Thursday, December 09, 2010

My Two Cents on NPD Being Removed from the Newest DSM

It seems there is some expectation that I have an opinion and need to weigh in on the latest news about NPD and four other personality disorders being removed from the upcoming DSM V since a few people have emailed me about this development. I haven't felt compelled to say anything because I've already stated what my position on psychiatry's labels is. In case you haven't read every word of this blog I'll consent to stating my reaction to the above news. It is more of a non-reaction, really.

Okay, to be systematic about this, the New York Times published an article on November 29, 2010 about the deletion of Narcissistic Personality Disorder from the upcoming DSM. You can find the article here. It is titled, "Narcissism No Longer a Psychiatric Disorder."

Let me state categorically that this deletion in no way affects any of the content of this blog. This blog is established on the authority of eyewitnesses as well as the authority of an objective morality not on the authority of the grand poobahs of psychiatry. I have been unimpressed with the so-called science behind the labeling game of this profession and have stated so on this blog. You know as well as I do that a pen stroke in some stuffy conference room doesn't dismiss the reality of those who are malignantly narcissistic. These pointy-headed academics cannot eradicate the colossal damage narcissists inflict in every realm of human interaction with their decision to shift or erase labels.

Here are a couple quotes from my own blog that should clarify for you how little this news affects my view of anything on this subject. In my article titled, "Narcissist or psychopath....both are human predators" I stated:

Speaking of categorization...I think we would all do well to remember the rather arbitrary lines that have been drawn up for us by the psych community. They are allowed the freedom to re-draw the lines as they deem necessary which only tends to prove the non-scientific nature of the categorization.

Rather a succinct statement for such a windy blogger. But there it is. The labels are not scientific. With this in mind, they can f*&% around with the labels all they want. It won't change a damned thing as far as we are concerned. It will change the way these people are given "treatment", but considering how few actually ever end up in a clinical setting I'm not sure it is going to affect much there either. All this newest deletion of NPD and four other labels does is prove my statement above...once again. Labels aren't science. They are names. What the academic egg heads decide to name a thing isn't going to change my view on those people out there who wreak their damage on everyone in their sphere of influence. Period.

In my blog post titled, "Irresponsible Journalism or Psychologists...or Both" I was talking about the psychoanalyzing of Blagojevich (then mayor of Chicago) going on in the media at the time. The quotes are longer to provide some of the context:

First of all, the so-called professionals love to tell us laypeople that we are not qualified to determine whether or not someone we know has NPD by comparing that individual's behaviors with an checklist. What the article from the Sun-Times illustrates to me is how the 'professionals' are the ones who are unqualified. I think it is highly unprofessional for a psychologist to make pronunciations on someone's mental state to the media when that psychologist has never even met the person in question. They should at least try to uphold some of the standards they hold the rest of us to. They tell us we can't diagnose persons whom we've grown up with or married or worked with for years yet, sight unseen, they can make absolute statements about a person's mental health just from reports they've read in the media and a few pictures of a person? Bah.

This is just one very good illustration of why you should ignore anyone, especially the 'professionals', who tells you that you can't tell whether or not someone in your life has NPD. They don't know Jack themselves. No one knows what NPD is more than someone who has suffered from its predations for years. Eggheads in ivory towers only know NPD from textbooks.

Obviously, I've already expressed how little reverence I have for the labeling game of the professionals. This being the case I'm not affected when they again play with their labels. Whatever. While they're masturbating themselves with their power to pronounce someone mentally ill or "normal" I'm content to know what I know. That is because I know what I know from extensive personal experience. I know what I've seen, heard and lived through, so the labels that are in the DSM, or that aren't in the DSM, don't affect my knowledge or shift my past experience in the least.

I used the label of NPD on this blog because of the ease of communication. It was a convenient label for a couple of reasons. First, because it was an objective listing of behaviors to compare someone's actions to in order to know that we're talking about the same animal. Second, the description of the behaviors and attitudes that this label represented has become rather well known to the general public which means that people who are searching for answers on this subject will usually use the label of NPD. So it made sense for me to use the psychological term for ease of communication and in order to reach as many people out there looking for answers as I could. I didn't use the label of NPD on this blog because I recognize the authority of psychiatry to draw the lines or make the labels correctly in every instance. They had it right with the over-arching description of Narcissistic Personality Disorder so I consented on that basis alone to use their label. They had the label right because it was restricted to describing what is observable about this personality type. Observation is the basis of real science. Therefore I wasn't opposed to using a label that was based on the scientific exercise of what can be observed. Because the label of NPD was a comprehensive, over-arching view of this personality type it has become a good tool for the clinicians out there who have to deal with these people in therapy. This reality tends to prove that the label was an effective description of the scope of behaviors seen in narcissists. Again, another vote in favor of the label NPD.

