Why they think you’re a narcissist.

By David Joel Miller.

Have you been called a narcissist?

Proud peacock.

Narcissist?
Photo courtesy of Pixabay.com

Among the reasons that people come to counseling, conflicts with others are high on the list. When a relationship comes apart, whether that relationship is a work one or an intimate one, it’s common to blame the other person. Sometimes both people involved, blame each other. The accusations usually include calling each other selfish, self-centered, and narcissistic.

At first encounter, the narcissist looks full of self-confidence. Closer examination may reveal someone who feels insecure, and needs reassure. Counselors and coaches find people who are high in narcissism difficult to work with. They are prone to think highly of themselves while having low opinions of others. Here are some of the behaviors that may be causing others to label you a narcissist.

You have grand dreams.

Having great dreams is a wonderful thing. Beginning to think that because you are pursuing large goals, you are an important person, is the result of an exaggerated sense of self-importance. Pursue huge dreams but avoid getting a large head. If you want to accomplish great things you need to keep your ego in check.

You think there is no limit to your success.

You can be great at a few things, good at some things, but no one is successful at everything. If you start believing everything you do is better than others, you are leaving reality for delusions. Expecting to win and everything leaves you unprepared for setbacks. Believing you’re the greatest at everything alienates others around you.

You need lots of applause to keep you going.

Recognition feels wonderful, but if you begin to have cravings for admiration, you are headed towards the narcissistic addiction. Expecting everyone to recognize your greatness, and then being hurt when they fail to give you the admiration you expect, reeks of Narcissism.

You expect to be treated in special ways.

Feelings of entitlement are warning signs you are on the road to narcissism. Be careful about believing your own PR. Regardless of the position you occupy treat others the way you would like to be treated. If you start believing that you deserve special treatment, you’ll start looking down at others. Believing your superior drives others away. Your specialness may be pathological narcissism.

You believe it’s okay to get over on others.

The best deals are the ones where both people benefit. If you start believing that it’s okay to take advantage of others, others will not want to be around you. Severely narcissistic people treat others as objects there only to meet their needs. If you treat people like things, you create resentments. If you act narcissistic, people will call you a narcissist.

You can’t feel empathy.

Not being able to put yourself in another’s shoes, results in others not wanting to walk alongside you. Narcissists see things only from their point of view. They can’t understand what others are feeling.

Have you convinced yourself that other envy you?

Riding the envy Express is a fast track to loneliness. Once you convince yourself that others are jealous of you, it’s easy to start being envious of them. Hater’s convince themselves that everyone else hates them.

Your successes have made you arrogant.

Once you convinced yourself that you can do everything better than others, that everyone hates you, and that you are entitled special treatment, your thinking, your behavior, and your speech become arrogant.

People make you angry.

If you come to believe that your anger is caused by other people you have begun to take yourself far too seriously. Take ownership of your feelings. Others have their reasons for what they say and do. Don’t fall into the trap of believing that others behavior has something to do with you.

Your anger quickly turns to rage.

You start excusing your anger outbursts, and now you are going from zero to homicidal rage in seconds’ flat. Living in the land of rage points to your already having crossed the border into narcissism.

Your self-esteem has blown up like a balloon.

Rapidly expanding self-esteem requires lots of input to keep it inflated. Have you experienced complement shortage, and you are constantly fishing for compliments to keep your ego fed. If you believe that others ought to be recognizing your greatness, telling you how wonderful you are, you have left the land of reality.

You do a lot of blaming others?

As you feel more important and more entitled, you may start believing your failures are the results of others letting you down. The more you take the “it’s not my fault” stance, the easier it is to find others to blame. People who become highly narcissistic never accept any blame.

As a highly important person, you expect perfection from others.

The more your ego inflates, the more you expect perfection of others. You said impossibly high standards and those around you feel the strain. Setting impossibly high goals for others, while making excuses for yourself is the narcissistic thing to do.

More about Narcissists.

As we move through our series of Narcissism posts, feel free to ask questions and leave comments. To help you find these posts, below are some links to point you in the right direction. Keep in mind that all the posts about narcissists appeared in the narcissism category but links to future posts will not be live until future posts appear.

Narcissism category.                          Personality disorders.

Narcissistic traits.                               Psychology. (coming soon)

Narcissistic relationship partner.        Relationships.

Self-esteem.                                        Narcissistic Personality Disorder.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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Are you dating a narcissist?

By David Joel Miller.

