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- Intuition
Intuition is supposed to be a form of direct access. Yet, direct access to what? Does it access directly "intuitions" (abstract objects, akin to numbers or properties - see "Bestowed Existence")? Are intuitions the objects of the mental act of Intuition? Perhaps intuition is the mind's way of interacting directly with Platonic ideals or Phenomenological "essences"? By "directly" I mean without the intellectual mediation of a manipulated symbol system, and without the benefits of inference, observation, experience, or reason.
Kant thought that both (Euclidean) space and time are intuited. In other words, he thought that the senses interact with our (transcendental) intuitions to produce synthetic a-priori knowledge. The raw data obtained by our senses -our sensa or sensory experience - presuppose intuition. One could argue that intuition is independent of our senses. Thus, these intuitions (call them "eidetic intuitions") would not be the result of sensory data, or of calculation, or of the processing and manipulation of same. Kant's "Erscheiung" ("phenomenon", or "appearance" of an object to the senses) is actually a kind of sense-intuition later processed by the categories of substance and cause. As opposed to the phenomenon, the "nuomenon" (thing in itself) is not subject to these categories. - The Shattered Identity
I. Exposition
In the movie "Shattered" (1991), Dan Merrick survives an accident and develops total amnesia regarding his past. His battered face is reconstructed by plastic surgeons and, with the help of his loving wife, he gradually recovers his will to live. But he never develops a proper sense of identity. It is as though he is constantly ill at ease in his own body. As the plot unravels, Dan is led to believe that he may have murdered his wife's lover, Jack. This thriller offers additional twists and turns but, throughout it all, we face this question: - Misdiagnosing Narcissism - Asperger's Disorder
(The use of gender pronouns in this article reflects the clinical facts: most narcissists and most Asperger's patients are male.)
Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD), though evident as early as age 3 (while pathological narcissism cannot be safely diagnosed prior to early adolescence). - The Roots Of Pedophilia
Pedophiles are attracted to prepubescent children and act on their sexual fantasies. It is a startling fact that the etiology of this paraphilia is unknown. Pedophiles comes from all walks of life and have no common socio-economic background. Contrary to media-propagated myths, most of them had not been sexually abused in childhood and the vast majority of pedophiles are also drawn to adults of the opposite sex (are heterosexuals).
Only a few belong to the Exclusive Type - the ones who are tempted solely by kids. Nine tenths of all pedophiles are male. They are fascinated by preteen females, teenage males, or (more rarely) both. - The Psychology Of Torture
There is one place in which one's privacy, intimacy, integrity and inviolability are guaranteed – one's body, a unique temple and a familiar territory of sensa and personal history. The torturer invades, defiles and desecrates this shrine. He does so publicly, deliberately, repeatedly and, often, sadistically and sexually, with undisguised pleasure. Hence the all-pervasive, long-lasting, and, frequently, irreversible effects and outcomes of torture.
In a way, the torture victim's own body is rendered his worse enemy. It is corporeal agony that compels the sufferer to mutate, his identity to fragment, his ideals and principles to crumble. The body becomes an accomplice of the tormentor, an uninterruptible channel of communication, a treasonous, poisoned territory. - The Narcissist As Eternal Child
"Puer Aeternus" – the eternal adolescent, the semipternal Peter pan – is a phenomenon often associated with pathological narcissism. People who refuse to grow up strike others as self-centred and aloof, petulant and brattish, haughty and demanding – in short: as childish or infantile.
The narcissist is a partial adult. He seeks to avoid adulthood. Infantilisation – the discrepancy between one's advanced chronological age and one's retarded behaviour, cognition, and emotional development – is the narcissist's preferred art form. Some narcissists even use a childish tone of voice occasionally and adopt a toddler's body language. - Misdiagnosing Narcissism - Generalised Anxiety Disorder (gad
(The use of gender pronouns in this article reflects the clinical facts: most narcissists are men.)
Anxiety Disorders – and especially Generalised Anxiety Disorder (GAD) – are often misdiagnosed as Narcissistic Personality Disorder (NPD). - On Empathy
The Encyclopaedia Britannica (1999 edition) defines empathy as:
"The ability to imagine oneself in anther's place and understand the other's feelings, desires, ideas, and actions. It is a term coined in the early 20th century, equivalent to the German Einfühlung and modelled on "sympathy." The term is used with special (but not exclusive) reference to aesthetic experience. The most obvious example, perhaps, is that of the actor or singer who genuinely feels the part he is performing. With other works of art, a spectator may, by a kind of introjection, feel himself involved in what he observes or contemplates. The use of empathy is an important part of the counselling technique developed by the American psychologist Carl Rogers." - The Revolution Of Psychoanalysis
"The more I became interested in psychoanalysis, the more I saw it as a road to the same kind of broad and deep understanding of human nature that writers possess."
