Tag: personality disorder

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Personality Psychology

Psychoeducation: Do I have Personality Issues?

Navigating through one’s troubles is difficult. To have issues is part of being human. However, it can often feel as if our problems are not really solvable.

So what does one do?

Perhaps one of your colleagues said something particularly rude to you. Or maybe things at home seem to be conflicted. Maybe the person you love or have feelings for has started acting cold. Problems in relationships are inevitable.

But do you feel as if others can never understand you?

Do you try to one-up every other person you are in conflict with?

Or perhaps you feel incredible ‘pain’ when the people you trust do not meet your expectations.

And you do not see this level of pain in others.

It’s not that you don’t feel happy. You feel very happy when things are going right.

But when things are not going okay, it becomes impossible to stand it. So, to cope with this, you react explosively or even violently. This can even mean that you try to control this pain by hurting yourself physically.

If you have felt this way throughout most of your life, you might have features of a personality disorder.

What is a Personality Disorder?

Personality is a complex system of enduring traits and/or behaviors. It remains generally stable throughout life. So, a personality disorder is basically enduring sets of traits or behaviors that cause significant problems throughout one’s life.

How does a Personality Disorder Develop?

Most personality researchers agree on the fact that personality starts developing during childhood when an individual is exposed to various concepts, beliefs and behaviors. For example, a child born to more conservative parents is more likely to have conservative beliefs and behaviors. However, as the child grows older, other people begin influencing him/her. Friends and peers became a major part of life during school years. Teachers also play a major role.

Nevertheless, at some point, the individual gathers enough information to adopt certain patterns of thinking and behaving.

Following this line of reasoning, a personality disorder emerges when there are some major conflicts early on in an individual’s life. These could be a very conflict-ridden relationship between the parents. Or it could be how a caregiver might be too strict or too lenient with this person.

Moreover, a child might be shamed publicly at school or in the playground, which could make them behave in ways to protect themselves. And these behaviors could then become very inflexible.

Experiencing Personality Issues

If an individual feels as if the environment that his or her parents or caregivers have given them does not match the environment of practical or general life – this causes problems. This happens for most – if not all – of us. However, imagine if your childhood environment was very mismatched with the environment outside, in practical life.

Personality issues and disorders are ‘out of the social norm.’ If they were within the social norms, they would not be called major problems.

Hence, people who experience these personality problems tend to feel as if they are separated from everyone else’s experience. They might not understand how ‘regular people’ deal with life’s tribulations so easily.

On the other hand, some people with personality issues might feel as if they deal with these problems better than others. They may view themselves as superior. Because that is what they have felt much early on in life.

Such individuals might try to seek out people who are like them. A person with narcissistic personality disorder might thus try to associate with individuals who they perceive better than others. Similarly, an individual with borderline personality disorder might feel more drawn to people that have been traumatized as well.

If you find that your attachment styles in social relationships compromise them, especially if this has happened throughout your life, there is a high probability that you have personality complications. Furthermore, if your social behaviors seem to cause others a lot of issues – or even if you alone think that they have always troubled others – there too is a high probability of personality issues.

However, how can you be sure that there really is a significant problem?

Why Self-Diagnosis Can Do More Harm than Good

Self-diagnosis is the behavior of assigning oneself a disorder and/or disease without consulting with a certified practitioner. This behavior is concerning because it can make the individual try to act according to the condition they have diagnosed themselves with. They might not have that issue. But they might try to assume the stereotypical image of the disorder.

Moreover, relying solely on self-diagnosis might result in the person not seeking the relevant management for the problem. The presentation of bipolar 2 disorder and borderline personality disorder can often be very similar. But the way they are treated is very different. Wrongly assuming that you have a personality disorder can unnecessarily put off the correct management plan.

Personality issues are significant problems in behavior that might elude to a personality disorder. If you believe that you or someone you know might have this, it is important to seek the relevant help. By doing so, you can help improve or even save lives.

Categories
Dark Personality Psychology Psychological Tips

The Positives of Psychopathy

M Abdullah Qureshi

Psychopathy is a psychological construct that refers to callous and unemotional patterns of attitudes or behaviors. While much of the popular opinion on psychopathy is actually negative, there are some behaviors of psychopaths which are also seen positively. An evidence of the allure of psychopathy can be seen in the fact that Ted Bundy, the American serial killer who reportedly killed 30 women between 1974 and 1978, received fan mail during his incarceration.

But this article does not talk about why psychopathy is attractive. Rather, I argue that certain behaviors that are classically found in psychopaths can actually produce good outcomes.

Psychopathy can actually be a helpful trait in various contexts.

As evidence, there was a large survey of psychologists, attorneys, and professors. The researchers gave them a list of psychopathic features. Following this, they asked the volunteers to say if they knew someone in their field who had those traits and was either good at their job or bad at it. The findings were interesting because the people who took part did say that successful psychopaths can be found in all fields.

