Narcissistic Personality Disorder (NPD) : DSM- IV Diagnostic Criteria. What is a personality disorder?[from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1.
DSM- IV, of the American Psychiatric Association. European countries use the diagnostic criteria of the World Health Organization.]An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. A personality disorder is a pattern of deviant or abnormal behavior that the person doesn't change even though it causes emotional upsets and trouble with other people at work and in personal relationships. It is not limited to episodes of mental illness, and it is not caused by drug or alcohol use, head injury, or illness. There are about a dozen different behavior patterns classified as personality disorders by DSM- IV.
[from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1994, commonly referred to as DSM-IV, of the American Psychiatric Association. A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). Binge-eating disorder — Learn about symptoms, causes, treatment and coping for this eating disorder.
All the personality disorders show up as deviations from normal in one or more of the following: (1) cognition - - i. . Narcissistic Personality Disorder.
While grandiosity is the diagnostic hallmark of pathological narcissism, there is research evidence that pathological narcissism occurs in two forms, (a) a grandiose state of mind in young adults that can be corrected by life experiences, and (b) the stable disorder described in DSM- IV, which is defined less by grandiosity than by severely disturbed interpersonal relations.The preferred theory seems to be that narcissism is caused by very early affective deprivation, yet the clinical material tends to describe narcissists as unwilling rather than unable, thus treating narcissistic behaviors as volitional - - that is, narcissism is termed a personality disorder, but it tends to be discussed as a character disorder.This distinction is important to prognosis and treatment possibilities.If NPD is caused by infantile damage and consequent developmental short- circuits, it probably represents an irremediable condition.On the other hand, if narcissism is a behavior pattern that's learned, then there is some hope, however tenuous, that it's a behavior pattern that can be unlearned. . The clinical literature on NPD is highly theoretical, abstract, and general, with sparse case material, suggesting that clinical writers have little experience with narcissism in the flesh.There are several reasons for this to be so: -- The incidence of NPD is estimated at 1% in the general population, though I haven't been able to discover the basis of this estimate.- - Narcissists rarely enter treatment and, once in treatment, progress very slowly.
We're talking about two or more years of frequent sessions before the narcissist can acknowledge even that the therapist is sometimes helpful. It's difficult to keep narcissists in treatment long enough for improvement to be made - - and few people, narcissists or not, have the motivation or the money to pursue treatment that produces so little so late.- - Because of the influence of third- party payers (insurance companies), there has been a strong trend towards short- term therapy that concentrates on ameliorating acute troubles, such as depression, rather than delving into underlying chronic problems. Narcissists are very reluctant to open up and trust, so it's possible that their NPD is not even recognized by therapists in short- term treatment. Purely anecdotal evidence from correspondents and from observations of people I know indicates that selective serotonin- reuptake inhibitors, such as Prozac, aggravate narcissists' grandiosity and lack of social inhibition. It has also been suggested that self- help literature about bolstering self- esteem and getting what you want out of life or that encourages the feeling of victimization has aggravating effects on NPD thinking and behavior.- - Most clinical writers seem unaware that narcissists' self- reports are unreliable. This is troubling, considering that lying is the most common complaint about narcissists and that, in many instances, defects of empathy lead narcissists to wildly inaccurate misinterpretations of other people's speech and actions, so that they may believe that they are liked and respected despite a history of callous and exploitative personal interactions.[from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1.
DSM- IV, of the American Psychiatric Association. European countries use the diagnostic criteria of the World Health Organization.]A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.[jma: NPD first appeared in DSM- III in 1. Additionally, there is considerable overlap between personality disorders and clinicians tend to diagnose mixes of two or more. Grandiosity is a special case, but lack of empathy and exploitative interpersonal relations are not unique to NPD, nor is the need to be seen as special or unique. The differential diagnosis of NPD is made on the absence of specific gross behaviors.