Anna Freud - The Fundamentals Of Psychological Theories
All theories - scientific or not - start with a problem. They aim to solve it by proving that what appears to be "problematic" is not. They re-state the conundrum, or introduce new data, new variables, a new classification, or new organizing principles. They incorporate the problem in a larger body of knowledge, or in a conjecture ("solution"). They explain why we thought we had an issue on our hands - and how it can be avoided, vitiated, or resolved.
Scientific theories invite constant criticism and revision. They yield new problems. They are proven erroneous and are replaced by new models which offer better explanations and a more profound sense of understanding - often by solving these new problems. From time to time, the successor theories constitute a break with everything known and done till then. These seismic convulsions are known as "paradigm shifts". - Critique And Defense Of Psychoanalysis
“I am actually not a man of science at all. . . . I am nothing but a conquistador by temperament, an adventurer.”
(Sigmund Freud, letter to Fleiss, 1900) - The Intermittent Explosive Narcissist
Narcissists invariably react with narcissistic rage to narcissistic injury.
These two terms bear clarification: - Pathological Narcissism, Psychosis, And Delusions
One of the most important symptoms of pathological narcissism (the Narcissistic Personality Disorder) is grandiosity. Grandiose fantasies (megalomaniac delusions of grandeur) permeate every aspect of the narcissist's personality. They are the reason that the narcissist feels entitled to special treatment which is typically incommensurate with his real accomplishments. The Grandiosity Gap is the abyss between the narcissist's self-image (as reified by his False Self) and reality.
When Narcissistic Supply is deficient, the narcissist de-compensates and acts out in a variety of ways. Narcissists often experience psychotic micro-episodes during therapy and when they suffer narcissistic injuries in a life crisis. But can the narcissist "go over the edge"? Do narcissists ever become psychotic? - The Narcissist's Confabulated Life
Confabulations are an important part of life. They serve to heal emotional wounds or to prevent ones from being inflicted in the first place. They prop-up the confabulator's self-esteem, regulate his (or her) sense of self-worth, and buttress his (or her) self-image. They serve as organizing principles in social interactions.
Father's wartime heroism, mother's youthful good looks, one's oft-recounted exploits, erstwhile alleged brilliance, and past purported sexual irresistibility - are typical examples of white, fuzzy, heart-warming lies wrapped around a shriveled kernel of truth. - Serial Killers
Countess Erszebet Bathory was a breathtakingly beautiful, unusually well-educated woman, married to a descendant of Vlad Dracula of Bram Stoker fame. In 1611, she was tried - though, being a noblewoman, not convicted - in Hungary for slaughtering 612 young girls. The true figure may have been 40-100, though the Countess recorded in her diary more than 610 girls and 50 bodies were found in her estate when it was raided.
The Countess was notorious as an inhuman sadist long before her hygienic fixation. She once ordered the mouth of a talkative servant sewn. It is rumoured that in her childhood she witnessed a gypsy being sewn into a horse's stomach and left to die. - The Pathology Of Love
Recent studies buttress the unpalatable truth that falling in love is, in some ways, indistinguishable from a severe pathology. Behavior changes are reminiscent of psychosis and, biochemically speaking, passionate love closely imitates substance abuse. Appearing in the BBC series Body Hits on December 4, Dr. John Marsden, the head of the British National Addiction Center, said that love is addictive, akin to cocaine and speed. Sex is a "booby trap", intended to bind the partners long enough to bond.
Using functional Magnetic Resonance Imaging (fMRI), Andreas Bartels and Semir Zeki of University College in London showed that the same areas of the brain are active when abusing drugs and when in love. The prefrontal cortex - hyperactive in depressed patients - is inactive when besotted. How can this be reconciled with the low levels of serotonin that are the telltale sign of both depression and infatuation - is not known. - The Habit Of Identity
In a famous experiment, students were asked to take a lemon home and to get used to it. Three days later, they were able to single out "their" lemon from a pile of rather similar ones. They seemed to have bonded. Is this the true meaning of love, bonding, coupling? Do we simply get used to other human beings, pets, or objects?
Habit forming in humans is reflexive. We change ourselves and our environment in order to attain maximum comfort and well being. It is the effort that goes into these adaptive processes that forms a habit. The habit is intended to prevent us from constant experimenting and risk taking. The greater our well being, the better we function and the longer we survive. - The Habit Of Identity
In a famous experiment, students were asked to take a lemon home and to get used to it. Three days later, they were able to single out "their" lemon from a pile of rather similar ones. They seemed to have bonded. Is this the true meaning of love, bonding, coupling? Do we simply get used to other human beings, pets, or objects?