The question this article attempts to answer is: what are the positives of psychopathy?

So, let’s dive straight into it!

Charisma

A study looked at the personalities, behaviors, and results of the lives of 315 people. They discovered a link between psychopathy and charm. They also discovered that these people were more likely to “work the system” in order to get ahead. People in general gravitate towards charismatic individuals. It can be through the way that they conduct themselves with others.

Charisma can elevate others’ perception of you. For example, another study showed that the superiors of ‘corporate psychopaths’ thought they were great at their jobs and should get awards. According to the higher-ups, these people were organizational stars.

Problems with Charisma

It is also important to consider that charisma is often used as a mask in psychopathy. The first study I quoted also indicated that many times, psychopathic people who were very charming were able to cheat on their partners, lie, abuse their work rights, or commit crimes without getting caught or punished. This was more common for psychopathic people who were less charismatic.

Moreover, studies also showed that these corporate stars bullied, scared, and forced those below them to do things that were not acceptable.

So, I would recommend you to separate the wheat (charisma) from the chaff (exploitation).

Confidence

People who are psychopaths are known for not being able to change their bad habits or stop responding to punishments. This is not exactly a desirable trait.

However, consider this persistence in the context of pursuing a tough goal. Whatever the world throws at you, you remain persistent. That’s not really bad at all!

Some scientists link psychopaths’ inability to change old habits to a “low fear IQ,” or a higher threshold for reacting to things that make you afraid. People who are less sensitive to dangerous cues tend to have a fearless personality as kids, which can grow into social confidence, daring behavior, and mental strength as teens and adults.

Problems with Very High Confidence

If we generalize this very low fear to one’s entire life – that’s when we get into the problematic waters. It could happen that in one’s high confidence level, they might perform tasks very wrongly. This would lead to eventual failures.

Moreover, if this is a recurring behavior, the individual might continue to fail again and again.

Having sais that, as long as the low fear is used in a few demanding situations, psychopathy could actually make a person confident in themselves.

Target-directed Attitude

Psychopaths have been proven to be less affected by conflicting information. It has been shown in task-based studies that they only attend to the prepotent goal-related information.

They do not seem to be affected by peripheral non-target information.

This means that psychopaths focus less on information that is not directly related to a goal they have if they are on to something. The pinpoint focus on the goal at hand is actually a great trait to have – as long as it can be controlled.

By focusing on the target and remaining fixated on it, one could ignore unnecessary anxiety-causing information. We already know that anxiety can be debilitating in itself. So, only attending to the goal might actually cause you much less distress.

Problems with High Levels of Target-directed Attitude

One can very easily overlook important conflicting information – much as is the case with too high confidence. In fact, pursuing a target single-mindedly could also mean that the individual neglects other responsibilities.

This could then cause major issues in domestic life. This tilt towards just one direction would mean that other important things would just be ignored completely.

High Self-Esteem

Self-esteem is the psychological trait which signifies how we feel about ourselves. People who have psychopathic personality problems are said to have high self-esteem.

However, this can vary with the subtypes of psychopathy.

Researchers have found that there are two types of psychopathy: main psychopathy and secondary psychopathy. These two types share antagonism, hostility, and rashness.

But the two are different in a way that has to do with their social habits called “withdrawal–sociability.”

Psychopaths who are of the primary type tend to be outgoing, dominating, confident, and low in anxiety. Secondary psychopaths, on the other hand, tend to be less social, have low self-esteem, be moody and nervous, and have more mental health problems.

Feeling good about oneself can lead to various desirable outcomes, even a decade onward!

Problems with Very High Self-Esteem

However, having too high a self-esteem could lead to a lack of insight – a problem with most psychopaths. This, conversely, has bad outcomes because out of very high self-esteem, the person might not take into account all the risks involved in setting unrealistic goals.

This could lead to major failures.

Conclusion

While psychopathy is considered to be a part of the dark tetrad of personality, it is a nuanced trait. There are factors of psychopathy which in many situations could actually be considered very ideal. Perhaps that is the main reason why many psychopaths continue to build successful careers and lives. However, it is also very possible that such individuals have built up many adaptive behaviors to either mask or manage their psychopathy.

Whatever the case might be, there is definitely a lot to be learnt from even dark personality traits!

Categories
Psychiatric Disorders

Diagnostic Features of Attention-Deficit/Hyperactivity Disorder

Written by Najwa Bashir

ADHD is a brain condition characterized by problems with not paying attention, getting things done, or being too active and impulsive. People with inattention and disorganization can’t stay on task, don’t seem to listen and lose things they need for jobs at levels that aren’t appropriate for their age or level of development. Overactivity, pacing, not being able to stay sat, interrupting other people’s activities, and not being able to wait are all signs of hyperactivity-impulsivity that are too much for the person’s age or level of development. During youth, ADHD often happens at the same time as “externalizing disorders” like oppositional defiant disorder and conduct disorder of some people. ADHD often lasts into adulthood, which can make it hard to function in social, school, and work settings (American Psychiatric Association, 2022, p. 36).