Can you spot the narcissist in your life?

dating a narcissist

Is he a narcissist?
Photo courtesy of Pixabay.com

Being in a relationship with a narcissist can result in long-term emotional damage. Much has been written about the consequences of relationships with narcissists. There are books about healing from the damage narcissists can do. Some people report having had multiple relationships with narcissistic others.

How do narcissists manage to appear so wonderful at the beginning of relationships? Do you know the signs to watch for to spot a narcissist? How long does it take for a narcissist to reveal they’re true nature?

People in recovery from relationships with narcissists have reported that in the early stages of dating, the narcissist is a great deal of fun to be with. On average, it took seven dates for the narcissist’s true nature to appear. Unfortunately, many people had begun sexual relations with the narcissist before the troubling aspects appeared. They often did not realize what they have gotten into in time.

It’s important to know that there are several kinds of narcissism. In psychology, sometimes the term narcissism describes people who are high in self-confidence. In mental health, pathological narcissism is called Narcissistic Personality Disorder. There’s a world of difference between being in a relationship with a strong, assertive person and having a partner who only thinks about themselves.

First date with a narcissist.

People who sought treatment for the consequences of being in a relationship with a narcissist reported that in the beginning, the narcissist appeared agreeable, competent, intelligent, confident and entertaining. The narcissist is often a very good dresser. They’re likely to surround themselves with expensive things, fancy cars, extravagant homes, luxury possessions, rather than practical items.

When the narcissistic problems appear.

By the seventh date, the problems were apparent. The narcissist began acting arrogant, overestimating their abilities, bragging and hostile. Pathological narcissists consider themselves successful with the opposite sex because of having had many serious relationships. Often they were dating and sleeping with, multiple people at the same time.

Highly narcissistic people experience more extreme emotions. While emphasizing how strongly they were attracted sexually, they had high levels of jealousy and obsessed over their partner.

Relationships with narcissists are characterized by being full of turmoil and are high in instability.

Most narcissists are men.

The characteristics that define narcissism are traits that have traditionally been valued in men. The narcissist is all about being important. The have a high need for admiration. Grandiosity and self-centeredness are other defining characteristics of narcissism. Narcissists are competitive, but for them, competition is all about winning. Some high self-esteem is a good thing, but having too high an opinion of yourself results in toxic relationships.

Women who score high narcissistic traits.

Some women score high on personality tests for some narcissistic characteristics. Rather than being important, women tend to emphasize being close. They’re likely to be overly invested in others. As a result, women are more likely to be diagnosed with borderline personality disorder or dependent personality disorder.

It’s common to find dependent people, those with low self-esteem, attracted to narcissists. In the early stages of the relationship being with this fabulous other makes them feel good about themselves. Unfortunately, they rarely realize they have begun a relationship with a narcissist until they are so deeply involved they find it impossible to leave.

More about Narcissists.

As we move through our series of Narcissism posts, feel free to ask questions and leave comments. To help you find these posts, below are some links to point you in the right direction. Keep in mind that all the posts about narcissists appeared in the narcissism category but links to future posts will not be live until future posts appear.

Narcissism category.                          Personality disorders.

Narcissistic traits.                               Psychology. (coming soon)

Narcissistic relationship partner.        Relationships.

Self-esteem.                                        Narcissistic Personality Disorder.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Narcissistic Personality Disorder (F60.81.)

By David Joel Miller.

Pathological Narcissism.

Proud peacock.

Narcissist?
Photo courtesy of Pixabay.com

When certain patterns of behavior, or your inner experience, become continuing, pervasive, and inflexible and deviates from what your culture expects, you may have a personality disorder. Narcissistic personality disorder involves an extreme need for admiration, delusions of grandeur or grandiosity, and a lack of empathy.

This particular disorder is rarely diagnosed because those with Narcissistic Personality Disorder do not believe there is anything wrong with them. Lacking empathy, the narcissist blames their problems on others. What brings the narcissist to therapy is most likely extreme impairment in social relationships or a deteriorating job functioning.

One great paradox of narcissists is that despite their beliefs in their superiority, they often are very vulnerable to challenges to their self-esteem. Narcissists need to feel they are better than others in order to feel okay about themselves. This dichotomy results in a high sensitivity to criticism. They often meet perceived attacks with rage.

Even when forced into counseling, the narcissist likely will continue to insist that the problems are caused by others. The DSM lists nine characteristics of narcissistic personality disorder. Having five or more of the characteristics is required to receive the diagnosis. I have paraphrased these from the APA DSM-5.