Even though I am dismissive of the "science" of labels I do recognize the great power this profession wields because of their generally accepted power to label. This profession's ability to apply labels to their fellow human beings has a potentially profound effect on lives. It is a power that is too often misused and can devastate lives. When I apply a label to a person I don't have that kind of power. That is because my labels don't have the authority to put someone into an institution without their consent therefore depriving them of their freedom. My labels can't force a person into therapy. My labels can't deny a person a job or put them in prison. My labels can't make money for innumerable doctors or sell pharmaceuticals. My labels are therefore quantifiably different than those that psychiatry makes. The power to name things is a significant thing when you are called a scientist and have the power brokers of society acceding to your right to make those labels.

All this being said, I suspect that this newest development will not be permanent. The article in the New York Times hints at the internal war that has commenced between the clinicians who actually deal with these people and the academics who largely don't. I'll be mildly interested to see who wins the war. I'm hoping that reality wins. Narcissists are not normal because they exist in large numbers. Narcissists are destructive and often dangerous to others. And by dangerous I don't just mean in the mortal sense. They are dangerous to the emotional and mental well-being of others. They destroy lives without necessarily taking lives. This is not normal. Not ever. The DSM manual may be the bible of the psychiatric world, but it isn't ours. Know what you know and let those in their cloistered halls of academe play their little naming games amongst themselves.

25 comments:

Sara said...

First, Hurray! I discovered your blog a while back, subscribed to it, and I swear 24 hours later you posted that you would not be posting anymore. Lord knows why I left it in my RSS feeds. Laziness, probably.

Second, I never really got the impression that with the change to the DSM, those who had been labeled NPD would now be labeled "normal." I think they just get a labeled as some other disorder. Did I misread that?

Anna Valerious said...

That wasn't my impression nor the impression of the clinicians who are opposing this new way of classification. Now patients won't be labeled as having a disorder, per se, but the therapist is supposed to pick various traits from a list. Mix and match style. The danger of this, in my estimation, is that diagnoses will likely fail to paint the big picture. It is kinda like going to see a urologist for a bladder problem when you have metastatic cancer that has spread to the bladder. The urologist may miss the big picture and treat you for a bladder infection when you have a much bigger problem than that i.e. a cancer that started elsewhere and is now affecting the bladder, but is a much bigger problem overall than just the bladder issue. Perhaps that is simplistic as an explanation but will perhaps give a picture of the problem with this new "ala carte" method of picking a few traits from a list rather than diagnosing the bigger issue. I think the end result is that it will normalize much of the aberrant behaviors of the narcissist.

rys said...

Whether or not NPD is left in the DSM V, I'm glad to see it in the public discussion. Usually the psychiatrists interviewed on the panel in the news are in favor of keeping it in (at least the ones I've seen). They bring it up in the real sense, not the 'Hollywood Disease' or 'Social Media frenzy' sense.

To answer Sara's question, I understand that they are considering a list that will be used...basically the symptoms of the missing PDs without the name. The doctor would check off the traits displayed, but it wouldn't result in a label.

Pavitra said...

Good article... my thoughts on this:

- Maybe some of these lofty experts are trying to eliminate the NPD label because it's hitting a little too close to home when they're busy admiring themselves in the mirror.

- If they do remove the NPD label from the DSM, let's be optimistic. It just gives the rest of society the opportunity to use a better and more colorful descriptor... a**hole is my favorite, personally :-)

mulderfan said...

I'm past worrying about the label..whack job, nutbar, fuck-up, etc. all work for me! What narcissist would end up in therapy anyway?

All that's important is the realization that I didn't cause and I can't fix it, so fuck 'em!

Kathleen said...

Wow. As I got to Anna's comment I couldn't believe what I was reading. My mom went to a urologist because she had an infection -- she died of a spinal tumor which affected her ability to urinate. And the urologist never found it. I was stunned with Anna's analogy.

Putting that aside, Shakespeare wrote "A rose by any other name would smell as sweet."

Who cares what it's called? Didn't we all find some sort of RELIEF when we did tag it, name it, recognize that it's REAL?
Call it whatever you want or don't call it anything at all -- all I know is I will stay away from my inlaws. They wreak havoc on my psychological well-being.

- Kathleen

Shaun said...

My interpretation was that this was necessary because of the misdiagnosis of many patients due the overlapping symptoms of the disorders. In fact, the Cluster B PDs are almost interchangeable based on the symptoms displayed and their severity.

The new way to diagnose allows a bit more "wiggle" room without holding fast to a diagnosis. Instead of saying person A had Borderline Personality Disorder, per DSM IV, now this person will be personality disordered with Borderline traits (and/or Narcissistic traits, etc), per DSM V.

As you've emphatically stated, the label doesn't matter - the experience does. I concur, and I think this is where the diagnosis and treatment of PDs is headed. I don't see it as eliminating the disorder as much as broadening the scope of the diagnosis and treatment based on traits, not narrowly defining the disorder as 'x' therefore we treat it with 'y'.