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental and behavioral illnesses that kids and teens come to see for help. People with ADHD often have signs and problems that last a long time, even into adulthood. A lot of the time, ADHD is linked to other problems, like mood, worry, or drug abuse issues. Untreated ADHD has a lot of social and community costs over a person’s lifetime, such as poor academic and job performance, crime, car accident safety, and relationship problems (Wilens & Spencer, 2010). ADHD is one of the most common neurological diseases in the world. About 5–7% of children and teens (Polanczyk et al., 2007; Thomas et al., 2015) and about 2.5% of adults (Fayyad et al., 2017; Song et al., 2021) have it. A careful clinical review of symptoms and functional problems is needed to make a diagnosis of ADHD. Important standard factors help doctors make accurate diagnoses, such as the Diagnostic and Statistical Manual of Mental Disorders – 5th version (DSM 5) (Da Silva et al., 2023). According to DSM 5 TR, the following are the diagnostic criteria and features of attention-deficit/hyperactivity disorder.

Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

A. A pattern of persistent lack of attention and/or hyperactivity-impulsivity that gets in the way of working or growth, as shown by (1) and/or (2):

  1. Not paying attention: at least six of the following symptoms have been present for at least six months in a way that is not consistent with the child’s developmental level and has a direct negative effect on social, academic, or work activities:
    Note: The symptoms are not just a sign of oppositional behavior, resistance, anger, or not being able to understand what to do or how to do it. There must be at least five signs for older teens and adults (17 years and up).
    a. Doesn’t pay close attention to details or makes careless mistakes in school, work, or other activities (for example, forgets or skips details, produces incorrect work).
    b. Often has trouble staying focused on tasks or games (for example, has trouble staying on task during classes, talks, or long reading).
    c. During direct communication, often doesn’t seem to listen (e.g., mind seems elsewhere, even when there aren’t any obvious distractions).
    d. In general, doesn’t do what they’re told and doesn’t finish schoolwork, jobs, or work duties (for example, they might start a task but get distracted quickly).
    e. Has a lot of trouble planning activities and tasks (for example, can’t keep things in order; work is often messy and disorganized; suffers from poor time management and misses deadlines).
    f. Usually avoids, dislikes, or doesn’t want to do things that take long-term mental effort, like schoolwork or chores; for older teens and adults, this could include writing reports, filling out forms, or going over long papers.
    g. Frequently drops things they need to do things (like school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, cell phones, etc.).
    h. Is quickly distracted by outside stimuli, which for later teens and adults may include thoughts that aren’t connected.
    i. Forgets to do things like do jobs and run errands, or for older teens and adults, remember to return calls, pay bills, and keep meetings.
  2. Hyperactivity and impulsivity: At least six of the following symptoms have been present for at least six months in a way that is not consistent with the child’s age or level of development and has a bad effect on social, academic, or work activities:
    Note: The symptoms are not just a sign of oppositional behavior, resistance, anger, or not being able to understand what to do or how to do it. There must be at least five signs for older teens and adults (17 years and up).
    a. Moves their hands or feet around a lot or squirms in their seat.
    b. Often gets up from their seat when they are supposed to stay put, like when they are in class, the office, or another place of work, or when they need to stay put in other situations.
    c. Runs around or climbs up often when it’s not proper to do so. Note: In teens and adults, it may just mean feeling restless.
    d. Not able to play or do other fun things alone very often.
    “Is often on the go,” acting like they are “driven by a motor” (e.g., can’t or doesn’t like being still for long periods of time, like in restaurants or meetings; others may see them as restless or hard to keep up with).
    f. Talks too much a lot of the time.
    g. Often blurts out an answer before the question is finished (for example, finishing other people’s words; can’t wait their turn in a talk).
    h. Often has trouble waiting for his or her turn (for example, in line).
    Often stops or gets in the way of other people’s conversations, games, or activities (for example, butts into conversations, games, or activities; may start using other people’s things without asking or getting permission; for teens and adults, may get in the way of or take over what others are doing).

B. Several signs of not paying attention or being restless and reckless were present before the age of 12.
C. In two or more places (like at home, school, or job; with friends or family; doing other things), the person shows several signs of not paying attention or being hyperactive-impulsive.
D. There is strong proof that the symptoms impair or lower the quality of social, academic, or professional performance.
E. The symptoms aren’t just a part of schizophrenia or another psychotic disorder, and they can’t be explained by another mental disorder, like a mood disorder, an anxiety disorder, a dissociative disorder, a personality disorder, or heavy or light drug use.