Habit forming in humans is reflexive. We change ourselves and our environment in order to attain maximum comfort and well being. It is the effort that goes into these adaptive processes that forms a habit. The habit is intended to prevent us from constant experimenting and risk taking. The greater our well being, the better we function and the longer we survive. - Is Psychology A Science?
All theories - scientific or not - start with a problem. They aim to solve it by proving that what appears to be "problematic" is not. They re-state the conundrum, or introduce new data, new variables, a new classification, or new organizing principles. They incorporate the problem in a larger body of knowledge, or in a conjecture ("solution"). They explain why we thought we had an issue on our hands - and how it can be avoided, vitiated, or resolved.
Scientific theories invite constant criticism and revision. They yield new problems. They are proven erroneous and are replaced by new models which offer better explanations and a more profound sense of understanding - often by solving these new problems. From time to time, the successor theories constitute a break with everything known and done till then. These seismic convulsions are known as "paradigm shifts". - Narcissism And Personality Disorders
Are all personality disorders the outcomes of frustrated narcissism?
During our formative years (6 months to 6 years old), we are all "narcissists". Primary Narcissism is a useful and critically important defense mechanism. As the infant separates from his mother and becomes an individual, it is likely to experience great apprehension, fear, and pain. Narcissism shields the child from these negative emotions. By pretending to be omnipotent, the toddler fends off the profound feelings of isolation, unease, pending doom, and helplessness that are attendant on the individuation-separation phase of personal development.
Well into early adolescence, the empathic support of parents, caregivers, role models, authority figures, and peers is indispensable to the evolution of a stable sense of self-worth, self-esteem, and self-confidence. Traumas and abuse, smothering and doting, and the constant breach of emerging boundaries yield the entrenchment of rigid adult narcissistic defenses. - Common Features Of Personality Disorders
Psychology is more an art form than a science. There is no "Theory of Everything" from which one can derive all mental health phenomena and make falsifiable predictions. Still, as far as personality disorders are concerned, it is easy to discern common features. Most personality disorders share a set of symptoms (as reported by the patient) and signs (as observed by the mental health practitioner).
Patients suffering from personality disorders have these things in common:
They are persistent, relentless, stubborn, and insistent (except those suffering from the Schizoid or the Avoidant Personality Disorders). - Cluster B Personality Disorders
The DSM-IV-TR (2000) defines a personality disorder as:
"An enduring pattern of inner experience and behavior that deviates markedly from the expectations the individuals culture (and is manifested in two or more of his or her areas of mental life:) cognition, affectivity, interpersonal functioning, or impulse control."
Such a pattern is rigid, long-term (stable), and recurrent. It manifests itself in all areas of life (it is pervasive). It is not owing to substance-abuse or a medical condition (such as head trauma). It renders the subject dysfunctional "in social , occupational, or other important areas" and this impairment causes distress. - Axes Of Personality Disorders
Personality disorders are like tips of icebergs. They rest on a foundation of causes and effects, interactions and events, emotions and cognitions, functions and dysfunctions that together form the patient and make him or her what s/he is.
The DSM uses five axes to analyze, classify, and describe these data. The patient (or subject) presents himself to a mental health diagnostician, is evaluated, tests are administered, questionnaires fulfilled, and a diagnosis rendered. The diagnostician uses the DSM's five axes to "make sense" and meaningfully organize of the information he had gathered in this process.
Axis I demands that he specify all the patient's clinical mental health problems that are not personality disorders or mental retardation. Thus, Axis I includes issues first diagnosed in infancy, childhood, or adolescence; cognitive problems (e.g., delirium, dementia, amnesia); mental disorders due to a medical condition (for instance, dysfunctions caused by brain injury or metabolic diseases); substance-related disorders; schizophrenia and psychosis; mood disorders; anxiety and panic; somatoform disorders; factitious disorders; dissociative disorders; sexual paraphilias; eating disorders; impulse control problems and adjustment issues. - Mmpi-ii Test
The MMPI (Minnesota Multiphasic Personality Inventory), composed by Hathaway (a psychologist) and McKinley (a physician) is the outcome of decades of research into personality disorders. The revised version, the MMPI-II (also known as MMPI-2), was published in 1989 but was received cautiously. MMPI-II changed the scoring method and some of the normative data. It was, therefore, hard to compare it to its much hallowed (and oft validated) predecessor.
The MMPI-II is made of 567 binary (true or false) items (questions). Each item requires the subject to respond: "This is true (or false) as applied to me". There are no "correct" answers. The test booklet allows the diagnostician to provide a rough assessment of the patient (the "basic scales") based on the first 370 queries (though it is recommended to administer all of 567 of them).
