Tag Archives: Psychopathy

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.

Empathy and Expressing Emotions

In chapter three of the book Look Me in the Eye, John Elder Robison talks about empathy and the expression of emotion. He describes a situation in which an acquaintance informs him tht someone he doesn’t know has died. He smiles, being glad that he and his own family wouldn’t die in the same way and are safe for now. The acquintance responds furiously, because why would he smile at someone else’s death? Robison is regularly accused of psychopathy for similar lack of empathy. Then again, he has strong emotional reactions to soomething happening to his own family.

I can relate to what Robison describes, only to an even greater extent. He describes the thoughts he has when there’s a plane crash in Uzbekistan, as rational empathy: he’s aware that it’s sad that people are killed and knows that the victims’ families are grieving, but it doesn’t affect him personally. On the other hand, when his father had been in an accident, he was anxious and nervous and did care on a deeper emotional level. Then again, when his mother’s car was on fire, he immediately went to fix it.

These are three different kinds of responses: rational empathy with no emotional reaction, emotional empathy as in feeling personally touched, and emotional empathy with the urge to fix someone’s problems.

I for one don’t often experience a strong emotional response when something “big” happens. When my maternal grandfather had a brain bleed in 1995, I was worried because I’d had one myself. I didn’t realize that his brain bleed was very different, and I didn’t particularly feel any emotion when he died five days later. I did feel the need to care for my mother, who ran towards me for comfort at the funeral. This lack of actual emotional empathy was amplified when my maternal grandmother, to whom I had no emoitonal connection, died in 2007. I was in an emotional crisis two days before her death and called my parents, stammering only “I, I.” My father was extremely pissed, saying: “It isn’t about you. Your grandmother is dying don’t you know!” A few months later, I remember talking to my mother and, when she referred to “grandma”, asking which one./P>

In this sense, I’m more self-centered, possibly even selfish, than Robison. I honestly have never had an emotional response to someone dying. That is, I do sometimes feel touched when I realize people have passed away, but this seems unrelated to the events of their deaths. An online acquaintance died sometime in 2013, and I still have moments where my inner children are sad that they can’t talk to hers anymore. Then again, the emotional response is not strong.

It isn’t, in my opinion, a psychopathic tendency that drives me not to be touched by people’s deaths. I do feel sadness when other people are sad, even if it’s for a relatively minor reason. Rather, it seems to be that I’m captured by details more than by the bigger picture of someone having died. For example, when a fellow patient told us that he had been diagnosed with terminal cancer in late 2007, I smiled at the funny spin on a nurse’s name he made rather than reacting emotionally to his diagnosis.

The intersection of autism and borderline personality disorder, which is essentially an attachment disorder, is interesting here. It is probably an autistic tendency to be captured more by the details of an event than the bigger picture, as in the laughing at a pun when being informed someone has cancer. Then again, I do have strange attachments sometimes. I should technically care more about my grandma’s death than about an online friend kicking me off her mailing list, but the reaction was reversed. Is this selfishness? It could be, but then again, I too have strong emotional reactions to other people’s sadness, sometimes if they’re people I hardly know.

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.