Specify if:
F90.2 If both Criteria A1 (not paying attention) and A2 (being hyperactive or impulsive) have been met for the past 6 months, the person will be given a combined presentation.
F90.0 Presentation that is mostly not paying attention: If Criteria A1 (not paying attention) is met but Criteria A2 (hyperactivity or recklessness) has not been met in the last 6 months.
F90.1 If Criteria A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) has not been met in the last 6 months, the person is likely to be hyperactive or impulsive.
Specify if:
In partial remission: Less than the full set of standards have been met for the past 6 months, but the symptoms still make it hard to function in social, school, or occupational settings.
Specify the current severity:
Mild: There are few or no symptoms that go beyond those needed to make the diagnosis, and the symptoms don’t make it hard to do things at work or in social situations.
Moderate: There are symptoms or problems with functioning that are between “mild” and “severe.”
Severe: There are a lot of symptoms, more than what is needed to make a diagnosis, or several very bad symptoms. The symptoms make it very hard to function in social or work settings.

Diagnostic Features for Attention-Deficit/Hyperactivity Disorder

  • Attention-deficit/hyperactivity disorder (ADHD) is characterized by a pattern of chronic inattention and/or hyperactivity-impulsivity that gets in the way of working or growth. ADHD kids with inattention act out by getting sidetracked, not following through on directions, not finishing work or jobs, having trouble staying focused, and being disorganized. This isn’t because they are defiant or don’t understand.
  • Hyperactivity is when a person does too much of something, like running around when it’s not proper, or when they fidget, tap, or talk too much. Adults with hyperactivity may be very antsy or wear other people out with all their activity. If someone acts impulsively, they do things quickly and without thinking, which could hurt themselves (for example, running into the street without looking).
  • Impulsivity could mean that a person wants benefits right away or can’t wait to get them. People who act on impulse may be socially offensive (for example, talking over other people too much) or make big decisions without thinking about the long-term effects (for example, applying for a job without enough information).
  • ADHD starts in childhood.
  • The fact that several symptoms must be present before age 12 shows how important a significant clinical picture during childhood is. At the same time, a younger age at onset is not given because it is hard to say for sure when the symptoms started in youth.
  • It is not always accurate for adults to remember symptoms from their youth, so it is helpful to get extra information. ADHD can’t be confirmed if there aren’t any signs before age 12.
  • If signs of what seems to be ADHD show up for the first time after age 13, they are more likely to be caused by another mental problem or the brain effects of drugs.
  • The problem must show up in more than one place, like at home, at school, and at work. It’s usually not possible to get a good picture of a person’s major symptoms in different settings without talking to people who have seen them in those situations.
  • Most of the time, signs change based on the situation and place.
  • Signs of the disorder might not be present if the person is rewarded often for good behavior, is closely watched, is in a new place, is doing very interesting things, is constantly stimulated from the outside (for example, by electronic screens), or is interacting with one person at a time (for example, in the clinician’s office).

The aforementioned criteria and features by DSM 5 TR can be kept into consideration to diagnose individuals with attention-deficit/hyperactivity disorder. Early diagnosis can ensure the treatment is started in the early phase of the individual’s life to help him deal with the issues and avoid farsighted adverse consequences.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Da Silva, B. S., Grevet, E. H., Silva, L. C. F., Ramos, J. K. N., Rovaris, D. L., & Bau, C. H. D. (2023). An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder. Discover Mental Health, 3(1), 2. https://doi.org/10.1007/s44192-022-00030-1
  • Fayyad, J., Sampson, N. A., Hwang, I., Adamowski, T., Aguilar-Gaxiola, S., Al-Hamzawi, A., … & Kessler, R. C. (2017). The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys. ADHD Attention Deficit and Hyperactivity Disorders, 9, 47-65. https://doi.org/10.1007/s12402-016-0208-3
  • Polanczyk, G., De Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American journal of psychiatry, 164(6), 942-948. https://doi.org/10.1176/ajp.2007.164.6.942
  • Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11. https://doi.org/10.7189/jogh.11.04009
  • Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994-e1001. https://doi.org/10.1542/peds.2014-3482
  • Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine, 122(5), 97-109. https:/doi.org/10.3810/pgm.2010.09.2206
Categories
Psychiatric Disorders

Diagnostic Features of Autism Spectrum Disorder

Written by Najwa Bashir

Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by problems communicating with others, limited hobbies, and doing the same things over and over again (American Psychiatric Association, 2013). Autism spectrum disorder, or ASD, is a group of brain disorders. Patterns of behavior, hobbies, activities, and social problems that happen over and over again are what define this range. Some kids with ASD have behavior and mental health issues. This is because ASD is a difficult neurodevelopmental disease. Unfortunately, these kids get upset when things change around them because they aren’t very good at adapting. The signs start in early childhood and make it hard to do normal things. Language problems, brain challenges, and epilepsy happen more often in children with ASD than in the general population (Mughal et al., 2022).