Based on numerous studies, the items are arranged in scales. The responses are compared to answers provided by "control subjects". The scales allow the diagnostician to identify traits and mental health problems based on these comparisons. In other words, there are no answers that are "typical to paranoid or narcissistic or antisocial patients". There are only responses that deviate from an overall statistical pattern and conform to the reaction patterns of other patients with similar scores. The nature of the deviation determines the patient's traits and tendencies - but not his or her diagnosis! - Narcissistic Personality Disorder - Clinical Features
Clinical Features of the Narcissistic Personality Disorder
Opinions vary as to whether the narcissistic traits evident in in infancy, childhood, and early adolescence are pathological. Anecdotal evidence suggests that childhood abuse and trauma inflicted by parents, authority figures, or even peers provoke "secondary narcissism" and, when unresolved, may lead to the full-fledged Narcissistic Personality Disorder (NPD) later in life.
This makes eminent sense as narcissism is a defense mechanism whose role is to deflect hurt and trauma from the victim's "True Self" into a "False Self" which is omnipotent, invulnerable, and omniscient. This False Self is then used by the narcissist to garner narcissistic supply from his human environment. Narcissistic supply is any form of attention, both positive and negative and it is instrumental in the regulation of the narcissist's labile sense of self-worth. - Narcissist Vs. Psychopath
We all heard the terms "psychopath" or "sociopath". These are the old names for a patient with the Antisocial Personality Disorder (AsPD). It is hard to distinguish narcissists from psychopaths. The latter may simply be a less inhibited and less grandiose form of the former. Indeed, the DSM V Committee is considering to abolish this distinction altogether.
Still, there are some important nuances setting the two disorders apart:
As opposed to most narcissists, psychopaths are either unable or unwilling to control their impulses or to delay gratification. They use their rage to control people and manipulate them into submission. - Narcissistic Personality Disorder - Prevalence And Comorbidity
What is the Difference between Healthy Narcissism and the Pathological Kind?
In my book "Malignant Self Love - Narcissism Revisited", I define pathological narcissism as:
"(A) life-long pattern of traits and behaviors which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition." - The Psychopath And Antisocial
Roots of the Disorder
Are the psychopath, sociopath, and someone with the Antisocial Personality Disorder one and the same? The DSM says "yes". Scholars such as Robert Hare and Theodore Millon beg to differ. The psychopath has antisocial traits for sure but they are coupled with and enhanced by callousness, ruthlessness, extreme lack of empathy, deficient impulse control, deceitfulness, and sadism.
Like other personality disorders, psychopathy becomes evident in early adolescence and is considered to be chronic. But unlike most other personality disorders, it is frequently ameliorated with age and tends to disappear altogether in by the fourth or fifth decade of life. This is because criminal behavior and substance abuse are both determinants of the disorders and behaviors more typical of young adults. - Tat Diagnostic Test
The Thematic Appreciation Test (TAT) is similar to the Rorschach inkblot test. Subjects are shown pictures and asked to tell a story based on what they see. Both these projective assessment tools elicit important information about underlying psychological fears and needs. The TAT was developed in 1935 by Morgan and Murray. Ironically, it was initially used in a study of normal personalities done at Harvard Psychological Clinic.
The test comprises 31 cards. One card is blank and the other thirty include blurred but emotionally powerful (or even disturbing) photographs and drawings. Originally, Murray came up with only 20 cards which he divided to three groups: B (to be shown to Boys Only), G (Girls Only) and M-or-F (both sexes). - Structured Interviews
The Structured Clinical Interview (SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. Consequently, there are 12 groups of questions corresponding to the 12 personality disorders. The scoring is equally simple: either the trait is absent, subthreshold, true, or there is "inadequate information to code".
The feature that is unique to the SCID-II is that it can be administered to third parties (a spouse, an informant, a colleague) and still yield a strong diagnostic indication. The test incorporates probes (sort of "control" items) that help verify the presence of certain characteristics and behaviors. Another version of the SCID-II (comprising 119 questions) can also be self-administered. Most practitioners administer both the self-questionnaire and the standard test and use the former to screen for true answers in the latter. - Schizoid Personality Disorder
Schizoids enjoy nothing and seemingly never experience pleasure (they are anhedonic). Even their nearest and dearest often describe them as "automata", "robots", or "machines". But the schizoid is not depressed or dysphoric, merely indifferent. Schizoids are uninterested in social relationships and bored or puzzled by interpersonal interactions. They are incapable of intimacy and have a very limited range of emotions and affect. Rarely does the schizoid express feelings, either negative (anger) or positive (happiness).
