explain the difference.

These terms are borrowed from the study of DID, dissociative identity disorder, where switching is the regulatory mechanism among the various personality segments or figments known as alters.

So consensual switching is when the switching is anticipated so that the borderline knows, for example, tomorrow, I'm going for an exam at school. I'm not prepared. I'm highly stressed. I'm highly anxious. And she knows that switching is about to occur. She knows she's going to switch to a secondary psych.

Similarly, a narcissist is faced with a public speaking engagement, and he knows that he's not prepared, or he knows that his enemies and detractors are in the crowd, in the audience. He anticipates bad things, a failure, public humiliation, modification. So he steals himself, he prepares himself for this eventuality. And he knows that he's going to switch. He knows he's going to become a temporary or transient borderline.

So when the borderline and the narcissist realize in advance that they're going to switch because they anticipate anxiety that is known as consensual switching.

Another type of switching is forced switching.

Forced switching is when there is a war, a conflict, a battle between self states within the borderline and the narcissist.

Now remember that in Philip Bromberg's work on self states as extended by myself, by your humble servant.

So in this theory of self states, mental illness is when the regulatory mechanism, the allocated mechanism, the mechanism that allocates resources between self states is defunct, or deficient, or problematic, or dysfunctional.

So the self states compete for resources. They're all active simultaneously, and they compete for resources.

That's a definition of mental illness in the self states, in my self states work.

So forced switching is when several self states compete for dominance in a specific environment, or under certain circumstances, or in reaction to situations, triggers, and cues and provocations.

So they compete, and there's a battle going on, a war going on. And in this particular case of forced switching, you are likely to see in the borderline, in the narcissist, elements of each self state appearing for a brief minute moment and vanishing, and then another, another self state emerges. And the new self state, the second, second self state can be diametrically opposed to the first self state.

So you see kind of a whirlwind, a tornado, a hurricane of, of self states in a mixer, and in the narcissist and the end or the borderline, they actually switch between multiple self states within minutes. It's an extremely disorienting experience to the observer, because you can't tell who, who are you faced with? Who are you talking to? And finally, the, the conflict is resolved.

And one of the more dominant self states take over, takes over, and the narcissist and the borderline settle.

So switching ends, forced switching ends in settlement, settled switching.

So at that point, one self state is evident and observable. But again, in forced switching, this is preceded by a period where multiple self states manifest, are expressed, are visible and disannable, observable. And again, this is extremely disorienting. And the final, the final type of third type of switching is the trigger switching. It's when, as I said, triggers in the environment, cues, messaging, signaling, events, including memories, anticipation, anxieties, internal cues and external cues trigger the switching. The switching in this particular case is essentially a defense constellation or a constellation of defense mechanism.

And there's a self state that is best suited to respond to the challenges of the new environment or the new person in the borderlines and narcissist life, or the crowds, or the challenge, or whatever, modification or whatever, and this self state takes over, but it is triggered from the outside.

So consensual switching is triggered from the inside, owing to anticipation of challenging events or stress or anxiety. Forced switching is internal battle between self states that has to do with a change in the environment.

So the battle is triggered, but not any specific self state. Triggered switching is when the environment triggers a specific self state, there's no conflict, there's no battle, there's no argument. It's clear that this specific self state is best for this new environment.

These are the three types of switching.

But what are the signs of switching?

Switching exactly like psychosis is preceded by a prodromal phase, prodromal phase.

Prodromal phase is just a fancy way of saying the phase that precedes the switching itself.

And it is this phase, this stage that you can observe signs, harbingers, red alerts, warnings, warnings that switching is about to occur.

Number one, a rigid body posture. The body becomes almost catatonic. There is strong muscle tones. There is a very stilted type of motion. So there is sensory motoric impairment. And this could lead to pseudo fainting, kind of loss of consciousness, or at least dislocation or instability, physical instability.

So something in the body, and the body, it's a reaction that is very similar to the way we react to a threat. It's like a deer in the headlights. It is as if the borderline of the narcissist or about to switch frees because they perceive it as a threat.

So rigid body posture could culminate in pseudo fainting, loss of consciousness, momentary loss of consciousness.

The next sign is calm before the storm, an eerie calm, menacing, ominous calm, a little like in a horror movie, when we know something bad is going to happen.

And it's just the music that cues us into this.

The music informs us that something horrible is going to happen.

So there's this calm before the storm, the eye of the cyclone, and behavior changes.

The borderline of the narcissist during this calm period, during this calm period, they're a typically kind, reasonable, even submissive. They're averse to conflict. They say yes to everything. They don't react to criticism or disagreement or even abuse in any way. And it's as if they have changed and became normal, healthy, or even I would say codependent and people pleasers.

And this is extremely eerie, very creepy, because it is a polar change. It is a radical, dramatic transformation. It doesn't last, of course. It's just a sign of imminent looming, switching.

But this phase is always there. When you see the narcissist in the borderline, calm, pacified, reasonable, consensual, seeking, submissive, conflict averse, kind, nice, compassionate, empathic, one would say, something's wrong. They're about to switch.

