Tag Archives: Narcissistic Personality Disorder

Narcissistic and Antisocial Personality Disorders #Write31Days

31 Days of Mental Health

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:


  1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.

  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.

  3. Impulsivity or failure to plan ahead.

  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

  5. Reckless disregard for safety of self or others.

  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

  7. 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.


  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

  3. 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).

  4. Requires excessive admiration.

  5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.

  6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.

  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

  8. Is often envious of others or believes that others are envious of him or her.

  9. 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.

What Are Personality Disorders? #Write31Days

31 Days of Mental Health

Welcome to day 10 in the #Write31Days challenge on mental health. Today, I will discuss the broad category of disorders I’ve been diagnosed with: personality disorders. Though there is some debate as to whether borderline personality disorder should be conceptualized as a personality disorder, it currently is.

A personality disorder is a pervasive pattern of dysfunctional thought, behavior and emotion that is stable across time and across situations. It is out of line with cultural expectations and causes distress or impairment. It usually emerges in early adulthood, though adolescents may be diagnosed as being at risk for developing a personality disorder. In fact. when I attended a conference on BPD in 2013, a psychiatrist specializing in this said that BPD can be reliably diagnosed from age sixteen on. In other disorders, such as antisocial personality disorder, there is a specific age requirement of being over eighteen.

The Diagnostic and Statisticla Manual of Mental Disorders, both DSM-IV and DSM-5, divides specific personality disorders into three subcategories, called clusters. These are:


  • Cluster A includes paranoid, schizoid and schizotypal personality disorders. Individuals exhibiting these disorders often appear odd or eccentric. The disorders in this cluster can precede schizophrenia. I tend to think of cluster A personality disorders as “psychosis light”.

  • Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders. Individuals with disorders in this cluster are often seen as dramatic, emotional or erratic. People with cluster B personality disorders are often perceived as among the most difficult people to get along with. When peope think of personality disorders in general, they mostly mean cluster B disorders. The same goes for treatment programs focused on personality disorders.

  • Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Individuals with cluster C personality disorders tend to be anxious or fearful.


In DSM-5, it is stated clearly that the clustering of personality disorders, while it has some merit, may not be very useful in clinical practice. After all, many people exhibit traits of personality disorders across clusters. When a person has features of more than one personality disorder but doesn’t teet the full criteria of any, they may be diagnosed with an unspecified personality disorder. People with other specified personality disorder display behavior that is seen as a personality disorder but isn’t listed specifically in DSM-5. Examples include passive-aggressive and self-defeating personality disorder.

There are some clear gender differences in how commonly personality disorders occur. Antisocial personality disorder occurs far more often in males than females. Borderline, histrionic and dependent personality disorder occur more in females. Though this may reflect real gender differences, it is also likely that stereotypical views shape clinicians’ diagnoses. For example, I once read that BPD is really about as common in males as in females but is overdiagnosed in women and underdiagnosed in men. Women misdiagnosed with BPD are often later found to have ADHD, which interestingly used to be seen as a typical male disorder.

diagnosticians always need to be aware of a patient’s cultural background and life history. After all, in some cultures, behavior that is seen as disordered in the western world may be normal. People who experienced extreme stress or trauma may also exhibit long-lasting dysfunctional behavior patterns and be misdiagnosed with personality disorders when they really have PTSD. Veterans are disproportionately often diagnosed with personality disorders, for example.

Effects of Institutional Abuse

A few days ago I was stumbling across blogs as I found Kim Saeed’s post on narcissistic abuse and the prison camp effect. I have never been in a relationship with a narcissist, but for some reason, I could relate to its effects. Then today I came across a post on confusion and forgiveness in emotional abuse. Some points in this post struck a chord with me. I often am convinced that I’m the one doing something wrong in every case of disagreement. This is common in abuse survivors in relation to their abuser, but I do it in any case where there is a perceived power dynamic, and I see power dynamics everywhere. Even with supportive people like my husband, I find myself second-guessing myself.

My therapist has said that I have likely been in a situation where other people controlled my life all along. This was not intended by the individuals who did this and isn’t necessairly bad. Children need some level of direction from their parents, for example. Where it gets problematic is where the child or adult becomes more controlled by parents, carers, staff or other authrotiy figures than is healthy for them. I am using the standard of the controlled person’s health here rather than society’s norms, because society allows for and even condones a lot of harmful power dynamics. Prison camps for example. What I mean is, being controlled in a way that is socially accepted can still be harmful and may have the same effects as narcissistic abuse.

One factor that makes institutional abuse, like prison camps of psychiatric abuse, more complicated than abuse by an individual, is however that the individual is not solely to blame. For example, psychiatric patients are commonly subjected to solitary confinement and forced treatment. This is institutional abuse. It involves a generally accepted power dynamic. The nurse who secluded me or the countless nurses who threatened it were not narcissists (although I have my doubts about the doctor who shove the seclusion plan down my throat without consent). They were simply doing their job, and their job was to control even if it’s for goodness’ sake.

Personality Disorders Do Not Make You Unloveable

A while ago, I mentioned having read in a women’s magazine about two people who were parents of adults with borderline personality disorder. I just reread these stories, and the first one attributed all his daughter’s unfavorable characteristics – the fact that she only came around when she needed her parents, the fact that she wouldn’t allow the parents to see her child, etc. -, to BPD. This is a pretty common theme. If you c heck out any site for family of borderlines, you’ll see that borderlines are inevitably characterized as unloveable and their unloveability is inevitably due to their BPD.

Let me set this straight for you: no mental illness makes a person intrinsically unloveable, except maybe in certain cases where the criteria of that mental illness are inevitably bad, and then we’re having a circular argument. I’m talking about psychopathy, for example, but even people with this condition may want to heal.

Borderlines and others with personality disorders more commonly than those without them have characteristics that are undesirable. For this reason, a personality disorder may cause someone to appear unloveable, but then it’s still not that personality disorder in itself that causes it, but the way the patient chooses to handle their disorder. I for one fight my BPD tendencies and try hard to recover. This doesn’t mean I’m there already – I am not, and there are still characteristics of mine that are pretty undesirable. Then again, everyone has more or less undesirable traits, and it is only when these traits cause a person to either suffer significantly or become a danger to themselves or others, that we call it a personality disorder.

Let’s also consider the fact that most people with mental illness, including personality disorders, suffer at least as much from their illnesses as those around them do. The cluster of disorders to whcih BPD belongs in DSM-IV, is characterized by the patients being a pain in the ass. Psychopathy and narcissism are in the same cluster, but then again even people with these conditions may want to heal and try to hurt their relatives as little as possible.

It’s true, most mental illnesses include odd or annoying behaviors, or they wouldn’t be recognized as mentally illnesses. I for one get extremely annoyed by most people with psychotic disorders. Then again, does this mean that psychotic disorders make someone annoying? No. It’s the annoying behavior that is inappropriate, and people without mental illness may well exhibit the same behavior, only it isn’t seen as part of a mental illness. I remember a few years back the Institute for the Study of the Neurologically typical proposing criteria for normal personality disorder, neurotypical disorder, etc. as a humorous rebuttal of the idea that those without mental illness are saved from being a pain in the ass. Check them out and have a good laugh and, if you’re normal or neurotypical, realize the truth in some of this.