The World Health Organization (WHO) reports that 0.76 percent of children around the world have ASD. However, this only includes about 16 percent of all children in the world (Baxter et al., 2015). The Centers for Disease Control and Prevention (CDC) says that about 1.68% of 8-year-old children in the US (or 1 in 59 children) are identified with ASD (Biao, 2018; Palinkas et al., 2019). Parent-reported ASD findings in the US in 2016 were 2.5% on average (Kogan et al., 2018). Autism and Developmental Disabilities Monitoring Network (ADDM) data shows that the number of people with ASD in the US more than doubled between 2000–2002 and 2010–2012 (Biao, 2018). It might be too early to say anything about trends, but in the US, the number of people with ASD seems to have leveled off, with no statistically significant rise from 2014 to 2016 (Xu et al., 2018). No changes have been made to the DSM-5 diagnostic standards yet, so it’s too early to say what effect they will have on frequency (Palinkas et al., 2019).

ASD can happen to people of any race, ethnicity, or income level, but not everyone with ASD is diagnosed the same way. It has been shown that ASD is more common in white children than in black or Hispanic children (Baio, 2018). Even though the differences seem to be going down, they may still be there because of shame, limited access to healthcare services, or the fact that a patient’s first language is not English (Hodges et al., 2020).

People all over the world who have ASD have a lot of health problems. Finding ASD early can lower the number of children who have developmental problems and help them communicate better (Salari et al., 2022). The following text mentions the diagnostic criteria and features of autism spectrum disorder according to DSM 5 TR (American Psychiatric Association, 2022).

Diagnostic Criteria for Autism Spectrum Disorder

A. Consistent problems with social contact and interaction in a variety of settings, shown by any or all of the following, either now or in the past (examples are meant to show, not list all of them; see text):

  1. Problems with social and emotional exchange, such as an odd social approach and an inability to have a normal back-and-forth talk; less sharing of interests, feelings, or affect; or failing to start or respond to social interactions.
  2. Lack of skills in nonverbal communication behaviors used for social interaction, such as not combining verbal and nonverbal communication well, having problems with eye contact and body language, not understanding and using gestures properly, or not using any facial expressions or nonverbal communication at all.
  3. Problems with making, keeping, and understanding relationships, such as having trouble changing how they act in different social situations, having trouble making friends or sharing pretend play, or not being interested in their peers.

B. Limited, recurring patterns of behavior, hobbies, or activities, as shown by at least two of the following, either now or in the past (examples are provided for reference only; see text):

  1. Movements, objects, or words that are patterned or repeated, such as simple motor stereotypies like lining up toys or spinning objects, echolalia, or using unique phrases.
  2. Insisting on things staying the same, not changing, or speaking or acting in a certain way over and over again (for example, being very upset by small changes, having trouble with transitions, having rigid thought patterns, welcome practices, or having to take the same route or eat the same food every day).
  3. Very limited, fixed interests that are intense or focused in a way that isn’t normal (for example, a strong connection to or preoccupation with strange items, interests that are too limited or that last too long).
  4. Being overly or underly sensitive to sensory input or showing an odd interest in sensory parts of the environment (for example, not caring about pain or temperature, being sensitive to certain sounds or textures, smelling or touching things too much, or being visually interested in lights or movement).

C. Symptoms must be present in the early stages of development, but they may not show up fully until social demands are too much for the person’s limited abilities, or they may be hidden by tactics learned later in life.
D. The symptoms make it hard to act normally in social, professional, or other important areas of life.
E. Intellectual developmental disorder (also called intellectual disability) or global developmental delay are not better ways to explain these problems. A lot of the time, intellectual developmental disorder and autism spectrum disorder happen together. To identify both of them at the same time, a person’s social speech skills must be below what is normal for their age.

Note: People who have a sure-fire DSM-IV diagnosis of autism spectrum disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise defined should be given that label. If someone has major problems with social communication but doesn’t otherwise meet the standards for autism spectrum disorder, they should be checked for social (pragmatic) communication disorder.
Specify the current level based on problems with social contact and limited, repeated patterns of behavior:
Requiring very strong strength
Requiring a lot of help
Needing help:
Specify if:
Whether there is intellectual disability along with it
Together with or without language problems
Specify if:
linked to a known genetic or other health problem or external cause (Note on the code: add more code to find the genetic or other medical problem that goes with it.)
linked to a mental, behavioral, or neurological issue
Specify if:
With catatonia

