Tag Archives: Personality Disorders

First Appointment for My Second Opinion

Like I said on Tuesday, I had my first appointment for the independent second opinion I requested regarding my diagnosis yesterday. I had chosen to be referred to my province’s university hospital, where the psychiatry department has expertise on autism as well as personality disorders. I after all wanted them not to be too prejudiced for or against an autism diagnosis for me. I mean, I have had autism diagnosed previously and think I have this, but there must be a reason my treating psychologist doesn’t agree. The most important reason for this is her believing that, because I developed hydrocephalus as a baby, my diagnosis should be some form of unspecified brain injury. Since this isn’t in the diagnostic handbooks, I’m now left with “just” a personality disorder, a diagnosis I dispute.

I had a two-hour meeting with a clinical neuropsychologist and a medical psychology intern. Because I had somehow seemed to remember the appointment would take only 30 minutes, this was quite a change of game to me. I however handled it well and was in fact glad that I could explain things. I had thought they’d just rely on the questionnaires I’d filled out last week, which couldn’t possibly give them a complete picture.

First, the neuropsych said I’d come to the right place, as this psychiatry dept know brain injury, autism as well as personality disorders. I said I knew and that I’d requested to be referred here myself. She then asked me to explain my impairments. I focused on sensory and organizational skills difficulties, as my social impairments are not too obvious in my current setting. I mean, I’ve heard nurses say I can’t possibly be autistic because I can hold down a normal-sounding conversation with them. I can, but then again conversations like this aren’t meant to be truly reciprocal. I instead gave examples of sensory difficulties and problems with daily activities.

Then we went over my struggles and strengths throughout life. I started by recounting my elementary school experiences. I realized I remembered social isolation from as early as Kindergarten on. I also mentioned I remembered feeling practically burned out by age five, insofar as a five-year-old can have this experience. I forgot to mention that my parents have always said I was a cheerful preschooler at least and didn’t start having serious trouble until I had to learn Braille by age seven, presumably because I didn’t accept my blindness. I did however explain my difficulties in accepting my blindness. I explained that I temporarily accepted my blindness, or at least pretended I did, when I went to regular school at age thirteen, but never truly accepted it.

I mentioned having some friends in first to third grade, mostly older girls who babied me. I did have one friend in later elementary school too, but did experience more social isolation and trouble navigating the more complex friending process from age nine on. At this point, my behavior problems also became worse. I mentioned screaming, self-harm and physical aggression, though I only know I was physically aggressive because my mother reported it to my diagnostician in 2007. I also mentioned being good at academics. The psychologists asked about my interests. I mentioned drawing maps and calendar calculation. She didn’t ask about play, which was one area in which I was okay if behind. I mean, I still played with dolls by age twelve, but that may be considered a strength in the realm of autism, as it shows imagination.

My parents encouraged me to develop age-appropriate intersts when I was about ten. Looking back, I don’t think they knew what my peers were into either. I told the psychologist about the Backstreet Boys poster on my wall, that I only had for the purpose of fitting in. Another example that I only remember just now is my pretending to be an Ajax fan. Ajax is a major Dutch football club from Amsterdam. I am originally from Rotterdam, which has its own major football club whose fans hate Ajax, but I went to school in another city, so all my peers were Ajax fans.

When I was thirteen, I transitioned from special education to a mainstream secondary school. I mentioned feeling extreme stress then, being bullied and isolated. I did mention the four girls I was “friends” with for a few months in my first year at this school, explaining that I was way too open and clingy to them and pushed them away. I also mentioned clinging to my sister’s friends’ big sisters in later elementary school. I mentioned seeing friends in a more materialistic way than most older children see their friends. I mean, when one girl in late elementary school gave her friends candy, I believed I was her friend when she gave me candy too. I even imitated her friends by asking this girl, in the same tone of voice as they did, “Got something to chew on?”

I didn’t go into that much detail about my secondary school struggles. Honestly, I barely remember this time period, even though I kept a diary throughout secondary school. I did mention feeling like I was out of my own body or living in a movie throughout adolescence. I am surprised as I write about and recall my meeting that I barely used technical terms. I consider this a good thing.