1. Excessive self-importance, grandiosity.

They expect that everyone will recognize their superiority to others. The narcissist boasts, brags, and exaggerates their accomplishments and are shocked when other people do not recognize their superiority. There is an exception to this if they actually are superior. As the saying goes, it’s not bragging if you can do it.

2. They live in a fantasy world of power and success.

They are preoccupied with fantasies of limitless excesses, absolute power, unrivaled beauty, and brilliance, or ideal love. Narcissists are prone to compare themselves favorably with famous people.

3. The narcissist has a firm belief that they are better than others.

He believes that he should only associate with other superior beings. They expect to attend the best schools, drive the best car, and live in the best neighborhood. Believing they are better than others, they are quick to find fault with the accomplishments of others.

4. The narcissist can’t live without the worship or admiration of others.

Narcissists are often desperate for recognition from others. They expect to be the center of attention and are shocked when others don’t notice them. Narcissists will fish for compliments and be insulted when they feel underappreciated.

5. The narcissist believes they deserve special treatment.

Because they believe they are superior to others, they expect their needs to receive the highest priority. They have a sense of entitlement and a belief that the rules should not apply to them. They see themselves as too important to have to wait for their turn or to stand in line.

6. Give the narcissist a chance he will use you to meet his needs.

Given his sense of entitlement, it’s not surprising; narcissists have no qualms about using others. Sometimes this is a lack of sensitivity, but it may also be rooted in their belief that they are more important and deserving than others. Don’t expect a narcissist to feel guilty for taking advantage of others.

7. Empathy is foreign to narcissists.

The narcissist is incapable of seeing things from others point of view. He can’t see why the feelings or needs of others should matter and expects others to be fully committed to meeting his needs. While they will talk at great lengths about their concerns, they will have no patience to listen to the problems of lesser beings.

8. Narcissists feel entitled to the most and the best.

The narcissist believes others hate him and are jealous. He believes he is entitled to the biggest and best. If someone else has something of value, the narcissist believes it should belong to them.

9. The narcissist excels at arrogance.

The narcissist criticizes everyone. They are quick to use derogatory labels such as stupid, lazy, fat, and rude.

Having read those nine characteristics, you probably have a pretty good mental picture of a narcissist. While I referred to the narcissist as he, it is possible to encounter a narcissistic she also. Some of the characteristics of this and other personality disorders sound like immaturity. To use the personality disorder label, we require that this disorder first begins in early adulthood.

In adolescents, these characteristics may not be fixed and would be described as narcissistic traits. In the adult population, it is estimated that up to 6% of the population have severe enough narcissistic traits to receive the diagnosis of Narcissistic Personality Disorder. About 75% of those with Narcissistic Personality Disorder are men. One possible explanation for the high rate of narcissism in men is our culture’s emphasis on competition and winning. More on that in an upcoming post.

Narcissistic Personality Disorder overlaps and co-occurs with depression, especially Persistent Depressive Disorder, and hypomania in bipolar disorder. People with Narcissistic Personality Disorder often also have Histrionic, Borderline, Antisocial, and Paranoid Personality Disorders.

More about Narcissists.

As we move through our series of Narcissism posts, feel free to ask questions and leave comments. To help you find these posts, below are some links to point you in the right direction. Keep in mind that all the posts about narcissists appeared in the narcissism category but links to future posts will not be live until those future posts appear.

Narcissism category.                          Personality disorders.

Narcissistic traits.                               Psychology. (coming soon)

Narcissistic relationship partner.        Relationships.

Self-esteem.                                        Narcissistic Personality Disorder.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Questions about Narcissists?

By David Joel Miller.

Has a Narcissist caused you pain?

Proud peacock.

Narcissist.
Photo courtesy of Pixabay.com

If you have experienced a narcissist in your life, you know the pain they can cause. Growing up with a narcissistic parent can affect the rest of your life. Dating a narcissist can undermine your self-esteem. Narcissists make very poor relationship partners. Narcissism was once a very rare diagnosis, over the last couple of decades, the problems of narcissism have been on the rise. Narcissists are often attracted to people with low self-esteem. This increase in the number of narcissists and the way the words narcissist and narcissism are used is creating more questions than it has answered. In this blog post, and some future ones, let’s take a look at the challenge of narcissists.

This increase in the number of narcissists and the way the words narcissist and narcissism are used is creating more questions than it has answered. In this blog post, and some future ones, let’s take a look at the challenge of narcissists.

What’s with all this talk about narcissism?