Schizoids never pursue an opportunity to develop a close relationship. Schizoids are asexual - not interested in sex. Consequently, they appear cold, aloof, bland, stunted, flat, and "zombie"-like. They derive no satisfaction from belonging to a close-knit group: family, church, workplace, neighborhood, or nation. They rarely marry or have children. - Rorschach Inkblots Test
The Swiss psychiatrist Hermann Rorschach developed a set of inkblots to test subjects in his clinical research. In a 1942 monograph, Rorschach postulated that the blots evoke consistent and similar responses in groups patients. Only ten of the original inkblots are currently in diagnostic use. They were selected by John Exner. He also systematized the administration and scoring of the test.
The Rorschach inkblots are ambiguous forms, printed on 18X24 cm. cards, in both black and white and color. Their very ambiguity provokes free associations in the test subject. The diagnostician stimulates the formation of these flights of fantasy by asking questions such as "What is this? What might this be?". S/he then proceed to record, verbatim, the patient's responses as well as the inkblot's spatial position and orientation. An example of such record would read: "Card V upside down, child sitting on a porch and crying, waiting for his mother to return."
Having gone through the entire deck, the examiner than proceeds to read aloud the responses while asking the patient to explain, in each and every case, why s/he chose to interpret the card the way s/he did. "What in card V prompted you to think of an abandoned child?". At this phase, the patient is allowed to add details and expand upon his or her original answer. Again, everything is noted and the subject is asked to explain what is the card or in his previous response gave birth to the added details. - Mmci-iii Diagnostic Test
The third edition of this popular test, the Millon Clinical Multiaxial Inventory (MCMI-III), has been published in 1996. With 175 items, it is much shorter and simpler to administer and to interpret than the MMPI-II. The MCMI-III diagnoses personality disorders and Axis I disorders but not other mental health problems. The inventory is based on Millon's suggested multiaxial model in which long-term characteristics and traits interact with clinical symptoms.
The questions in the MCMI-III reflect the diagnostic criteria of the DSM. Millon himself gives this example (Millon and Davis, Personality Disorders in Modern Life, 2000, pp. 83-84): - Histrionic Personality Disorder
Most patients with the Histrionic Personality Disorder are women. This immediately raises the question: Is this a real mental health disorder or a culture-bound syndrome which reflects the values of a patriarchal and misogynistic society? A man with similar traits is bound to be admired as a "macho" or, at worst, labeled a "womanizer".
Histrionics resemble narcissists - both seek attention compulsively and are markedly dysphoric and uncomfortable when not at the center of attention. They have to be the life of the party. If they fail in achieving this pivotal role, they act out, create hysterical scenes, or confabulate.
Like the somatic narcissist, the histrionic is preoccupied with physical appearance, sexual conquests, her health, and her body. The typical histrionic spends huge dollops of money and expend inordinate amounts of time on grooming. Histrionics fish for compliments and are upset when confronted with criticism or proof that they are not as glamorous or alluring as they thought they are. - Disorder-specific Tests
There are dozens of psychological tests that are disorder-specific: they aim to diagnose specific personality disorders or relationship problems. Example: the Narcissistic Personality Inventory (NPI) which is used to diagnose the Narcissistic Personality Disorder (NPD).
The Borderline Personality Organization Scale (BPO), designed in 1985, sorts the subject's responses into 30 relevant scales. These indicates the existence of identity diffusion, primitive defenses, and deficient reality testing. - Borderline Personality Disorder
The fact that the Borderline personality disorder is often found among women makes it a controversial mental health diagnosis. Some scholars say that it is a culture-bound pseudo-syndrome invented by men to serve a patriarchal and misogynistic society. Others point to the fact the lives of patients diagnosed with the disorder are chaotic and that the relationships they form are stormy, short-lived, and unstable. Moreover, not unlike compensatory narcissists, people with the Borderline Personality Disorder often display labile (wildly fluctuating) sense of self-worth, self-image and affect (expressed emotions).
Like both narcissists and psychopaths, borderlines are impulsive and reckless. Like histrionics, their sexual conduct is promiscuous, driven, and unsafe. Many borderlines binge eat, gamble, drive, and shop carelessly, and are substance abusers. Lack of impulse control is joined with self-destructive and self-defeating behaviors, such as suicidal ideation, suicide attempts, gestures, or threats, and self-mutilation or self-injury. - Avoidant Personality Disorder
People suffering from the Avoidant Personality Disorder feel inadequate, unworthy, inferior, and lacking in self-confidence. As a result, they are shy and socially inhibited. Aware of their real (and, often, imagined) shortcomings, they are constantly on the lookout, are hypervigilant and hypersensitive. Even the slightest, most constructive and well-meant or helpful criticism and disagreement are perceived as complete rejection, ridicule, and shaming. Consequently, they go to great lengths to avoid situations that require interpersonal contact - such as attending school, making new friends, accepting a promotion, or teamwork activities. Hence the Avoidant Personality Disorder.