Borderline Personality Disorder has several conspicuous similarities to NPD, but BPD is characterized by self- injury and threatened or attempted suicide, whereas narcissists are rarely self- harming in this way. BPD may include psychotic breaks, and these are uncharacteristic of NPD but not unknown. The need for constant attention is also found in Histrionic Personality Disorder, but HPD and BPD are both strongly oriented towards relationships, whereas NPD is characterized by aloofness and avoidance of intimacy. Grandiosity is unique to NPD among personality disorders, but it is found in other psychiatric illnesses. Psychopaths display pathological narcissism, including grandiosity, but psychopathy is differentiated from NPD by psychopaths' willingness to use physical violence to get what they want, whereas narcissists rarely commit crimes; the narcissists I've known personally are, in fact, averse to physical contact with others, though they will occasionally strike out in an impulse of rage. It has been found that court- ordered psychotherapy for psychopaths actually increases their recidivism rate; apparently treatment teaches psychopaths new ways to exploit other people. Bipolar illness also contains strong elements of grandiosity.
See more on grandiosity and empathy and its lack below.]The disorder begins by early adulthood and is indicated by at least five of the following: Translation: Narcissistic Personality Disorder (NPD) is a pattern of self- centered or egotistical behavior that shows up in thinking and behavior in a lot of different situations and activities. People with NPD won't (or can't) change their behavior even when it causes problems at work or when other people complain about the way they act, or when their behavior causes a lot of emotional distress to others (or themselves? This pattern of self- centered or egotistical behavior is not caused by current drug or alcohol use, head injury, acute psychotic episodes, or any other illness, but has been going on steadily at least since adolescence or early adulthood. NPD interferes with people's functioning in their occupations and in their relationships: Mild impairment when self- centered or egotistical behavior results in occasional minor problems, but the person is generally doing pretty well.
Moderate impairment when self- centered or egotistical behavior results in: (a) missing days from work, household duties, or school, (b) significant performance problems as a wage- earner, homemaker, or student, (c) frequently avoiding or alienating friends, (d) significant risk of harming self or others (frequent suicidal preoccupation; often neglecting family, or frequently abusing others or committing criminal acts). Severe impairment when self- centered or egotistical behavior results in: (a) staying in bed all day, (b) totally alienating all friends and family, (c) severe risk of harming self or others (failing to maintain personal hygiene; persistent danger of suicide, abuse, or crime). An exaggerated sense of self- importance (e. Grandiosity is the hallmark of narcissism.
So what is grandiose? The simplest everyday way that narcissists show their exaggerated sense of self- importance is by talking about family, work, life in general as if there is nobody else in the picture.
DSM 5 - Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. By Dr. Cheryl Lane, Ph.
DThe Diagnostic and Statistical Manual of Mental Disorders – often referred to as the DSM – is the diagnostic bible for mental health professionals. A publication of the American Psychiatric Association, the first version of the DSM was released over 6. Since that time it has undergone several revisions, with the most recent edition, the DSM- IV, published in 1.
Minor updates were made to the 4th edition, in the DSM- IV- TR, which was released in 2. The newest edition - the DSM- 5 – is scheduled to be released in May of this year (2. The DSM contains information regarding every official psychiatric disorder.
Each diagnostic listing contains detailed information regarding the specific criteria required for a diagnosis, as well as a thorough overview of that particular disorder. The overview discusses diagnostic features, subtypes (when indicated, e. With each revision of the DSM, changes are made that impact the way disorders are classified and diagnosed. These changes are made based on a variety of factors, including new research- based finding as well as the input of experts from a variety of professions including psychiatry, psychology, neurology, pediatrics, social work, and several others. Since 1. 95. 2, it’s no surprise that the cumulative changes to the DSM have been substantial. Diagnostic criteria for listings in this newest edition of the DSM were finalized and approved on December 1, 2.
APA’s board of trustees. The DSM- 5 will have 3 sections. Section 1 includes an introduction and instructions on how to use the new version; Section 2 covers the diagnostic categories; Section 3 includes conditions that need additional research, a glossary of terms, and other important information. Following are some of the most salient changes to the new DSM: No More Multiaxial Assessment System.