You may have noticed the word narcissist and discussions of narcissism has been coming up a lot lately. It shows up in news reports, blog posts, comments, and increasingly in the literature about relationships. From the way, the word narcissist is being used; it is clear that various people have very different ideas about narcissists. Because of the things I have read recently about narcissism I’ve been looking at the research into narcissism. The research is very inconsistent, and clearly, the authors are talking about different things.

The word narcissism appears to be the victim of both overused and imprecise use. In future posts, I want to explore what narcissism is and why it looks differently in different circumstances. Our exploration of narcissism will require a series of posts. I will work these posts in as time and space permit.

First the questions about narcissism, with a brief explanation, and then some links to help you find the variety of narcissism you would like information about.

What is Narcissistic Personality Disorder?

Narcissistic Personality Disorder is a recognized mental illness with a very specific set of criteria. This diagnosis is one of extreme, pathological levels of narcissistic characteristics. Most therapists rarely use this diagnosis. It is most likely to come up in criminal justice work where the client is also a prisoner, accused of or convicted of a serious crime. Narcissistic Personality Disorder frequently co-occurs with several other diagnosable mental illness. Other kinds of narcissistic behavior are frequently described and sometimes treated by therapists, despite not meeting the criteria Narcissistic Personality Disorder. More on this condition will be in an upcoming blog post.

What is a narcissistic relationship partner?

Some relationship or couple’s therapists use the term narcissistic partner to describe the way one person may act in a relationship. If you been in the relation with the narcissistic person, you know how painful it can be. When relationships break up, many people describe their ex as narcissistic and uncaring. The term narcissist is sometimes used as a synonym for selfish and self-centered behavior. Your partner’s behavior may range anywhere from mild narcissistic thoughts and actions to extremely high levels of narcissism. Both people in the relationship may become more narcissistic with time as they teach each other these thoughts and behaviors.

Why are people with low self-esteem attracted to narcissists?

Therapists see a lot of clients who have been in abusive relationships. Many of these people grew up in homes with a caregiver who was emotionally unavailable or abusive. As adults, these individuals often find themselves attracted to people they later described as narcissists. Many people would describe themselves as having low self-esteem and have been in multiple relationships with partners who they would describe as narcissists.

What is the connection between charisma and narcissism?

Several research studies have described the phenomena of charisma. While not all charismatic people are narcissists, when you first meet them, narcissists are often very charismatic. It can take a long time to see through the charisma and recognize the narcissism.

Why are so many middle and upper managers high in narcissism?

Narcissism in one form or another is common in managers. In the short run, narcissistic managers can produce some amazing result. Some are successful over the long haul. Very narcissistic managers can also create human wreckage, high turnover, and some spectacular failures.

What is trait narcissism?

In the field of psychology, there’s been a lot of research on a thing called trait narcissism. This trait connects to a lot of other personality characteristics. People who are low in self-esteem are low in trait narcissism. When we treat people with low self-esteem, as their self-esteem rises, so does their level of trait narcissism. What the psychology field means by trait narcissism and what mental health means by Narcissistic Personality Disorder are very different concepts.

Can narcissism be a good thing?

People who are high in trait narcissism have more self-esteem and self-confidence. Some of this research suggests that too little narcissism may be causing emotional and mental disorders. If some narcissism is a good thing, we need to know when narcissism is useful and which narcissistic characteristics are good ones.

How can you spot a narcissist?

When you’re initiating a new relationship, you can expect people to put their best foot and best face forward. Before you get into a new romantic relationship, it could be useful to spot the signs that this person is a narcissist. If you’re doing the hiring, you might want to take another look at a narcissistic job candidate before you hire them and they demolished your organization.

Can you think of any other questions about narcissists and narcissism we should ask?

More about Narcissists.

As we move through our series of Narcissism posts, feel free to ask questions and leave comments. To help you find these posts, below are some links to point you in the right direction. Keep in mind that all the posts about narcissists appeared in the narcissism category but links to future posts will not be live until future posts appear.

Narcissism category.                          Personality disorders.

Narcissistic traits.                               Psychology. (coming soon)

Narcissistic relationship partner.        Relationships.

Self-esteem.                                       Narcissistic Personality Disorder.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What are personality disorder clusters?

By David Joel Miller.

What are the three main groups of personality disorders?

What is? Series

What are personality disorder clusters?
Photo courtesy of Pixabay.com

The newest edition of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders divides personality disorders into three categories based on their similarities.  Personality disorders are long-term or enduring patterns of behavior.  The old way of thinking about these issues was that this is just the way someone is and treatment was not likely to be successful.