I went on to describe my increasing struggles with self-harm and aggression after high school. I described my crisis of 2007. I didn’t go into that much detail regarding my psychiatric hospital years. I did mention some of my current struggles, like with handling unexpected situations. The psychologist asked about my challenging behavior, such as wandering, self-harm and aggression. I said it’s a lot less frequent now that I’m on medication but still happens. The psychologist wants to speak to my psychologist at the institution regarding psychological treatments for these behaviors. I haven’t had any and have never had the impression that my psychologist feels any would be helpful. This got the neuropsychologist to say she may also write some reccommendations for treatment into her report.

At the end, she concluded she does see signs of autism, but wants my parents (likely my father) and husband to fill out some questionnaires too. I will also get a bunch of questionnaires. Since they are in print only, I said I’d need help filling them out. The psychologist offered to have the intern help me, as I would not feel truly free to be honest to my nursing staff or even my husband. I liked that. She also said she wants me to get some neuropsychological testing done to provide further validation for my strengths and weaknesses. I said my psychologist had not felt this would be possible or even necessary. Some tests may not be possible but others are and this psychologist does feel it’d be helpful.

I also got a bunch of questions regarding depressive symptoms. The psychologist at one point pulled out what sounded like the DSM criteria for major depressive disorder. She didn’t finish questioning me on them, as she drifted off a bit.

I had to have bloodwork done to rule out physical causes of psychiatric symptoms. The intern took me to the waiting room, where my sister-in-law was waiting. She came to me, but I didn’t recognize her and the intern had not seen her before, so she assumed my sister-in-law was the nurse for the blood draw. As she lead me out of the psychiatry department, I remembeed to ask who she was and to say I needed to have bloodwork done. We returned and a real nurse came to do the blood draw. I am extremely hard to draw blood from, so the nurse tried three times, then called a colleague. After he drew blood, he asked whether this had been an intake interview. Since that’s what it’s called, I said “Yes”. This meant I had to have my blood pressure (pretty high), temperature, weight and height (I’m still obese) and waist and hip measurements taken. I forgot to say I’m not going for treatment here, which seemed to be the reason the nurse wanted these numbers. I had not grown in abdominal measurements since they were last taken last year, thank goodness.

Overall, I’m pretty happy with the way this appointment has gone. I will get a letter setting a date for an appointment for the questionnaires and tests.

Spectrum Sunday
Keep Calm and Carry On Linking Sunday

Dear Psychologist: Why I Believe I’m Autistic (And Why It Matters)

My psychologist wrote the referral letter for my second opinion last Wednesday. Because this second opinion thingy is now becoming real, I have been thinking of why I believe I’m autistic after all – and why it matters. I have tried to explain this quite a few times already, but nobody amongst my staff seems to understand. Because some of my readers just might actually get it, I’m writing it on my blog. I chose to write this in the form of an open letter to my psychologist, but I’m not sure I’ll ever consciously point it out to her.

Dear Psychologist,

You have been telling me ever since you became my responsible clinician in late 2014 that you don’t believe I’m autistic. You initially said brain injury explains my symptoms far better, but you seemed not to care. We needed to treat symptoms, not syndromes, you said. Yet last summer, you changed my diagnosis. And you changed it again. And again. You claim this was at my request. Fair enough, I told you I wasn’t happy with just a borderline personality disorder and adjustment disorder diagnosis and I wanted a second opinion. However, it was you who offered to change my diagnosis to brain injury-related personality change, apparently to avoid me getting a second opinion. I was stupid enough to go along. The further diagnostic changes were solely your responsibility.

Yes, I told you it doesn’t matter whether my diagnosis is borderline personality disorder and adjustment disorder or dependent personality disorder, BPD traits and depressive disorder NOS. To me, neither diagnosis explains why I’ve been having problems all my life. After all, personality disorders first become apparent in a person’s teens or early twenties, not when a person is a young child.

There were – or at least, there should’ve been – many signs of a developmental disability when I was young. Even things that my parents tout as signs of genius, should when combined with the signs that point to delay, signal a developmental disability. Like my ability to calendar calculate. Or my first word. It was “aircraft industry”, echoed from my grnadpa when I was ten-months-old (seven months corrected).