In prior versions of the DSM, a system that included 5 "axes" or dimensions was used for diagnostic and treatment purposes. The axes were. This system will be replaced with a more simplified, nonaxial documentation approach in the DSM- 5. Essentially, the former first three Axes (I, II, and III) will be combined, with separate notations for the other two former Axes, covering psychosocial and environmental factors (IV), as well as disability (V). Restructured Order of Chapters. The order of chapters (2. DSM- 5 will be different from past editions, with related disorders / chapters grouped together. For example, one of the new chapters is Trauma- and Stressor- Related Disorders", which will include Posttraumatic Stress Disorder.
New Diagnoses. Disruptive Mood Dysregulation Disorder – The addition of this diagnosis will hopefully reduce the number of children misdiagnosed with Bipolar Disorder, who are subsequently prescribed heavy duty drugs as part of their treatment. Prominent symptoms of DMDD include a persistent, irritable mood and frequent, major anger outbursts or tantrums. Some healthcare providers are concerned about this diagnosis, arguing that the symptoms aren’t necessarily abnormal and shouldn’t warrant a mental health diagnosis. Opponents to this new addition also argue that these symptoms may also be caused by several other psychiatric disorders.
Hoarding Disorder – Serious hoarding behavior affects a significant percentage of the population. Previously regarded as a symptom or subtype of Obsessive- Compulsive Disorder (also a symptom of Obsessive- Compulsive Personality Disorder), it will now be listed as a separate, distinct disorder. The primary symptom is the inability (or persistent difficulty) to discard or give up possessions, regardless of their actual value. Historically, compulsive hoarding has been a difficult behavior to treat successfully. Binge Eating Disorder – Symptoms include regularly eating unusually large amounts of food in a discrete period of time. Individuals with this disorder feel unable to control their binge eating.
It is often done privately and accompanied by negative feelings (e. Their binge eating is not followed by an inappropriate attempt to compensate (e. Bulimia Nervosa or Anorexia Nervosa.
Prior to the DSM- 5, individuals with this binge eating pattern have been diagnosed with Eating Disorder NOS (not otherwise specified). Excoriation Disorder – Individuals who compulsively pick their skin for no apparent reason, such as the presence of an underlying medical condition, may be given this new diagnosis. This disorder, sometimes called dermatillomania, will be included in the Obsessive- Compulsive and Related Disorders" chapter in DSM- 5.
Revised Diagnoses. Autism Spectrum Disorder – This is likely one of the most significant (and controversial) diagnostic changes in the DSM- 5. It includes the disorders formerly known as Autistic Disorder, Asperger’s Syndrome, Pervasive Developmental Disorder, and Childhood Disintegrative Disorder. Posttraumatic Stress Disorder – PTSD will now include 4 (instead of just 3) distinct diagnostic clusters. Behavioral symptoms will receive more focus, as will the unique developmental aspects with regards to children and teens with PTSD.
Pedophilic Disorder – This will be the new name for the disorder formerly known as Pedophilia. The diagnostic criteria will remain the same. Substance Use Disorder – This new disorder will combine what was formerly two disorders – Substance Abuse and Substance Dependence. Specific Learning Disorder – This will replace Learning Disorders and will include learning problems in mathematics, oral language, written language, and reading. A specifier will be used to denote the specific area of learning difficulties. Removal of Bereavement Exclusion – This change acknowledges the fact that bereavement and Major Depression are not always entirely separate.
Grief following a loss is a significant psychological stressor and may trigger a major depressive episode in some individuals. Disorders Requiring Further Research The DSM- 5 includes Attenuated Psychosis Syndrome (a precursor to schizophrenia), Internet Use Gaming Disorder, Non- Suicidal Self- Injury, and Suicidal Behavioral Disorder in this section. It is important to note that treatment for disorders in this category will likely not be covered by health insurance, as they still need more research. Rejected Proposed Disorders.
Disorders that were considered for the DSM- 5, but later rejected include Anxious Depression, Hypersexual Disorder, Parental Alienation Syndrome, and Sensory Processing Disorder.These disorders, although legitimate per some mental health professionals, are not included with the disorders requiring further research. How To Install Pine Plank Ceiling .
They were deemed as having insufficient research to warrant inclusion. Source: American Psychiatric Association, Dec.