Next. The next sign is changes in body self-image. Somatoform changes. So the narcissist and borderline are likely to suddenly begin to dissect their bodies, to analyze their bodies. They're going to say, I've gained a lot of weight. I'm too fat. I'm too this. I'm sick. I'm having palpitations. I'm over sweating. I can't sleep.

So they begin to emphasize their bodies. What they're doing is actually they're somatizing. They're somatizing the stress and the anxiety and the adverse environmental cues. They're using their bodies to express the pending looming trauma.

This is Van der Kolk's work and Gabor Maté's to some extent. So there's a change, changing bodily self-image that proceeds switching because switching is experienced more mostly as bodily.

When you ask the borderline and the narcissist how they experience switching, they typically would describe changes in their bodies, not in their mind. As far as they're concerned, they're the same person. Nothing has changed with their minds. The minds are the same. Something has happened to their bodies.

So they somatize the switching.

Next is a dramatic, but a seriously radical, extreme change in identity. Suddenly behaviors change, preferences change, values change, beliefs change. There's over emotionality. There's a transformed cognitive style, unrecognizable cognitive style, and so on and so forth.

When you see a new personality emerging that has literally nothing to do with the previous personality, when you see a new identity coalescing where no identity has preceded it or another identity has preceded it, which doesn't share anything with a new one. There's no common denominator. It's as if a new person is born in front of your eyes, fully formed with new ideals, new values, new hopes, new dreams, new wishes, new beliefs, new commitments, new behaviors, and so forth.

When there is such a massive transition, these are self-states. What you're witnessing is switching.

Now, of course, this is most expressible and manifest in multiple personality dissociative identity disorder. Not all DIDs, not all forms of DID, but in the extreme forms of DID, this is most manifest.

But anyone who has witnessed a borderline transition or switch, anyone who has been the unfortunate observer of a switching event in a narcissist can tell you that it is no less dramatic than the most dramatic switches in DID in multiple personality.

Absolutely no less dramatic.

The changes in the borderline and in the narcissist, when they switch from one self-state to another, are equivalent of the same potency and intensity as switching in DID, in dissociative identity disorder.

Now, this is usually followed by a phase of talkativity, hyper-verbalizing, which is essentially a psychotic feature. Talkativity, hyper-reflexivity, there is a huge confusion between external objects and internal objects. And this leads, for example, to extreme paranoia because events, objects that are interacting inside your mind are perceived as external and vice versa.

External objects are perceived as internal. When the narcissist and the borderline switch, the borders, the boundaries between internal and external, here and there, me and the world, these boundaries dissolve. They don't become fuzzy or blurred, they dissolve.

And this is known as hyper-reflexivity. And coupled with hyper-verbalizing, talkativity, this is extremely reminiscent of schizophrenia.

Extremely reminiscent. In schizophrenia, we have what is known colloquially as the word salad. It's disorganized speech. And this happens in switching. This phase is usually short, but doesn't have to be. Could last for a few days, but typically is more like few minutes to a few hours.

And this psychotic phase, essentially psychosis, this psychotic phase known as a psychotic micro-episode, this micro-psychotic state or pseudo-psychotic state is followed by a period of subdued slow-motion, hesitant reactivity. It's very reminiscent of waking up from a dream. It's as if they're having switched from one self-state to another, the borderline and the narcissist are waking up into the reality of the new self-state.

The previous self-state is not perceived as some kind of nightmare, some kind of dream from which the narcissist and borderline have awakened.

So there's the new self-state takes over, but there is this transition, which is again the equivalent of waking up. Having transitioned fully to the new self-state, there is impulsivity. There is pronounced impulsivity, acting on impulse recklessly. It's as if the narcissist or borderline are testing the limits, the capacities, the potency, the abilities of the new self-state.

Let's see what you can do. Let's see how far we can take it. They're testing the new self-state the same way they're testing intimate partners, because exactly like an intimate partner, it's an internal object.

So they are abusing the new self-state. They're putting it to the test by misbehaving. They're actually creating adverse conditions, which the self-state has to cope with and somehow ameliorate, mitigate and solve.

So there is a period of impulsivity and recklessness, which are reminiscent of psychopathy.

As you can see, switching involves a tour across multiple mental health disorders.

So it's like the borderline of the narcissist, kaleidoscopically transition between psychosis and psychopathy. And they are kind of all over the place in terms of mental health diagnosis, which makes switching exceedingly difficult to capture in rigid clinical terms.

It's a flux. It's a situation of flux.

And finally, the last stage of switching is dissociation. The narcissist and the borderline dissociate the previous self-state away, deleted, eliminated, forget it. This creates a memory gap. This creates lost time. The narcissist compensates for this by confabulating. The borderline compensates for this by denying that there are memory gaps and so on, by feeling guilty, by developing self-directed paranoia. She doesn't know what she may have done during the lost time and by relying on an external partner, on an intimate partner to regulate herself and her memory.

Dissociation usually is the last phase and the narcissist and the borderline settle into the new self-state.

The new self-state could last hours, days, months, years, even decades. There's no telling. It all depends again on a variety of triggers, stimuli, provocations, events, people, behaviors of people, choices and decisions of others and so on and so forth. They're going to trigger perhaps the next switching event and maybe not.