Inevitably, Avoidants find it difficult to establish intimate relationships. They "test' the potential friend, mate, or spouse to see whether they accept them uncritically and unconditionally. They demand continue verbal reassurances that they really wanted, desired, loved, or cared about. - Codependence And The Dependent Personality Disorder
There is great confusion regarding the terms co-dependent, counter-dependent, and dependent. Before we proceed to study the Dependent Personality Disorder in our next article, we would do well to clarify these terms.
Codependents - Defense Mechanisms
According to Freud and his followers, our psyche is a battlefield between instinctual urges and drives (the id), the constraints imposed by reality on the gratification of these impulses (the ego), and the norms of society (the superego). This constant infighting generates what Freud called "neurotic anxiety" (fear of losing control) and "moral anxiety" (guilt and shame).
But these are not the only types of anxiety. "Reality anxiety" is the fear of genuine threats and it combines with the other two to yield a morbid and surrealistic inner landscape.
These multiple, recurrent, "mini-panics" are potentially intolerable, overwhelming, and destructive. Hence the need to defend against them. There are dozens of defense mechanisms. - Paranoid Personality Disorder
The paranoid's world is hostile, arbitrary, malicious, and unpredictable. Consequently, he or she distrusts others and suspects them. No good deed goes unpunished. Every gesture of goodwill is surely fuelled by ulterior, self-interested and uncharitable motives. Paranoids are firmly convinced that people are out to exploit, harm, get, or deceive them, sometimes just for the fun of it. Evil needs no pretext or context, it is just out there without good or sufficient cause.
These nagging doubts about the loyalty or trustworthiness of others gnaw at the paranoid's mind ceaselessly. No one is spared his constant brooding. His hypervigilance extends to family members, friends, co-workers, and neighbors. Persecutory delusions are common: most paranoids believe that they are at the epicenter of conspiracies and collusions, big and small, quotidian and earth-shattering. - Schizotypal Personality Disorder
Do you believe in UFOs and alien abductions? You may be suffering from the Schizotypal Personality Disorder. Do you believe in the immaculate conception of the Virgin Mary and in the resurrection of her son? Then you are merely a religious person.
In other words, it is OK to believe in certain "supernatural" phenomena just because such beliefs are socially acceptable and widespread. The Schizotypal Personality Disorder is one of the most culture-bound mental health diagnoses in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). Many of the diagnostic criteria of this "personality disorder" refer to behaviors which some say are utterly normative in certain cultures or sub-cultures. - Depressive Personality Disorder
The Depressive Personality Disorder is not yet recognized by the DSM Committee. It makes its appearances in Appendix B of the Diagnostic and Statistical Manual, titled "Criteria Sets and Axes Provided for Further Study." It is not clear in what way is the Depressive Personality Disorder different to other depressive illnesses, such as Dysthymic Disorder.
The Depressive has pervasive and continuous depressive cognitions (thoughts) and behaviors. They manifest themselves in every area of life and never abate. The patient is gloomy, dejected, pessimistic, overly serious, lacks a sense of humor, cheerless, joyless, and constantly unhappy. This dark mood is not influenced by changing circumstances. - Five Factor Personality Model
The Five Factor Model was suggested by two researchers, Costa and McCrae, in 1989. The designers of previous factor models sifted through bulky dictionaries and came up with thousands of words to describe human nature in all its variability. Not so the inventors of the Five Factor Model. It is based on and derived from various personality inventories. Surprisingly, it was proven to be as powerful as its vocabulary-based predecessors: it was able to predict subjects' behavior as accurately.
The Model consists of five high level dimensions. These are comprised of lower level facet traits. The dimensions allow the diagnostician to categorize the patient's overall propensities but do not provide for accurate predictions and prognoses regarding characteristics and likely behavior patterns. The facet traits make it possible to narrow down the range of behaviors and qualities consistent with the dimension. - Gender Bias In Diagnosing Personality Disorders
Ever since Freud, more women than men sought therapy. Consequently, terms like "hysteria' are intimately connected to female physiology and alleged female psychology. The DSM (Diagnostic and Statistical Manual, the bible of the psychiatric profession) expressly professes gender bias: personality disorders such as Borderline and Histrionic are supposed to be more common among women. but the DSM is rather even-handed: other personality disorders (e.g., the Narcissistic and Antisocial as well as the Schizotypal, Obsessive-Compulsive, Schizoid, and Paranoid) are more prevalent among men.
Why this gender disparity? There are a few possible answers: - Genetics And Personality Disorders
Are personality disorders the outcomes of inherited traits? Are they brought on by abusive and traumatizing upbringing? Or, maybe they are the sad results of the confluence of both?