Ralph said...

Even if the NPD label is removed from the newest DSM, I know for a fact that NPD truly does exist. Several relevant names were mentioned in earlier posts. I agree with all of them.

I thank you Anna for this blog as it helped me realize who the true villans were in my life by reinforcing my sanity.

Given the fact that the N personality adamantly denies any accountability for their actions, they are immune from counseling. They are basically right when they say "It's your problem, deal with it"

Anna Valerious said...

Thank you for your view on this, Shaun. If it is indeed as you describe then it would be an improvement. Time will tell how it will all shake out. Either way, I'm good. How the professionals parse this shit out doesn't matter much to me.

LaLa said...

I found your blog a few years back, and will never remove it from my RSS... your blog was a beacon of sanity when I was going through hell dealing with my own mother.

I agree that the DSM changing or removing NPD doesn't make a bit of difference; the absence of an official label doesn't matter.

Kathleen said...

Of course, we wont' really know what path the psychologists and psychiatrists will take in the future until we get there, but there is a bright side. Narcissism has been so talked about, so "out of the closet" that many younger people are aware of it.

One of those younger people is my daughter who will be going on to grad school next year --- she wants to be one of those egghead psycologists. She's been taught about narcissism in school (it's still in the DSM now!) and has also been exposed to her grandparents. SHE believes it's a real and dangerous condition.

All those in school now, undergrad and grad, are being taught about it. Perhaps the DSM notwithstanding, the new younger batch of psychologists will be more aware.

- Kathleen

Anna Valerious said...

The "eggheads" are the academicians, i.e., the ones who hang out with books, not clients. I doubt that is what your daughter plans to be.

Here's hoping you're right that the new batch of grads will be more aware of the problems that narcissism present. Especially to the victims. The narcissists don't have a problem...it's everyone around them who need the help!

EWriter said...

I read someplace that Ns will still fall within a personality disordered category if this happens. In my mind Narcissist is still the most accurate label. Where did I read that? Wish I remembered. I think what I read is that this would be combined with something--was it sociopath or borderline? can't dig that info out of the brain--but it would still be a cluster B personality disorder--I think that's what it is- a B. No matter--those of us familiar with the thing will still know its a really bad thing.

Jasmine said...

It's good to hear your voice again:) I eagerly read all of your posts last year, then I copied them off and worked through my issues by scribbling my thoughts and feelings in the margins. Though I was sad that you stopped blogging, I rejoiced in your victory:)

Thank you for writing from a well- informed Christian perspective. Sadly, my NF often twisted the Bible to suit his selfish whims. I'm successfully NC with my NF and EM for 16 months, largely due to reading your blog immediately after cutting them off. Thank you!!!

I wholeheartedly agree with you. Who cares what the so-called experts call the evil among us?! I know what I know.

I'm 51, happily married with a 25 yo son. My NF is a retired missionary and pastor. My two brothers and I repeatedly saw my so-called father instantly change from a selfish, pouting, raging nut job to a how-can-I-help-you saint at the ring of a door bell.
Being forced to listen to him lie from the pulpit during hundreds of sermons was the ultimate in bend- over-and-take-it punishment!

My *father* obviously *chose* how to behave depending on what would get him what he wanted in the moment. Very deliberate!!

Given what I personally witnessed countless times over 51 years, I REFUSE to let my NF off the hook by calling his *deliberate* evil behavior a disease he's *unable* to shuck off. Sorry, Daddy, I'm holding your feet to The Fire.

Julie Holloway said...

I just want to take a moment to tell you "thank you." You have such a special place in my heart. I am a southern girl and no one (besides you, my wonderful therapist and my husband) thinks it is okay to not speak to my mom. You getting this and you being a Christian has given me so much freedom to live and be and create and I am grateful to you for taking the time to write this blog so others can benefit from your wisdom!! This blog really meant a lot to me. Julie

Anna Valerious said...

Thank you, Julie. It means a lot to me to have you tell me that.

Barbara said...

2 Psychologist friends said NPD is being folded into Psychopathy/ Sociopathy - perhaps this is where it belongs - since most Ns are (IMHO) high functioning Psychopaths and it is on the same spectrum.

Anna Valerious said...

Barbara,

Yes, that is where it belongs, but it certainly remains to be seen if it will actually be put there. Nothing in the article hinted at what your psychologist friends have surmised. I hope your friends are right, though.

Kathleen said...

"Whatever happens, you can bet that NPD will still be with us for awhile. While you can take NPD out of the DSM, you can't as easily take NPD out of the people who have it."

By Randi Kreger, Psychology Today, 12/1/2010
http://tinyurl.com/2aevspt

- Kathleen

H2tat said...