Diagnostic Features of Autism Spectrum Disorder

  • As per criteria A and B, people with autism spectrum disorder have limited, repetitive patterns of behavior, hobbies, or activities and chronic problems with reciprocal social contact and social interaction. These signs show up early in life and make it hard to do normal things (Criteria C and D).
  • Core diagnostic features are clear during the developmental stage, but problems may not be seen in some situations because of assistance, compensation, and present supports.
  • The disorder also shows up in very different ways based on how severe the autism is, the person’s level of development, their chronological age, and maybe even their gender. This is where the word “spectrum” comes from.
  • People who don’t have intellectual or language impairments may have more minor signs of deficits (e.g., Criterion A, Criterion B) than people who do have intellectual or language impairments and may be working hard to hide these deficits.
  • Lack of social communication problems will be less obvious if a person has better communication skills in general (for example, speaks clearly and doesn’t have any brain disabilities). In the same way, Criterion B weaknesses (limited patterns of behavior and interests) might not be as clear if the interests are more in line with what kids their age normally like (like trains or Ancient Egypt instead of moving a string).
  • The problems with social contact and conversation that are listed in Criterion A are widespread and last a long time.
  • Verbal and unconscious communication problems in social situations show up in different ways based on the person’s age, level of intelligence, language skills, and other things like past and present care and support.
  • Lack of speech, language delays, trouble understanding speech, repeated speech, or speech that is too precise or stilted are just a few of the language problems that many people have. Autism spectrum disease makes it hard to use language for social contact, even when formal language skills like vocabulary and grammar are fine.
  • Lack of social-emotional exchange, or the ability to interact with others and share thoughts and feelings, can be seen in young children who don’t initiate social interactions or share emotions, and who also don’t copy other people’s behavior closely or at all.
  • Languages that do exist are often one-sided and don’t involve social reciprocity. They are used to ask for things or name things instead of to talk, share thoughts, or make comments. When it comes to older kids and people who don’t have intellectual disabilities or language delays, problems with social-emotional reciprocity may show up as issues with understanding and responding to complicated social cues like learning when and how to join a chat and what not to say.
  • Individuals who have come up with ways to deal with some social challenges still have trouble in new or uncontrolled situations and find it hard and stressful to consciously figure out what is socially natural for most people. Researchers think that this behavior may make it harder to diagnose autism spectrum disorder in these people, maybe especially in older women.
  • People who have problems with nonverbal communication skills for social interactions may not make eye contact, make eye contact less often, or use movements, facial expressions, body language, or speech intonation in ways that are not normal for their culture.
  • Impaired joint attention is an early sign of autism spectrum disorder. This can show up as not pointing, showing, or bringing things to share an interest with others, or as not following someone’s eye look or pointing.
  • People may learn a few useful gestures, but their collection is smaller than other people’s, and they don’t always use expressive motions when they’re talking to others. Teenagers and adults who speak more than one language may have trouble matching their body language with their speech, which can make their relationships seem strange, awkward, or over the top.
  • In some situations, impairment may be pretty subtle (for example, someone may make good eye contact when talking), but it will be clear if they can’t combine eye contact, gesture, body posture, prosody, and facial expression when they’re talking to other people, or if they have trouble keeping these things up for long periods of time or when they’re stressed. People who have trouble making, keeping, and understanding relationships should be rated by how well they meet age, gender, and cultural norms.
  • It’s possible that there isn’t any, very little, or normal social interest, which can show up as rejecting others, being passive, or approaching them in a way that seems hostile or annoying. These issues are especially clear with young kids, who don’t get enough shared social play and imaginative play (like age-appropriate, open pretend play). Later, they become very set in their ways when they play.
  • Older people may find it hard to understand what behavior is acceptable in some settings but not others (for example, being relaxed during a job interview) or the various ways that language can be used to communicate (for example, comedy, white lies). There may be a clear desire for doing things by yourself or with people who are much younger or older than you.
  • Many times, people want to make friends without having a full or accurate picture of what friendship really means (for example, bonds that only involve shared hobbies). It’s also important to think about your relationships with peers, coworkers, and providers (in terms of reciprocity).
  • As stated in Criterion B, someone with autism spectrum disorder also has limited, repetitive patterns of behavior, hobbies, or activities. These patterns can look different depending on the person’s age, ability, intervention, and present supports.
  • Some examples of stereotyped or repetitive behaviors are flapping the hands or flicking the fingers, using the same objects over and over (like spinning coins or lining up toys), and talking in the same way over and over (echolalia, which is the delayed or immediate repetition of heard words; using “you” when talking about oneself; using stereotyped words, phrases, or prosodic patterns).
  • Too much adherence to routines and limited patterns of behavior can show up as resistance to change (e.g., distress at what seem like small changes, like taking a different route to school or work; insisting on following rules; rigidity of thought) or ritualized patterns of speaking or acting (e.g., asking the same questions over and over, pacing a perimeter).
  • People with autism spectrum disorder often have very narrow, fixed interests that aren’t focused or intense enough. For example, a baby who is very attached to a pan or piece of string; a child who is obsessed with vacuum cleaners; an adult who spends hours making schedules.
  • Some interests and habits may be caused by an apparent over- or under-reactivity to sensory input. This can show up as strong reactions to certain sounds or textures, touching or smelling things too much, being fascinated by lights or spinning objects, or sometimes not caring about pain, heat, or cold.
  • Extreme reactions or routines about the way food tastes, smells, feels, or looks, or limiting food too much, are common and may be a sign of autism spectrum disorder.
  • A lot of people with autism spectrum disorder who don’t have problems with their intelligence or speaking learn to control their repeated behaviors in public. For these people, doing the same thing over and over, like rocking or moving their fingers, may help them relax or calm down. Special hobbies can be fun and inspiring, and they can also help you get an education and a job later on.
  • Limited, repeated patterns of behavior, hobbies, or activities may have been present as a kid or in the past, even if the symptoms are not present now. This means that the diagnostic criteria were met.
  • Criterion D says that the traits must make it clinically significant harder to do important things in social, occupational, or other areas of present performance.
  • Criterion E says that the person’s social communication problems, which may be joined by an intellectual developmental disorder (ID), are not in line with their developmental level; the problems are worse than what would be expected based on their level of development.