To identify the role of heredity, researchers have resorted to a few tactics: they studied the occurrence of similar psychopathologies in identical twins separated at birth, in twins and siblings who grew up in the same environment, and in relatives of patients (usually across a few generations of an extended family). - Masochistic Personality Disorder
The Masochistic personality disorder made its last appearance in the DSM III-TR and was removed from the DSM IV and from its text revision, the DSM IV-TR. Some scholars, notably Theodore Millon, regard its removal as a mistake and lobby for its reinstatement in future editions of the DSM.
The masochist has been taught from an early age to hate herself and consider herself unworthy of love and worthless as a person. Consequently, he or she is prone to self-destructive, punishing, and self-defeating behaviors. Though capable of pleasure and possessed of social skills, the masochist avoids or undermines pleasurable experiences. He does not admit to enjoying himself, seeks suffering, pain, and hurt in relationships and situations, rejects help and resents those who offer it. She actively renders futile attempts to assist or ameliorate or mitigate or solve her problems and predicaments. - Not Otherwise Specified (nos) Personality Disorder
It is a sign of the inadequacy of our current knowledge of personality disorders that both the American Diagnostic and Statistical Manual (DSM) and its international counterpart, the ICD, maintain a "Personality Disorders Not Otherwise Specified (NOS)" diagnostic category. It is a catch-all, meaningless, "diagnosis", a testament to the diagnostician's helplessness and ignorance in the face of human complexity which often defies neat classification.
Even the rudiments of this diagnostic category are in dispute. There is no agreement as to what traits and behaviors it applies to. The ICD, for instance, includes the Narcissistic Personality Disorder in the NOS category, insisting that it is not a full-fledged personality disorder. - Sadistic Personality Disorder
The Sadistic Personality Disorder made its last appearance in the DSM III-TR and was removed from the DSM IV and from its text revision, the DSM IV-TR. Some scholars, notably Theodore Millon, regard its removal as a mistake and lobby for its reinstatement in future editions of the DSM.
The Sadistic Personality disorder is characterized by a pattern of gratuitous cruelty, aggression, and demeaning behaviors which indicate the existence of deep-seated contempt for other people and an utter lack of empathy. Some sadists are "utilitarian": they leverage their explosive violence to establish a position of unchallenged dominance within a relationship. Unlike psychopaths, they rarely use physical force in the commission of crimes. Rather, their aggressiveness is embedded in an interpersonal context and is expressed in social settings, such as the family or the workplace. - Eclectic Psychotherapy
The early days of the emerging discipline of psychology were inevitably rigidly dogmatic. Clinicians belonged to well-demarcated schools and practiced in strict accordance with canons of writings by "masters" such as Freud, or Jung, or Adler, or Skinner. Psychology was less a science than an ideology or an art form. Freud's work, for instance, though incredibly insightful, is closer to literature and cultural studies than to proper, evidence-based, medicine.
Not so nowadays. Mental health practitioners freely borrow tools and techniques from a myriad therapeutic systems. They refuse to be labeled and boxed in. The only principle that guides modern therapists is "what works" - the effectiveness of treatment modalities, not their intellectual provenance. The therapy, insists these eclecticists, should be tailored to the patient, not the other way around. - International Classification Of Diseases (icd) 10
The International Classification of Diseases (ICD) is published by the World Health Organization in Geneva, Switzerland. It included mental health disorders for the first time in 1948, in its sixth edition. In 1959, following widespread criticism of its classificatory scheme, the WHO commissioned a global survey of taxonomies of mental health problems, which was conducted by Stengel. The survey uncovered great disparities and substantial disagreements as to what constituted mental illness and how it should be diagnosed (diagnostic criteria and differential diagnoses).
Yet, it was not until 1968 that Stengel's recommendations were implemented in the eighth edition. The ICD-8 was descriptive and operational and did not commit itself to any theory of etiology, pathogenesis, or psychological dynamics. Still, it sported a confusing plethora of categories and allowed for rampant comorbidity (multiple diagnoses in the same patient). - Negativistic (passive-aggressive) Personality Disorder
The Negativistic (Passive-Aggressive) Personality Disorder is not yet recognized by the DSM Committee. It makes its appearances in Appendix B of the Diagnostic and Statistical Manual, titled "Criteria Sets and Axes Provided for Further Study."
Some people are perennial pessimists and have "negative energy" and negativistic attitudes ("good things don't last", "it doesn't pay to be good", "the future is behind me"). Not only do they disparage the efforts of others, but they make it a point to resist demands to perform in workplace and social settings and to frustrate people's expectations and requests, however reasonable and minimal they may be. Such persons regard every requirement and assigned task as impositions, reject authority, resent authority figures (boss, teacher, parent-like spouse), feel shackled and enslaved by commitment, and oppose relationships that bind them in any manner. - Psychosexual Stages Of Personal Development
The Viennese neurologist, Sigmund Freud, was among the first to offer a model of psychological development in early childhood (within the framework of psychoanalysis). He closely linked the sex drive (libido) to the formation of personality and described five psychosexual stages, four of which are centered around various erogenous zones in the body.