Recently treatments for many of the personality disorders have become available.  Currently, we think of many of these personality disorders as problems of living which may occur in varying degrees.  Someone who is low in self-esteem might be described as low in narcissism.  If they were high in narcissism they might be lacking in the ability to empathize with others.  Below is a list of the clusters of Personality disorders with brief descriptions of the disorders in that cluster.  For longer discussions of the personality disorders see separate posts on the specific personality disorder.

Cluster A personality disorders.

This group of personality disorders includes people who appear odd or eccentric.  Among the Cluster A personality disorders, are Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder.

Paranoid Personality Disorder involves people who are more fearful of people, life, and events that would be warranted.  They are especially likely to think that other people are out to get them.

Those with Schizoid Personality Disorder are detached from others and seem to have little desire to have close personal relationships. They have less ability to express emotions.

In Schizotypal Personality Disorder, people are very uncomfortable in close relationships, have eccentric behavior and may have thinking or perceptual difficulties.

Cluster B personality disorders.

Cluster B personality disorders include things like Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.

Those with antisocial personality disorder seem to have little regard for others and their rights.  They don’t mind taking advantage of people around them.  This is different from those people who may make a life out of crime and intentionally steal from, or harm other.  Career criminals get a diagnosis of Adult antisocial behavior Z72.811.

People with Borderline Personality Disorder are likely to have a poor self-image, low self-esteem, fluctuating emotions and often are very impulsive in their relationships.  Those with Borderline Personality Disorder may also self-harm.

Histrionic Personality Disorder might be described as the typical “Sarah Bernhardt” actress.  Someone with histrionic personality disorder is excessively emotional and is always looking for more attention.

Cluster C personality disorders.

Cluster C personality disorders include disorders related to relationships with other people.  These personality disorders in Cluster C are thought to begin in early childhood. They include unusual ways of relating to close people in their life. This includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.

People with Avoidant Personality Disorder avoid other people, feel that they’re inadequate, and are often very sensitive to criticism.

Those with Dependent Personality Disorder are the people likely to become co-dependents.   They are often submissive, clingy, with an excessive need to find someone who will take care of them and control their lives.

Obsessive-Compulsive Personality Disorder is different and separate from Obsessive-Compulsive Disorder.  When the pattern of being obsessive-compulsive becomes a preoccupation with orderliness, perfection, control, having everything exactly the way they need it to be at all times, this moves from a single obsessive compulsive behavior to the level of a continuing personality disorder.

In addition to the three personality disorder clusters, two other personality disorder characteristics are described in the DSM-5.  Sometimes a personality disorder can be the result of medical conditions.  The DSM-5 also allows for other specified personality disorder or other unspecified personality disorder when one exists that does not fit this list.

Each of these personality disorders is described more completely in other “What is” posts about that specific personality disorder.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships your enjoyable activities or cause you personal distress.

Having mild forms of these disorders does not qualify unless it causes you problems.  In that case, you may have the issues, but you will not get the diagnoses. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem these characteristics need to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Personality Disorders

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What are Personality Disorders?

By David Joel Miller.

Update.

In the new DSM-5, the five-axis system was eliminated. Personality disorders are now included in the full list of mental, emotional, and behavioral disorders, just like any other mental health issue. I have left this post here, as originally posted because much of this information remains relevant. Not all of the changes we expected in the DSM-5 took place. For the current status take a look at some of the newer posts.

How many Personality Disorders are there?

Personality Disorders are a special class of mental illnesses that are considered different in kind and nature from other mental health problems. Mental illnesses in all their shades are recorded on Axis I. There are currently over 300 recognized Mental illnesses. Most mental illnesses have several standard treatments and if severe enough are likely to be covered by insurance or public funding. Not so with personality disorders.

Personality Disorders are kept separate. They are recorded on Axis II in a separate and small class of problems that just don’t seem to ever change or get better. They have long been considered like mental retardation, something we need to help with, but something that just won’t change. Personality Disorders are a short list, rarely over a dozen labels, though the list changes over time.

Personality Disorders are conditions in which the person to be diagnosed “deviates from expectations of their culture.” There are different. But that is not enough for the diagnosis to be imposed.

This pattern of “differentness” is “Pervasive and inflexible.” They stick to their irritating pattern no matter what. This pattern starts in adolescence or early adulthood and they just don’t change, “grow up” or “grow out of it.” So this pattern of differentness is “stable over time.” It is as if people with a personality disorder get stuck in one way of behaving and then can’t change their approach when they are in a different time or place.