So narcissists and borderlines are regulated from the outside. They are utterly responsive to the environment, the creatures of the environment. Everything that's happening inside them, including switching, is in 90% of the cases an import.

They're importing stimuli and so on and reacting to it.

There are some signs in switching that you can perhaps give your help to.

Muscle twitching, confusion, slow, heavy blinking, memory loss, headache, clearing the throat repeatedly, changing the pitch of voice, changing vocabulary, different temperament, different functional abilities or skills, lack of eye contact and changes to the eye itself, not black eye in all these booksheets, but changes, for example, dilated pupils and so on.

Changing handwriting, appearing spaced out, adjusting clothing, totally different wardrobe and sartorial fashion preferences and changing posture.

These are all external visible signs.

There's an article about emotional switching in borderline, in the literature, in the description of this video. So be alert, be attuned to your borderline or narcissist partner.

Switching is an inevitable and oft recurring situation in both narcissism and borderline. You can't avoid it.

If you're the narcissist or borderline's partner, you are going to be exposed to multiple events of switching in your partner and you better be prepared for them. You better be able to identify when this is happening, the warning signs, the prodromal stage and prepare yourself.

Switching implies that your partner has changed in very fundamental ways and you need to change equally. You need to somehow accommodate this new version of your partner in order to not create adverse situations and problems and worse.

So the partner switching forces you in a way to switch.

Identity disturbance is therefore a bit contagious. You need to adapt your identity to your partner's new identity.

It's very disconcerting because sometimes the switching is so radical and so dramatic and so extreme that you feel that you're in the presence of someone you've never met.

And this could last, you know, as I said, could last for months or years. Although in the vast majority of cases, it lasts only for hours or days, luckily for everyone involved.

But there's no guarantee that the next switch would lead the borderline and the narcissist back to the original.

So you have met a narcissist, you've met a borderline, you create a relationship with them, you form a relationship with them as a friend, as an intimate partner, whatever.

And then they switch. They switch from self state one with which you have created the relationship. They switch from self state one to self state two.

And you say to yourself, okay, right now they have switched from self state one to self state two. If I wait long enough and I'm patient and adaptable, if I accommodate them, if I don't engage in conflict and so on and so forth, they're going to switch from self state two back to self state one.

No, there's no guarantee of this. They can as easily and as likely switch from self state one to self state three. From self state two to self state three, you may end up having to cope with 20 or 30 or 40 versions of your borderline and narcissist throughout your time together.

Perhaps this is the most difficult task to accept that your intimate partner, the narcissist or the borderline, there's nobody there. It's a kaleidoscope. It's a mirror, a reflective mirror. It's there's no core. There's no identity. There's no person. There's no self. You're not interacting with someone. You're interacting with an assembly, a troupe, a theater troupe, the cast of a film. And you need to be in flux in order to remain with this kind of path.

Because if you're rigid, and if you are unitary, and if you do have a core, and if you insist on it, your relationship is going to be very short lived.

In a way, the borderline and the narcissist force you to flow, to evolve, to change, to switch, to become someone else every now and again.

On the one hand, it's an exhilarating, fascinating experience. On the other hand, it could be very disorienting and disconcerting and frightening. It's not for the faint of heart. That's for sure.

And here, I will switch you off.

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Professor Sam Vaknin discusses Body Integrity Dysphoria (BID) and its connection to fetishism and narcissism. BID is a psychological condition where individuals have an overwhelming desire to be disabled, often through amputation. Vaknin suggests that BID may be a form of fetishism, with the amputation or disability serving as the fetish. He also connects BID to narcissism, as individuals with BID may have grandiose fantasies of omnipotence and innate superiority. Vaknin argues that further research is needed to understand the physiological and psychological aspects of BID and its connection to fetishism and narcissism.

Asexuality, Grey Sexuality, and Narcissism

Professor Sam Vaknin discusses the concepts of hypoactive sexual desire disorder (HSDD), asexuality, and graysexuality. He clarifies that asexuality is a legitimate and healthy sexual orientation, but HSDD is a disorder that requires treatment if it causes distress. Vaknin also explains that all narcissists go through phases of asexuality during the pathology of their disorder, but not all asexuals are narcissists. He warns that asexuality has become a form of identity politics and may be exploited by narcissistic and psychopathic individuals.

EPCACE: Between PTSD and CPTSD (Trauma in Adulthood, Late Onset)

Professor Sam Vaknin discusses the diagnosis of Enduring Personality Change After Catastrophe Experience (EPCACE) and its differentiation from Complex Post-Traumatic Stress Disorder (CPTSD). He argues that EPCACE should not be subsumed under CPTSD, as the reactions to the diagnostic issues are not the same. He suggests that EPCACE should be reconceived with a set of diagnostic criteria that incorporate symptoms such as somatization, self-harm, and sexual dysfunction. He also believes that diagnoses such as masochistic personality disorder, sadistic personality disorder, and negativistic, passive-aggressive personality disorder should not have been eliminated.

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