Post 1. As a psychiatrist with personal experience with NPDs, I fully concur with Anna's views that this change in the DSM is essentially a non-event for all the reasons she enumerated. Perhaps some additional information about the DSM may be helpful in fully appreciating some of the reasons for its meretriciousness. (To save some of you from consulting a dictionary, "meretricious" is defined as apparently attractive but having in reality no value or integrity. I also use this word not unintentionally for its archaic meaning - of, relating to, or characteristic of a prostitute.)

Some of the individuals who first developed the DSM are well known among psychiatric circles to have severe NPD themselves. The interests of one DSM "innovator" in particular were in statistics and in ways to categorize knowledge generally. At the time in the 1960s, a dedicated system of classification of mental disorders was lacking. Previously these disorders were given codes in a manual called the International Classification of Diseases (ICD) along with all other medical disorders. Seeing an "opportunity," one DSM originator chose to go to medical school and specialize in psychiatry exclusively in order to have the credentials to create a classification system. Medicine and psychiatry were merely means to another end. The womb of the DSM resided in an obsessive individual who possessed a prominent dearth of humanity and who by the same token could have easily chosen to classify machine tools, toads or sea shells. In addition, for the initial DSM there was very little consensus. It is the product of just a few individuals. This was the inauspicious inception of the run-away train we now call the DSM.

Another critical point to remember is that the primary impetus for a classification of mental disorders was for research purposes - not for clinical utility. That is why it is a diagnostic and STATISTICAL manual. The use of medications in psychiatry began in earnest in the 1950s creating a need to do clinical trials. A system was needed to enable researchers to group individuals together diagnostically. One cannot for example do a trial of a drug for schizophrenia without defining the population for which the medication is purported to be effective. Thus the birth of the DSM and its subsequent revisions has been influenced in no small way by changes in the field of psychiatry and in pharmaceutical technology.

The pharmaceutical industry is not the only one that has influenced the evolution of the DSM. Since the 1980s, the health insurance industry has exerted an increasingly formidable influence on the way mental health disorders are viewed. Because it determines the reimbursement of treatment services, it creates demands on the field for the EXPLICIT purpose of decreasing expenditures. This industry has clearly had an impact on how individuals are diagnosed. In stage one, personality disorders were excluded from any reimbursement. The DSM then responded by creating all sorts of other reimbursable categories into which a psychiatrist could "fit" that patient. More recently the insurance companies for reimbursement considerations have created strata of severity of mental illnesses in which, for example, major depression, schizophrenia and full-blown bipolar disorder are reimbursed more fully than other less debilitating "disorders" such as adjustment disorders, anxiety disorders, etc.

Perhaps one day a historian will go back and rigorously track the developments in the DSM against the developments in the pharmaceutical and insurance industries. I am convinced that we will see clear concordance. (Continued)

prairiewoman said...

I have just learned about NPD--I am 57--my mother's emotional abuse has sucked the life out of me for this long. I am shocked there hasn't been more on this disorder available--thank you for your blog. It is a real disorder, and learning about it has been a freeing experience. I feel like a dog having its choke-collar removed. My mother has scapegoated me since I was 12. I was a child slave, ignored and passed over for any kind of kindness. I watched my siblings being treated as perfect beings, rewarded, given gifts, lavish weddings. My parents tried to get out of coming to my wedding, and then convinced my siblings not to come. My mother has had her 7 children's baby photos on her dresser. At a recent weddng, I noticed mine was missing. When I asked about it, she flew into a rage--I never did find out why it had vanished. There is no picture of me in her house. Every time there is any family problem, I am blamed. Right now I am being blamed for my sister's break-up with her partner. It is hard to walk away because my father's life is nearing an end, but once he goes, I will leave for good. My mother has money and uses it to control. My siblings will label me for leaving as they all think my mother is perfect. They have a mutual admiration society. I kpe thoping that if I fixed myself, she would like me. (She kept telling me that too.)I know now it is not possible, and giving up is a huge relief. Thank you for your blog!

mhy said...

Actually I find this a very interesting and intriguing development. I found it always a bit irritating that what I perceive as "evil" and "abusive" could be boxed into a "mental" or personality disorder.

Obviously it doesn´t make a big difference for those who suffered from abuse, but legally and medically there could come some good out of this.

For example,I prefer to see a child abuser for 10-life in prison than on the streets after two years of therapy. That just as a simplistic example.

q1605 said...

I think their preoccupation about which label applies to what is much ado about nothing. Let them try living with one of these monsters. They will be more concerned with no one blocking the exits.

mulderfan said...

"They will be more concerned with no one blocking the exits."

Made my day! Thanks for the laugh!

Unknown said...

Apparently, the DSM only considers conditions that cause impairment and distress to the individual patient. If this patient has NPD, they don't suffer impairment or distress at all. Their close associates do. Hence, a blind spot in the DSM exists.