These are cute factoids about me. They don’t necessarily signal autism when taken alone. Then there are the signs that point to delay. I had motor skills delays, but these could be due to dyspraxia or mild cerebral palsy. My parents don’t know whether these were ever labeled as such. I was a toe-walker – still am when stressed. Though I walked on time (at fourteen-months-old), I didn’t sit or roll over without physcal therapy intervention.

My language development was quite advanced. I did reverse pronouns, but my parents say this happened only for a short while. I took many things literally growing up. I also had one word that I’d use obsessively and often out-of-context after another. The psychologist who diagnosed me with Asperger’s in late 2007 brushed this off because I couldn’t come up with examples right then. I can now, but I don’t have the energy to elaborate in English.

My social and emotional development was delayed from a young age on. Even though I didn’t have many meltdowns or temper tantrums until I was about six, I did have my problems. I couldn’t talk to children my age. I had trouble forming friendships. I was even more self-centered than any young child.

When I became aware of my differences, I started acting out. Educational psychologists blamed this on my difficulty adjusting to blindness. What if I’d become aware of my social difference then, too? Even though I didn’t start regularly having temper outbursts till I was about six, I remember head-banging and hand-biting from a younger age. I also had this crawling movement in bed that parents of other kids went to the doctor for when the children were toddlers. Well, let me tell you I did this till I was nineteen.

When I became a teen, I had many more difficulties. One could no longer blame my high IQ, because I was in a high-level high school were 30% of the students were intellectually gifted. Maybe then I did it all because I’m blind, even though no-one at the school for the blind had displayed these behaviors either. Or maybe I was precocious for developing a personality disorder. I guess your logic would go like this.

I could give you dozens more examples of why I believe I’m autistic. I have been thinking on these for the last few days. Many, however, are just too embarrassing to go on my blog.

My parents may not be involved with my care now, but you never asked them participate in a developmental interview. Not that I’d want you to do an autism assessment on me, after all the flawed arguments you’ve spun. You won’t believe that someone with hydrocephalus can be autistic, even though there’s plenty of literature showing that they can. You won’t believe that preemies are more likely to develop autism than children born full-term. I even didn’t bother correcting you when you wrote in my referral letter that I had had a stroke. News flash: an intraventricular hemorrhage, which is the most likely cause of my hydrocephalus but was never ascertained, is not a stroke. I don’t expect you, a psychologist, to know the difference, but then at least stop basing your diagnosis on it.

But you’ll say we should look at symptoms, not syndromes. You’ll say it doesn’t matter for my care whether I’m diagnosed with brain injury, even if it isn’t in my DSM-IV classification, autism or a personality disorder. To be honest, the main reason this whole diagnosis thing is important to me, isn’t care. It’s understanding. I need recognition of my struggles. I need to know I’m not the only one. As much as you hate this, I need something I can google and join support groups for. I’m tired of shooting in the darkness. Granted, care matters too. Personality disorder patients have far fewer self-care problems than autistics and warrant a totally different approach. I wouldn’t mind that approach if it turly worked for me, but it doesn’t. However, I don’t mind having a personality disorder diagnosis along with autism – I had one for nearly three years.

You won’t understand a thing about autistic culture. I won’t explain. I don’t have the spoons for that. (Google the spoon theory if you want to know what I mean, if you even care.) Suffice it to say that autism is not just a disorder – it’s an identity. It’s something, unlike brain injury, that is part of us before we’re old enough to realize it. It’s not a disease – it’s a part of who I am.

Hannah Spannah

Diagnonsense, Oh Diagnonsense!

A few months ago, I wrote about my changing diagnosis. My autism diagnosis that’s been confirmed three times since 2007, was removed. That left me with just borderline personality disorder (BPD) as a diagnosis. If you thought I gracefully accepted this, you do not know me. I consulted with the patient liaison person at my institution, who recommended I seek a second opinion at another hospital. Now, three months on and we’re back at square one, and it’s not because an independent provider agreed with my psychologist.