The pursuit of pleasure ("the pleasure principle") and the avoidance of pain drive the infant to explore his or her self and the world at large. Pleasure is inextricably linked to sexual gratification. In the oral phase (from birth to 24 months), the baby focuses on the tongue, lips, and mouth and derives gratification from breast feeding, thumb sucking, biting, swallowing, and other oral exploratory activities. - Therapy And Treatment Of Personality Disorders
The dogmatic schools of psychotherapy (such as psychoanalysis, psychodynamic therapies, and behaviorism) more or less failed in ameliorating, let alone curing or healing personality disorders. Disillusioned, most therapists now adhere to one or more of three modern methods: Brief Therapies, the Common Factors approach, and Eclectic techniques.
Conventionally, brief therapies, as their name implies, are short-term but effective. They involve a few rigidly structured sessions, directed by the therapist. The patient is expected to be active and responsive. Both parties sign a therapeutic contract (or alliance) in which they define the goals of the therapy and, consequently, its themes. As opposed to earlier treatment modalities, brief therapies actually encourage anxiety because they believe that it has a catalytic and cathartic effect on the patient. - Changes In The Diagnostic And Statistical Manual (dsm) Iv
The DSM-IV dropped two diagnoses that made an appearance in the DSM-III: the masochistic and the sadistic personality disorders. But these are not the only differences between the two editions as far as Axis II (personality disorders) goes.
The DSM-IV considerably expanded and updated the introductory text while emphasizing dimensional models of personality and listing for the first time some of the dimensions espoused by the more important models. - Conduct Disorder
Children and adolescents with conduct disorder are budding psychopaths. They repeatedly and deliberately (and joyfully) violate the rights of others and breach age-appropriate social norms and rules. Some of them gleefully hurt and torture people or, more frequently, animals. Others damage property. Yet others habitually deceive, lie, and steal. These behaviors inevitably render them socially, occupationally, and academically dysfunctional. They are poor performers at home, in school, and in the community. As such adolescents grow up, and beyond the age of 18, the diagnosis automatically changes from Conduct Disorder to the Antisocial Personality Disorder.
Children with Conduct Disorder are in denial. They tend to minimize their problems and blame others for their misbehavior and failures. This shifting of guilt justifies, as far as they are concerned, their invariably and pervasively aggressive, bullying, intimidating, and menacing gestures and tantrums. Adolescents with Conduct Disorder are often embroiled in fights, both verbal and physical. They frequently use weapons, purchased or improvised (e.g., broken glass) and they are cruel. Many underage muggers, extortionists, purse-snatchers, rapists, robbers, shoplifters, burglars, arsonists, vandals, and animal torturers are diagnosed with Conduct Disorder.
Conduct Disorder comes in many shapes and forms. Some adolescents are "cerebral" rather than physical. These are likely to act as con-artists, lie their way out of awkward situations, swindle everyone, their parents and teachers included, and forge documents to erase debts or obtain material benefits. - Addiction And Personality
A voluminous literature notwithstanding, there is little convincing empirical research about the correlation between personality traits and addictive behaviors. Substance abuse and dependence (alcoholism, drug addiction) is only one form of recurrent and self-defeating pattern of misconduct. People are addicted to all kinds of things: gambling, shopping, the Internet, reckless and life-endangering pursuits. Adrenaline junkies abound.
The connection between chronic anxiety, pathological narcissism, depression, obsessive-compulsive traits and alcoholism and drug abuse is well established and common in clinical practice. But not all narcissists, compulsives, depressives, and anxious people turn to the bottle or the needle. Frequent claims of finding a gene complex responsible for alcoholism have been consistently cast in doubt. - Psychological Signs And Symptoms
The first encounter between psychiatrist or therapist and patient (or client) is multi-phased. The mental health practitioner notes the patient's history and administers or prescribes a physical examination to rule out certain medical conditions. Armed with the results, the diagnostician now observes the patient carefully and compiles lists of signs and symptoms, grouped into syndromes.
Symptoms are the patient's complaints. They are highly subjective and amenable to suggestion and to alterations in the patient's mood and other mental processes. Symptoms are no more than mere indications. Signs, on the other hand, are objective and measurable. Signs are evidence of the existence, stage, and extent of a pathological state. Headache is a symptom - short-sightedness (which may well be the cause of the headache) is a sign. | | |