Conclusion

Individuals all over the world who have ASD have a lot of health problems. Diagnosing ASD early can lower the number of children who have developmental problems and help people communicate better. So, health officials need to know how common ASD is and how it’s getting worse so they can plan and carry out the right steps to lessen its effects.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Baio, J. (2018). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR. Surveillance Summaries, 67. http://dx.doi.org/10.15585/mmwr.ss6706a1
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  • Mughal, S., Faizy, R. M, Saadabadi, A. (2022). Autism Spectrum Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525976/
  • Palinkas, L. A., Mendon, S. J., & Hamilton, A. B. (2019). Innovations in mixed methods evaluations. Annual review of public health, 40(1), 423-442. https://doi.org/10.1146/annurev-publhealth-040218-044215
  • Salari, N., Rasoulpoor, S., Rasoulpoor, S., Shohaimi, S., Jafarpour, S., Abdoli, N., … & Mohammadi, M. (2022). The global prevalence of autism spectrum disorder: a comprehensive systematic review and meta-analysis. Italian Journal of Pediatrics, 48(1), 112. https://doi.org/10.1186/s13052-022-01310-w
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Categories
Psychiatric Disorders

Diagnostic Features of Narcissistic Personality Disorder

Written by Najwa Bashir

Narcissism

Book III of Ovid’s Metamorphoses is where the word “narcissism” was first used. There is a story that Narcissus falls in love with his own image because of a curse. Narcissism, on the other hand, wasn’t used in psychology until the late 1800s (Mitra et al., 2024).

Northcote (1929) says that psychologist Havelock Ellis first used the word “narcissism” in 1898 to describe a patient whose behavior was similar to Narcissus’s. Freud wrote about “narcissistic libido” soon after in his book Three Essays on the Theory of Sexuality (Van Haute &Westerink, 2016).Ernest Jones, a psychologist, said that narcissism is a flaw in character (Kirsner, 2007). There was a case report on grave narcissism written by Robert Waelder in 1925. According to what he termed it, “narcissistic personality” (Guttman& with the Assistance of Irene Kagan Guttman, 1987). The DSM-I did not initially include NPD, even after these revisions. Narcissism wasnot even mentioned in the DSM until the release of DSM-II in 1968 (Schmidt, 2019).

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is characterized by feeling better than others, wanting to be admired, and lacking the ability to relate to other people’s feelings. It is not uncommon for individuals with NPD to experience difficulties in social and professional environments, and it is also common for them to have psychiatric and substance use issues. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and its cluster-based classification go into detail about the traits that make Cluster B personality disorders unique. These disorders include NPD, antisocial personality disorder, borderline personality disorder, and histrionic personality disorder (Mitra et al., 2024). In community groups, the rate of NPD is thought to be between 0% and 6.2%. Between 50 and 75 percent of people who have been labelled with NPD are men. Cluster B of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is where NPD fits in. This group is for “dramatic, emotional, and erratic” personality disorders. Antisocial, Borderline, and Histrionic Personality Disorders are also in this group (Kacel et al., 2017).

Diagnostic Criteria for Narcissistic Personality Disorder

An individual with narcissistic personality disorder consistently acts or fantasizes about being very important, needs praise, and doesn’t care about other people, according to DSM 5 TR (APA, 2022). These traits show up in a number of situations starting in early adulthood and include five or more than five of the below mentioned characteristics:

  1. Really thinks they’re great (for example, they might talk about their skills and achievements and want to be seen as better than other people even though they haven’t done as much).
  2. Is full of hopes for long-lasting success, power, beauty, brightness, or the perfect love.
  3. Thinks that they are “special” and unique, and that only other “special” or high-status people (or groups) can understand them or should hang out with them.
  4. Wants praise too much.
  5. Feels too privileged, which means they think they should be treated extra well or have all their needs met naturally.
  6. Shows interpersonal exploitative behavior, which means using other people to get what you want.
  7. In this case, the person doesn’t want to learn or connect with other people’s feelings and needs.
  8. Is or thinks that other people are jealous of them a lot of the time.
  9. Shows arrogant, haughty behaviors or attitudes.