This differentness needs to also cause them problems getting along with other people, holding a job or make them unhappy to get the diagnosis. They are not just a little different some of the time but a lot different all the time.

Some people could care less if they have a personality disorder or not. But most people who have a Personality Disorder are suffering, want and need help, no matter how we label or understand their problem.

Currently, there are ten recognized Personality Disorders in three groups or “clusters.” The DSM-5 due out next year probably will reduce that list to six personality disorders and a new “Personality Disorder Trait Specified.” Not sure what will happen to the people who have a disorder now when their diagnosis is abolished. Will they be declared cured? Or maybe we just give them a new mental illness to compensate them for their loss.

When I was in Grad School I though these personality disorders were interesting, did extra research and even wrote some papers on the topic. I considered specializing in treating these disorders. But what I discovered is that most people with a personality disorder come to the therapist for Depression, Anxiety and relationship problems just like anyone else. Also since these are “inflexible” patterns, only two of these disorders end up in treatment with any regularity.

Here are the clusters as they stand now with the included diagnosis. The descriptors are mine with my apologies to the APA. Clusters A and C first as Cluster B is the biggie.

Cluster A: These are the “Weird” people.

Paranoid Personality Disorder – They are scared all the time. Most are NOT Schizophrenic. We don’t see many of these people unless family or police call us as they are so afraid they never leave home. This diagnosis disappears with the DSM-5. Lots of luck on that one.

Schizoid Personality Disorder – Loners. They do not like being around other people even family. They don’t have or want friends. They would make great hermits. When the DSM-5 arrives they are all cured and free to head for a cave in the hills. Just watch out for the zoning enforcement people as those dudes like to talk.

Schizotypal Personality Disorder – Odd, superstitious and believe in signs, spirits and the supernatural. They may not have friends outside the family or only one close partner. If they think about something that needs to be done, say doing the laundry and then you go do it, they will believe that their thought caused you to do it. They often dress in odd ways. This description has been applied to people who look like “witches” etc. The DSM has an exemption here if they belong to a group that agrees with their beliefs. For the record Modern “Witches” who call themselves Wiccan do not wear funny clothes all the time and do not qualify for the diagnosis of Schizotypal. This is more common that the last two Personality Disorders and stays in the new DSM-5.

Group C Scared People

Avoidant Personality Disorder – they would like friends they are just sure no one will like them and so they avoid people. They are also sure people will criticize them or put them down so they don’t try. This one stays.

Dependent Personality Disorder – Needed, clingy afraid they will be abandoned. They always need help and what to be told and what to do. This diagnosis goes. Find yourself a dominant partner before your diagnosis is repealed or get help and become less needy.

Obsessive Compulsive Personality Disorder – This goes beyond everyday OCD. They want everyone else to do things just so. They are often stingy with money, needs to control everything and they have the rule book to do it. Often they cannot get anything done because their rules are so complex they can’t follow them. This one stays.

Cluster B. The people who cause others problems. Cluster B diagnoses are the most common diagnosis in prisons.

Antisocial Personality Disorder – They disregard the rights of others and violate those rights. This is the number one diagnosis of men in prison. This one needs a whole post all by itself.

Borderline Personality Disorder – The main ingredient here is lots of pain. Unstable interpersonal relationships, poor self-image, unstable mood, often impulsive with a chaotic life. Most people who are diagnosed with Borderline Personality Disorder are women. This traditionally is the number one diagnosis of women in prison. Many women with this diagnosis have been victims of one kind or another at an early age. They did what they had to do to cope in a bad situation but now the way they cope is not working. There are some really good treatments for this, especially DBT, but it takes a time to heal.

Histrionic Personality Disorder – Excessive emotionality and attention seeking sometimes referred to uncomplimentary as “Drama Queens.” Not common in practices and we are doing away with this diagnosis when the DSM-5 comes out. Most of these folks have their own T. V. shows by now so they can pay for therapy even without a diagnosis.

Narcissistic Personality Disorder – were keeping this one. Not sure why. Firs, we treat you for low self-esteem and then we tell you that you are Narcissistic. Most people who come for marriage counseling tell me their partner is Narcissistic.

This should be on a continuum. Is this a political season? How can we tell the Narcissists from the candidates? Don’t you need to be a lot Narcissistic to think you should be running the show? Does the top Narcissist get to run a Bank or Wall Street?

Running out of time and this post is going long. More on Personality Disorders to come. Do any of you have any thoughts on the topic?

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books