Welcome to day 13 in the #Write31Days challenge on mental health. Today, I’m continuing to write on personality disorders. Two personality disorders that are in cluster B along with borderline and histrionic personality disorders, are narcissistic and antisocial personality disorder. I have decided to lump these together as there’s a lot of overlap between them.
People with antisocial personality disorder (often referred to as sociopaths) display a pervasive pattern of disregard for or violation of the rights of others starting by age fifteen and continuing into adulthood. They meet at least three of the following criteria:
- Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
- Impulsivity or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
- Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
People with antisocial personality disorder (APD) showed evidence of conduct disorder (severe antisocial behavior) in childhood.
Skeptics say that antisocial personality disorder basically describes recidivist criminals and as such is not really an illness. They have proposed a more severe form of the disorder, called psychopathy, that they say more accuratey describes an actual disorder. Psychopathy referst o a combination of antisocial behavior, as well as lack of empathy and remorse and disinhibited behavior.
Proponents of the idea of psychopathy developed the psychopathy checklist, currently in its revised version as PCL-R. The PCL-R consists of a number of items rated by a mental health professional. A high PCL-R score is associated with narcissistic, antisocial and borderline personality disorder diagnoses.
Narcissistic personality disorder (NPD) refers to a pervasive pattern of feelings of grandiosity, as well as lack of empathy. People with NPD meet at least five of the following criteria.
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
- Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Both antisocial and narcissistic personality disorder are seen more in males than females. Narcissistic personality disorder occurs in roughly 6% of the population, while antisocial personality disorder may occur in up to 3%.
People with antisocial or narcissistic personality disorder do not usually seek treatment voluntarily. Many are referred to treatment through the criminal justice system. That being said, some narcissists may seek treatment if they experience a threat to their grandiose self-image, which may lead them to becoming depressed. They are also at increased risk of experiencing psychotic symptoms, which may then be incorrectly diagnosed as schizophrenia. Since both APD and NPD are hard to treat, mental health professionals should focus on co-existing disorders such as depression and on risk management if the person engages in criminal behavior.