On August 15, I talked to the patient liaison person, who on that same day E-mailed my psychologist asking her to make the necessary arrangements for me to get a second opinion. Instead, my psychologist told me she wanted to contact a psychiatrist at the brain injury unit first to inquire about the diagnosis of autism in people with brain injury. This doctor told her that indeed autism shouldn’t be diagnosed in people with brain injury, but the same is true of BPD. My psychologist would need to diagnose personality change due to a general medical conditon instead. I stupidly agreed with her changing my diagnosis herself rather than sending me to an independent psychiatrist or clinical psychologist.

My psychiatrist, who is the head clinician responsible for my care, however, disagreed with my psychologist’s diagnosis. My named nurse said they were throwing around all sorts of diagnoses at my treatment plan meeting last month. Eventually, my psychologist informed me they’d settled on dependent personality disorder, borderline personality disorder traits and a developmental disorder NOS. I hate the DPD label, but can see how I might have some of its features. I needed to see my treatment plan to see what they’d meant with developmental disorder NOS, which isn’t a diagnostic code in DSM-IV unless prefixed by “pervasive”. That would essentially mean autism. As it turned out, they hadn’t settled on this diagnosis, as the developmental disorder was gone.

Instead, I now have DPD, BPD traits and depressive disorder NOS. I asked my psychologist whether this was a coding typeo, but it wasn’t. Her explanation was that I may formally meet the criteria for this, but the main reason for the diagnosis is for insurance purposes. You see, I can’t be in the mental hospital without a diagnosis on axis I (anything that isn’t a personality disorder). A nurse even twisted my psychologist’s actions like she’d done me a favor.

Last week, when I found out my final diagnosis, I lost it pretty much and was considering checking myself out of the institution. My psychologist was called, because the nurses thought I said I was definitely leaving, which I can’t remember having said. My psychologist encouraged me to leave right then, which I refused. My husband instead came to pick me up thee nxt day for a night at home to have some distance.

Today, I spoke to the patient liaison person again. She was not happy at the fact that my psychologist had failed to cooperate with me in getting me a second opinion. This essentially means we’re back at where we started and I’m probably going to ask my psychologist to get me a second opinion again soon.

Compensatory Narcissism

A few weeks ago, I was reading Believarexic by J.J. Johnson. Yes, I know I reviewed it already. I didn’t talk about one of the themes in it though, which is competitiveness, perfectionism, narcissism and how these are interrelated. As I just came across a journaling prompt on comparing yourself, I wanted to discuss this now.

I am not a perfectionist. At least, not a successful one. I make a lot of careless mistakes. I also used to send out cards and crafts for swaps that were mediocre at best and worse than a five-year-old could’ve done them at worst. In other words, I am not one to go to great lengths in order to achieve perfection. Of course, my disordered eating is also an example of this. If I attempt to keep control at all, I fail miserably at it. A psychologist who evaluated me when I was eleven, wrote in her report that I lacked self-criticism, in fact.

That being said, I do recognize what Dr. Prakash told Jennifer in the book about being on the head of a pin. If you’re on the head of a pin, you see yourself as great, expect yourself to be great, but once you fail, you hate yourself. I do expect myself to excel or I give up. In this sense, I’ve fallen off my own (and others’) head of a pin so many times that I may look like I don’t care about it anymore. But I do.

I may not show it, but deep down, I’m very sensitive to criticism. Like, I like to think of my English as great, but I definitely know that my pronunciation is an exception to this (and my written English isn’t excelletn either) My husband sometimes jokes, asking “What language is that?” when I speak English. His spoken English isn’t perfect – I’ve never seen his written English -, but it’s better than mine, so I don’t correct him or laugh about it. That being said, knowing that my spoken English is pretty bad, I hardly ever try to use it, so I don’t improve on it. I’d rather stay on my head of a pin and get people I meet online to compliment me on my (written) English.

In some areas, I am competitive and know that I will never win. Like with blogging. I am an okay’ish blogger, but I’ll never be a great blogger, no matter how hard I try. I feel deep down that this is a major weakness of mine, but I blame it on external factors (here comes the lack of self-criticism), or at least uncontrolable ones. For example, I tend to reason that I could be a great blogger if I could use images, which I can’t because I’m blind.