Diagnostic Features of Narcissistic Personality Disorder

In the light of DSM 5 TR (APA, 2022):

  • Narcissistic personality disorder is characterized by a persistent pattern of arrogance, need for praise, and lack of empathy that starts in early adulthood and shows up in a range of situations.
  • People with narcissistic personality disorder often dream about being rich, powerful, smart, beautiful, or in love(Criterion 2). They may feel good about the respect and comfort they’ve been waiting for a long time and think of how they compare to popular or wealthy people.
  • People with narcissistic personality disorder believe they are one of a kind and expect others to agree (Criterion 3). These people can be shocked or even heartbroken when they don’t get the praise they think they deserve from other people. They might think that only high-status people can understand them and that they should only hang out with those people. The people they hang out with might seem “unique”, “perfect,” or “gifted.” People who have this problem think that their wants are unique and not something that regular people can understand. They feel better about their own self-worth when they think highly of the people they hang out with. They may insist on only having the “best” person (doctor, lawyer, barber, and teacher) or being connected with the “best” schools, but they may not trust the titles of those who let them down.
  • People with narcissistic personality disorder usually need a lot of praise (Criterion 4). They almost always have very low self-esteem, and because they deal with extreme self-doubt, self-criticism, and emptiness, they need to actively seek the admiration of others. A lot of their thoughts may be on how well they are doing and what other people think of them. They might think that everyone will be very happy to see them and be shocked if people don’t want their things. They may always want praise, and a lot of the time, they do a great job of it.
  • • These people think they deserve special treatment, which shows they have a sense of entitlement that comes from having a skewed sense of self-worth (Criterion 5). They expect they will be taken care of and get upset or angry when this doesn’t happen. For instance, they might think they don’t have to wait in queue and that other people should put their needs ahead of everyone else’s. They then get angry when other people don’t help them with “their very important work.” No matter what it means to other people, they will get what they want or think they need. Like, these people might expect others to be very committed, so they might give them too much work without considering how it will affect their own lives.
  • This feeling of privilege, along with not knowing or caring about other people’s wants and needs, can lead to people taking advantage of others, whether they are aware of it or not (Criterion 6). They only date or become friends with someone if they think that person will help them reach their goals or make them feel better about themselves in some other way. They often take extra things and special rights that they believe are theirs. Some people with narcissistic personality disorder take advantage of other people’s feelings, friendships, intelligence, or money on purpose so they can get what they want.
  • People with narcissistic personality disorder don’t want to or don’t understand what other people want, experience, or feel (Criterion 7). They usually have some cognitive empathy, which means they can see things from someone else’s point of view, but not much emotional empathy, which means they can’t actually feel what someone else is feeling. Some people may not realize how hurtful their words can be.
  • When needs, wants, or feelings are seen as signs of weakness or fear, people are less likely to care about them. People who are close to someone with narcissistic personality disorder often feel emotionally cold and uninterested in them back. These people are often jealous of other people or think that other people are jealous of them (Criterion 8).
  • They might feel bad about other people’s accomplishments or goods because they think they deserve those things more. They may severely undervalue the work of others, especially if those people have already been recognized or praised for their efforts. These people act cocky and haughty, and they often have snobbish, condescending, or condescending attitudes (Criterion 9).

Conclusion

Narcissistic personality disorder is a tough clinical syndrome because it shows up in different ways, is hard to treat, and makes it harder to treat other illnesses that often happen at the same time. Therefore, early diagnosis and seeking professional help on time is crucial. This article provides the diagnostic criteria and features for narcissistic personality disorder, which can facilitate the identification of the disorder’s evident symptoms.

References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Guttman, S. A., & with the Assistance of Irene Kagan Guttman. (1987). Robert Waelder on psychoanalytic technique: Five lectures. The Psychoanalytic Quarterly, 56(1), 1-67.https://doi.org/10.1080/21674086.1987.11927165
  • Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic personality disorder in clinical health psychology practice: Case studies of comorbid psychological distress and life-limiting illness. Behavioral Medicine, 43(3), 156-164. https://doi.org/10.1080/08964289.2017.1301875
  • Kirsner, D. (2007). Saving psychoanalysts: Ernest Jones and the Isakowers. Psychoanalysis and History, 9(1), 83-91.https://doi.org/10.3366/pah.2007.9.1.83
  • Mitra P, Torrico TJ, Fluyau D. Narcissistic Personality Disorder. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/
  • Northcote, H. (1929). Havelock Ellis’s studies. The Eugenics Review, 21(3), 237. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984869/
  • Schmidt, A. (2019). Comparison of Kernberg’s and Kohut’s Theory of Narcissistic Personality Disorder. Turk PsikiyatriDergisi, 30(2).https://doi.org/10.5080/u23484
  • Van Haute, P., &Westerink, H. (2016). Sexuality and its object in Freud’s 1905 edition of Three Essays on the Theory of Sexuality. The International Journal of Psychoanalysis, 97(3), 563-589.https://doi.org/10.1111/1745-8315.12480