I once read about this type of narcissism called compensatory narcissism. It isn’t an official mental health diagnosis, of course. However, it shows that people with narcissistic traits commonly have low self-esteem. That’s what Dr. Prakash told Jennifer in Believarexic too: that loving yourself too much and hating yourself are sometimes pretty close. Like I said, compensatory narcissism isn’t a formal diagnosis, so I can safely say I fit a lot of the proposed criteria without looking like a hypochondriac, can’t I?

Mummascribbles

Obsessive-Compulsive Personality Disorder (OCPD) #Write31Days

31 Days of Mental Health

Welcome to day 2 in the #Write31Days challenge on mental health. When you

Welcome to day 18 in the #Write31Days challenge on mental health. To be honest, this challenge is proving harder than I expected and I’m glad we have only two more weeks of it to go. Today, I’ll continue writing on personality disorders in cluster C. The last one in this category is obsessive-compulsive personality disorder (OCPD).

Obsessive-compulsive personality disorder is characterized by extreme orderliness, perfectionism and the need for mental and interpersonal control. People with OCPD find it hard to make decisions when rules and procedures do not strictly dictate the right path to follow. People with OCPD may also become upset when they don’t have full control over their physical or social environment. However, they often do not directly express their anger. For example, sometimes instead of expressing their frustration, the person with OCPD may worry and ruminate over their lack of control. At other times, they may express their anger very strongly when others deviate even minorly from the rules.

In order to be diagnosed with OCPD, a person has to meet four or more of the following criteria:


  1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

  2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).

  3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

  4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

  5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.

  6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

  7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

  8. Shows significant rigidity and stubbornness.

OCPD, for clarity’s sake, is distinct from obsessive-compulsive disorder (OCD). Though some studies have found high rates of co-occurrence between the two disorders, others have not. On the surface, the two disorders share some common behavior patterns, such as ritualistic tendencies. Hoarding, a need for symmetry and orderliness are also common in both disorders. A major difference between OCD and OCPD is that people with OCD are distressed by their obsessions and compulsions, whereas people with OCPD feel they are fully justified in their need for orderliness. As a result, while people with OCD commonly seek treatment, people with OCPD (like most people with personality disorders) often do not.

Dependent Personality Disorder (DPD) #Write31Days

31 Days of Mental Health

Welcome to day 17 in my #Write31Days challenge on mental health. Today, I’m continuing to write about personality disorders in cluster C. I’ll focus on dependent personality disorder (DPD). When I was about eighteen, I suspected I might have some features of this condition. (Then again, I suspected I was diagnosable with about half the DSM at the time.) I still relate to it, but it’s never been suggested that I have DPD.

Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of. This leads to submissive and clingy behavior and fear of separation. People with DPD meet at least five of the following criteria:


  1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

  2. Needs others to assume responsibility for most major areas of his or her life.

  3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.
  4.  
  5. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

  6. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

  7. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

  8. Urgently seeks another relationship as a source of care and support when a close relationship ends.

  9. Is unrealistically preoccupied with fears of being left to take care of himself or herself.


DPD shows overlap with borderline personality disorder in the fear of abandonment. It also shows overlap with avoidant personality disorder in the sufferer’s anxious and self-critical tendencies. However, people with DPD doubt their ability to do things on their own, whereas people with AvPD doubt their ability to succeed in social situations.

One of the characteristics of dependent personality disorder is urgently seeking another relationship when one ends. Another is volunteering to do unpleasant things in order to stay in a relationship in which one is taken care of. The combination of these traits may lead DPD sufferers into codependent relationships with abusers or addicts. However, the dynamic of codependency may also produce behaviors similar to DPD in people who are otherwise healthy.

Avoidant Personality Disorder (AvPD) #Write31Days

31 Days of Mental Health

Welcome to day 16 in the 31-day writing challenge on mental health. I am still tired and a lot is on my mind today. Still, I am resuming my writing on personality disorders today. After we’ve discussed the cluster B personality disorders (well, all except for borderline personality disorder, since I’ve discussed that a lot before), it’s now time to move on to cluster C. (I will discuss the personality disorders in cluster A after I write about psychosis and schzophrenia later this month.) People with cluster C personality disorders are predominately anxious or fearful. The most well-known personality disorder in this cluster, which I’ll discuss today, is avoidant personality disorder.

Avoidant personality disorder (AvPD) referst o a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to criticism. People with AvPD meet four or more of the followign criteria:


  1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.

  2. Is unwilling to get involved with people unless certain of being liked.

  3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.

  4. Is preoccupied with being criticized or rejected in social situations.

  5. Is inhibited in new interpersonal situations because of feelings of inadequacy.

  6. Views self as socially inept, personally unappealing, or inferior to others.

  7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.


Individuals with avoidant personality disorder avoid work, school or other activities that might lead them to be embarrassed or criticized. As a result, they often live an isolated life. When they do engage in social interacitons, they are often hypervigilant to the actions of others. This may in turn elicit criticism or ridicule, which then worsens the AvPD sufferer’s hypervigilance. For clarity’s sake: AvPD sufferers do want to have friends and often feel extremely lonely. The problem is they feel too anxious to attempt to make friends.

Avoidant personality disorder occurs in 2.4% of the population. It commonly co-occurs with social anxiety disorder (social phobia). It is not clear in fact whether social phobia and avoidant personality disorder are distinct conditions or essentially fall on the same spectrum.

Avoidant personality disorder may also co-occur with or be confused with panic disorder with agoraphobia, major depression, or dependent personality disorder, which I’ll discuss later on. It is often confused with autism spectrum disorders. After all, people with AvPD, especially if they already had social phobia when growing up, may have developed social skills problems because of their lack of involvement in social situations.

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.

Histrionic Personality Disorder (HPD) #Write31Days

31 Days of Mental Health

Welcome to day 12 in the 31 Days of Mental Health. Yesterday, I was originally intending on writing a post on personality disorders. I didn’t and I didn’t even write a draft. However, since this 31-day series is raising awareness of the borad spectrum of mental illness, I thought I’d make use of the opportunity to discuss some disorders I’ve not been diagnosed with. Today, I’m writing about a disorder that my therapist at one point hinted at when discussing the possibility that I had imagined my dissociation: histrionic personality disorder. For your information: she never suggested I had this and, when my husband looked over the criteria to make his own judgment, he said I’m about the opposite of this.

Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive emotionality and attention-seeking. Like all personality disorders, it sets on in early adulthood and is relatively stable across time and situations. People with HPD meet at least five of the following eight criteria:


  1. Is uncomfortable in situations in which he/she is not the center of attention.

  2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

  3. Displays rapidly shifting and shallow expression of emotions.

  4. Consistently uses physical appearance to draw attention to self.

  5. Has a style of speech that is excessively impressionistic and lacking in detail.

  6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.

  7. Is suggestible, i.e., easily influenced by others or circumstances.

  8. Considers relationships to be more intimate than they actually are.


People with HPD are often referred to as “drama queens”. Though this was my first online nickname and many people agreed I was a real drama queen, I only meet one criterion of HPD (suggestibility) consistently now.

Histrionic personality diosrder is more common in females than males. It occurs in about 1.8% of the general population. Like most personality disorders, the presentation of HPD tends to become less pronounced as the affected person ages.

People with HPD are quicker to seek help than those with other personality disorders. However, this may reflect a symptom of their condition, because they exaggerate their symptoms and difficulty functioning. They also may display all emotions with the same depth of expression, unaware of the subtleties of emotional experience. People with HPD are also emotionally needy. Therefore, once in therapy, it’s hard for them to terminate treatment.

Therapy for HPD should usually be supportive, relatively short-term and solution-focused. It is unlikely that a therapist will be able to “cure” a HPD sufferer, so it doesn’t make sense to invest in long-term therapy.

People with HPD may exhibit suicidal behavior or make suicidal gestures. They may also self-harm. Though this might be an expression of their need for attention, suicidality and self-harm should always be taken very seriously. Even if the person is just crying out for help, death or serious bodily harm may occur. Like with all people who are suicidal or engage in self-injury, a safety contract may help establish boundaries while keeping the patient safe.

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.